Many of those diagnosed with d-IBS are actually Non-Celiac Gluten Sensitive, and carry a Celiac gene, test positive for IgG antigliadin and IgG- tTG, not necessarily IgA antibodies in some cases. This study also points out many diarrhea d-IBS patients could actually be pre or latent Celiac and are being misdiagnosed as IBS patients.
1: Clin Gastroenterol Hepatol. 2007 Jun 4; [Epub ahead of print]
Predictors of Clinical Response to Gluten-Free Diet in Patients Diagnosed With Diarrhea-Predominant Irritable Bowel Syndrome.
, Schulzke JD
, Zeitz M
, Ullrich R
Medical Clinic A, Department of Gastroenterology, Endocrinology and Nutritrion, University Hospital Ernst Moritz Arndt Universität Greifswald, Greifswald, Germany.
BACKGROUND & AIMS: Gluten sensitivity might cause abdominal symptoms in the absence of villous atrophy. We examined the prevalence of celiac disease-associated serum antibodies in diarrhea-dominant irritable bowel syndrome (d-IBS) patients and their efficacy in combination with HLA-DQ2 expression to predict the response to gluten-free diet.
METHODS: HLA-DQA1()0501/DQB1()0201 expression and celiac disease-associated IgA and IgG serum antibodies against gliadin and tissue-transglutaminase were measured in 145 patients with d-IBS, 74 patients with untreated and treated celiac disease, and 57 patients with active IBD. Follow-up antibody levels, stool frequency, and gastrointestinal symptom scores were determined in 41 d-IBS patients (26 women, 15 men; median age, 46 years, range, 30-67 years) who participated in a nonrandomized evaluation of 6 months of gluten-free diet.
RESULTS: Increased celiac disease-associated serum IgG, but not IgA, was found in the majority of patients with treated (55%) as in most patients with untreated celiac disease (97%). In d-IBS patients, celiac disease-associated serum IgG antibodies (37%) and HLA-DQ2 expression (39%) were more frequent than in IBD patients (18% and 23%, respectively). After 6 months of gluten-free diet, stool frequency and gastrointestinal symptom score returned to normal values in 60% of d-IBS patients who were positive and in 12% who were negative for HLA-DQ2 and celiac disease-associated serum IgG; both parameters combined yielded positive and negative predictive values of 56% (95% confidence interval, 30%-80%) and 88% (69%-97%), respectively.
CONCLUSIONS: Celiac disease-associated serum IgG and HLA-DQ2 expression can identify likely responders to gluten-free diet in d-IBS patients.
PMID: 17553753 [PubMed - as supplied by publisher]
Predictors of Response to GF Diet in IBS
22 Jul 2007 14:15 #654