Tuberculosis – Increased Susceptibility 

What Is Irritable Bowel Syndrome?

[dropcap]I rritable bowel syndrome (IBS) is a motility disorder without anatomic cause involving the entire gastrointestinal tract that is characterized by these four features:

1) Abdominal pain usually relieved by defecation or passing of gas; 2) Disturbance of evacuation of stool; 3) Bloating and abdominal distention; 4) Mucus in the stool.

Current knowledge suggests that IBS is a frustrating multifactoral disorder associated with gut hypersensitivity of varying degrees, intestinal motility disturbances (muscle movement), brain-gut sensory dysfunction, and an exaggerated response to stress.

More recent research has also shown intestinal dysbiosis (altered gut microbe population), altered intestinal permeability and low-grade intestinal inflammation.

Importantly, patients with small intestinal bacterial overgrowth (SIBO) may wrongly be diagnosed as IBS because SIBO is also characterized by abdominal pain or discomfort, bloating, flatulence and loose motion. Small intestinal bacterial overgrowth is a condition in which there is overgrowth of bacteria in small bowel in excess of 10⁵ colony forming units per milliliter on culture of the upper gut aspirate. Frequency of SIBO varied from 4%-78% among patients with IBS and from 1%-40% among controls.¹ These two disorders can occur at the same time, which would require treatment for both.

Carbohydrate intolerance is a known trigger for IBS including lactose and  fructose intolerances, with and without malabsorption.²

Q: Is there a cure for irritable bowel syndrome?

A: No. Because symptoms vary from patient to patient, treatment is directed toward the individual symptoms and response. Generally, the older drugs belladonna and bentyl work well to allay spasms and do not cause nutritional deficiencies. However, symptoms return when the medications are stopped.

Irritable bowel syndrome is classified according to symptoms of bowel patterns.

• IBS-C signifies a pattern of constipation more than 25% of the movements.
• IBS-D signifies a pattern of diarrhea more than 25% of the movements.
• IBS-A signifies a pattern with costipation alternating with diarrhea.

The probiotic bifidobacterium infantis is advised to restore a healthy microbe population in the bowel for all types of IBS.

What Is Irritable Bowel Syndrome In Celiac Disease and/or Gluten Sensitivity?

Celiac disease and irritable bowel syndrome (IBS) patients have similar gastrointestinal symptoms, which can result in celiac disease patients being misdiagnosed as having IBS particularly because the diagnosis of IBS is based mainly on symptom assessment using symptom criteria such as the Rome III criteria. Therefore, celiac disease should be excluded in IBS patients. The situation is complicated even further by the fact that the abdominal symptoms in both IBS and celiac disease  patients are triggered by the ingestion of wheat products. However, whereas this is caused by gluten allergy in celiac disease patients, it is attributed in IBS patients to the long-sugar-polymer fructans in wheat.³

In non-celiac gluten sensitivity, it is not clear that gluten triggers the symptoms of IBS, but there is compelling evidence that carbohydrates (fructans and galactans) in the wheat does. Patients with non-celiac gluten sensitivity exhibit the same gastrointestinal and extragastrointestinal symptoms as those with IBS. Withdrawal of wheat products reduces the symptom severity and improves the quality of life in both NCGS and IBS patients.³

• Relationship between irritable bowel syndrome and celiac disease: Irritable bowel syndrome is an atypical symptom of celiac disease. There is an overlap of irritable bowel syndrome symptoms with those of celiac disease, and selected patients should be tested for the latter disease.⁴
• Relationship between irritable bowel syndrome and missed diagnosis of celiac disease: The implications of missed diagnoses of celiac disease in irritable bowel syndrome are the potential complications for osteoporosis, infertility, and an increased risk of malignant disease.⁵ Consequently, screening of patients with the common symptoms of IBS is becoming accepted standard of practice.⁶
• Relationship between irritable bowel syndrome and cost effectiveness of diagnosing celiac disease: A study by Mein and Ladabaum demonstrates that testing for celiac disease in patients with suspected irritable bowel syndrome is likely to be cost-effective even at a relatively low celiac disease prevalence and with small improvements in quality of life with a gluten free diet.⁷
• Relationship between irritable bowel syndrome and response to gluten after diagnosis. Fully gluten free diet adherent patients are more likely to have symptomatic responses to dietary gluten (SRDG) less than 1hr than patients who are partial/none adherent as are a third of patients with co-existing IBS. Inadvertent exposure to dietary gluten in the fully gluten free diet adherent group is more likely to result in a severe SRDG in comparison to symptoms arising prior to consistent gluten free diet adherence. IBS sufferers are also more likely to rate their SRDG as severe in nature.⁸

How Prevalent Is Irritable Bowel Syndrome In Celiac Disease and/or Gluten Sensitivity?

• A meta-analysis of research in the medical literature showed the pooled prevalence of IBS-type symptoms in all patients with celiac disease was 38.0% (95% CI, 27.0%-50.0%).⁹
• A postal survey of 224 biopsy-proven patients with celiac disease, prevalence of irritable bowel numbered 50 (22%).⁸

• On the other hand, prevalence of celiac disease in adults is 3.3% in patients with irritable bowel syndrome (IBS).¹⁰
• Prevalence of celiac disease among children with abdominal pain-related functional gastrointestinal disorders classified according to the Rome criteria as irritable bowel syndrome (IBS)  is 4.4%. Prevalence is 4 times higher than among the general pediatric population.¹¹
• Of 186 Asian patients with irritable bowel syndrome, 18% were positive for IgA DGP, showing non-celiac gluten sensitivity in Asia, a region where celiac disease is uncommon.¹²
• About one third of the IBS patients (90) included in a study of 305 patients were suffering from food hypersensitivity and were cured on the elimination diet.¹³

What Are The Symptoms Of Irritable Bowel Syndrome?

Irritable bowel syndrome is marked by these symptoms:

• Constipation, or
• Intestinal spasm and pain with diarrhea, or
• Alternating constipation and diarrhea.
• Bloating.
• Abdominal pain.

How Does Irritable Bowel Syndrome Develop In Celiac Disease and/or Gluten Sensitivity?

• Irritable bowel syndrome results from unclear etiology.

Does Irritable Bowel Syndrome Respond To Gluten-Free Diet?

Yes. Celiac disease-related irritable bowel syndrome responds to gluten free diet with improvements in quality of life.¹⁴ However, 20–37 % of celiac disease patients suffer from IBS symptoms despite adherence to a gluten-free diet because the inflammation caused by gluten intake may not completely subside.³

All Asian study patients with positive IgA DGP reported symptom improvement with gluten withdrawal.¹⁵

Probiotics are an important part of the diet for improving IBS. Lactobacilli are less gas producing than other bacteria. Therefore, administration of Lactobacilli in patients with IBS was associated with reduced gas-related symptoms. In a single blinded randomized control trial, IBS patients randomized to receive Lactobacillus acidophilus, Lactobacillus helveticus, and Bifidobacterium showed significant improvement in pain and bloating as compared to those who received placebo.¹

6 Steps To Improve Irritable Bowel Syndrome In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1 Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both irritable bowel syndrome and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.¹⁶
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2  Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.¹⁷
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.¹⁷
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.¹⁷.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.¹⁷
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.¹⁷
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.¹⁷
• Cocoa and Black Tea increase blood sugar.
• Rosemary. Increases blood sugar levels and should not be used by persons with insulin resistance or diabetes. [/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes green leafy vegetables such as lettuce and kale, also onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

• [dropcap]3  Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

• [dropcap]4  Manage Your Medications Safely:

[box type=”shadow” ]

Check all ingredients for the unwanted presence of lactose and/or fructose.

Certain medications used to treat irritable bowel syndrome deplete nutrients. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.

 This is not a complete listing.

SELECTIVE SEROTONIN RECEPTOR INHIBITOR (SSRI) ANTI-DEPRESSANTS

• Zoloft, Prozac and others deplete Coenzyme Q10, Vitamin B12, Riboflavin (Vitamin B2).

[/box]

• [dropcap]5 Nutritional Supplements To Help Correct Deficiencies:

[box type=”shadow” ]

The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient. Check all ingredients for the unwanted presence of lactose and/or fructose.

• Multivitamin/mineral combination that provides 100% once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
• B-Complex vitamins to restore vitamin B2. Adequate levels depend on mutually adequate levels of other B vitamins.
• Vitamin B12 as prescribed following blood test for status.
•  Coenzyme Q10 as prescribed.
• Probiotics – particularly bifidobacterium infantis which is advised to restore a healthy microbe population. Acidophilus lactobacillus has been shown to diminish rapidly in persons under stress of any kind, so it is important to replenish with supplements.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.[/box]

• [dropcap]6 Manage Natural Remedies: 

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion. However, because it increases blood sugar levels, it should not be used by persons with insulin resistance or diabete.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Irritable Bowel Syndrome In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

“Increased prevalence of celiac disease among pediatric patients with irritable bowel syndrome: a 6-year prospective cohort study.” This study investigating the prevalence of celiac disease among children with abdominal pain-related functional gastrointestinal disorders classified according to the Rome criteria found that the prevalence of celiac disease among children with IBS is 4 times higher than among the general pediatric population. Rome III classification of abdominal pain-related functional gastrointestinal disorders might help to select children who deserve screening for celiac disease.

This was a six-year (2006-2012) prospective cohort study conducted in a tertiary referral center (hospital) for the diagnosis and follow-up of gastrointestinal disorders in southern Italy (i.e., Bari, Italy). A total of 992 children (42.8% male; median age, 6.8 years) consecutively referred for recurrent abdominal pain by their primary care physicians without previous investigation were evaluated.

Patients were classified according to Rome III criteria as having IBS, functional dyspepsia, functional abdominal pain, or abdominal migraine. Prevalence of celiac disease in each category of abdominal pain-related functional gastrointestinal disorder was evaluated. Concentrations of IgA, IgA antitissue transglutaminase, and endomysial antibodies were measured, and a duodenal biopsy was performed in case of antibody positivity.

Of 992 children who were evaluated: 270 were classified as having IBS, 201 as having functional dyspepsia, and 311 as having functional abdominal pain, and 210 children were excluded from the study because they had an organic disorder or some other functional gastrointestinal disorder (not related to abdominal pain). Serologic testing was performed for all 782 children included in the study, and 15 patients tested positive for celiac disease (12 of 270 patients with IBS [4.4%], 2 of 201 patients with functional dyspepsia [1%], and 1 of 311 patients with functional abdominal pain [0.3%]).¹¹

“Prevalence of Anti-deamidated Gliadin Peptide Antibodies in Asian Patients With Irritable Bowel Syndrome.” This study investigating a consecutive cohort of Asian patients with irritable bowel syndrome (IBS) to de-termine the prevalence of gluten protein associated serology in IBS patients, which has not been formally studied, and its relation to histological and human leukocyte antigen (HLA) markers found that patients with IBS who were positive for IgA DGP improved on a gluten exclusion diet.

Included were a series of Asian, mainly Chinese, patients who had undergone serologic testing for IgA against deamidated gliadin peptide antibodies (IgA DGP) and IgA anti-endomysium antibodies, and who also had duodenal biopsies during clinical workup. In addition, a subset of Chinese patients with positive serology was further tested for HLA-DQ2 and HLA-DQ8.

Of 186 patients, 34 (18%) were positive for IgA DGP; bloating, abdominal pain, belching and diarrhea were the most commonly reported symptoms but diarrhea as the most bothersome symptom was significantly more common in IgA DGP positive patients. Mildly increased intra-epithelial lymphocytes on duodenal biopsy was also more common (29% vs. 9). Nine of 21 Chinese patients tested as IgA DGP positive undertook HLA-DQ2/DQ8 testing, with only 2 being positive for HLA-DQ8. All patients with positive IgA DGP reported symptom improvement with gluten withdrawal. “We believe this is the first report of non-celiac gluten sensitivity in Asia, a region where celiac disease is uncommon.”¹⁸

“Unclear abdominal discomfort: pivotal role of carbohydrate malabsorption.” This study investigating the prevalence of symptomatic lactose and fructose malabsorption in a large population of patients with IBS-like symptoms based on Rome II criteria found that carbohydrate malabsorption is a frequent but underestimated condition in patients with IBS-like symptoms although diagnosis can be easily confirmed by H2 breath testing. Celiac disease was found in 1 of 161 patients by upper endoscopy examination.

In this study, 2,390 patients with unclear abdominal discomfort underwent lactose (50 g) and fructose (50 g) hydrogen (H2) breath tests and depending on the results further testing with 25 g fructose or 50 g glucose, or upper endoscopy with duodenal biopsies. Additionally, this population was investigated regarding the prevalence of small intestinal bacterial overgrowth (SIBO) based on glucose breath test and celiac disease.

Of the 2,390 patients with IBS-like symptoms, 848 (35%) were symptomatic lactose malabsorbers and 1,531 (64%) symptomatic fructose malabsorbers. A combined symptomatic carbohydrate malabsorption was found in 587 (25%) patients. Severe fructose malabsorbers (pathologic 25 g fructose test) exhaled significantly higher H2 concentrations in the 50 g test than pa-tients with negative 25 g fructose test (P < 0.001). Out of 460/659 patients with early significant H2 increase in the lactose and fructose test who underwent a glucose breath test, 88 patients had positive results indicative of SIBO and they were significantly older than patients with negative test result (P < 0.01).¹⁹

“Differentiating coeliac disease from irritable bowel syndrome by urinary volatile organic compound analysis – a pilot study.” This study investigated if celiac disease, which causes altered gut fermentation patterns recognizable by volatile organic compounds (VOC) in urine, breath and feces, can be distinguished from irritable bowel disease (IBS) by a new test called Field Asymmetric Ion Mobility Spectrometry (FAIMS). This test analyzes the urinary (VOC) pattern. This study suggests that FAIMS offers a novel, non-invasive approach to identify those with possible celiac disease, and distinguishes from D-IBS. It offers the potential for monitoring compliance with a gluten-free diet at home.

Recruited were 47 patients: 27 with established celiac disease, on gluten free diets, and 20 with diarrhoea-predominant IBS (D-IBS). Collected urine was stored frozen in 10 ml aliquots. For assay, the specimens were heated to 40±0.1°C and the headspace analysed by Field Asymmetric Ion Mobility Spectrometry (FAIMS). Machine learning algorithms were used for statistical evaluation. Samples were also analysed using Gas chromatography and mass spectroscopy (GC-MS).

Sparse logistic regression showed that FAIMS distinguishes VOCs in celiac disease vs D-IBS with ROC curve AUC of 0.91 (0.83-0.99), sensitivity and specificity of 85% respectively. GCMS showed a unique peak at 4’67 found only in celiac disease, not D-IBS, which correlated with the compound 1,3,5,7 cyclooctatetraene. The presence of cyclooctatetraene in celiac disease specimens will need further validation.²⁰

“Factors influencing the type, timing and severity of symptomatic responses to dietary gluten in patients with biopsy-proven coeliac disease.” This study investigating the type, timing and severity of symptomatic responses (SRDG) to dietary gluten with reference to a range of disease-related factors found that patients with consistent gluten free diet adherence experience a SRDG faster and more severe in comparison to prior gluten exposure possibly demonstrating an adept immunological response. Anxiety and depression also enhance the speed of symptom onset and co-existing visceral hypersensitivity is a risk factor for severe reactions to dietary gluten. IBS sufferers are also more likely to rate their SRDG as severe in nature.

Method of study: Postal survey of 224 biopsy-proven patients including gluten-free diet adherence, symptom checklist, ROME II criteria and The Hospital Anxiety & Depression Scale. Case-note review was also conducted.

26% of respondents were male. Full gluten free diet adherence numbered 159 (70%). Irritable bowel syndrome (IBS) numbered 50 (22%). Anxiety numbered 30 (13%); Depression numbered 33 (14%); Anxiety & Depression numbered 72 (32%). Pruritus, fatigue and bloating were a more common SRDG in the partial/none gluten free diet adherent group. Co-existing IBS was associated with a greater prevalence of nausea and fatigue in response to gluten.

Fully gluten free diet adherent patients are more likely to have SRDG less than 1hr than partial/none adherent as are a third of patients with co-existing IBS and those patients at risk of both anxiety and depression. Inadvertent exposure to dietary gluten in the fully gluten free diet adherent group is more likely to result in a severe SRDG in comparison to symptoms arising prior to consistent gluten free diet adherence.⁸

“A comparison between two different in vitro basophil activation tests for gluten- and cow’s milk protein sensitivity in irritable bowel syndrome (IBS)-like patients.“ This study investigating the frequency of food hypersensitivity in patients with irritable bowel syndrome (IBS)-like clinical presentation demonstrated about one third of the IBS patients included in the study were suffering from food hypersensitivity and were cured on the elimination diet. This study also compared the diagnostic accuracy of two different methods of in vitro basophil activation tests.

Three hundred and five patients (235 females, age range 18-66 years) were included and underwent a diagnostic elimination diet and successive double-blind placebo-controlled challenges. Two different methods of in vitro basophil activation tests (BAT) (CD63 expression after in vitro wheat or cow’s milk proteins stimulation) were evaluated: one was performed on separated leukocytes [white blood cells], and the other on whole blood.

Ninety patients of the 305 studied (29.5%) were positive to the challenges and were diagnosed as suffering from food hypersensitivity. BAT on separate leukocytes showed a sensitivity of 86% and a specificity of 91% in food hypersensitivity diagnosis. BAT on whole blood showed a sensitivity of 15%-20% and a specificity of 73% in food hypersensitivity diagnosis (p<0.0001 compared to the other method). The BAT based on CD63 detection on whole blood samples did not work in food hypersensitivity diagnosis and showed a significantly lower sensitivity, specificity and diagnostic accuracy than the assay based on separated leukocytes.¹³

“Serological testing for coeliac disease in patients with symptoms of irritable bowel syndrome: a cost-effectiveness analysis.” This study demonstrated that testing for Celiac Disease in patients with suspected IBS is likely to be cost-effective even at a relatively low celiac disease prevalence and with small improvements in quality of life with a gluten free diet.¹⁴

“Association of adult coeliac disease with irritable bowel syndrome: a case-control study in patients fulfilling ROME II criteria referred to secondary care.” This study assessing the association of celiac disease with IBS in patients fulfilling Rome II criteria demonstrated that a panel of immunological tests including IgG antigliadin, IgA antigliadin, and EMA should be mandatory in assessment of patients who fulfill diagnostic criteria for IBS when referred to secondary care. The implications of missed diagnoses are the potential complications for osteoporosis, infertility, and an increased risk of malignant disease.²¹

“A primary care cross-sectional study of undiagnosed adult coeliac disease.” This study to establish prevalence of celiac disease in the general population and in specific conditions such as IBS demonstrated a prevalence of 3.3% celiac disease in participants with IBS.²²

Sources:

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9. Sainsbury A, Sanders DS, Ford AC. Prevalence of irritable bowel syndrome-type symptoms in patients with celiac disease: a meta-analysis. Clin Gastroenterol Hepatol. 2013 Apr;11(4):359-65.e1. doi: 10.1016/j.cgh.2012.11.033. [↩]
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13. Carroccio A, Brusca , Mansueto P, D’alcamo A, Barrale M, Soresi M, Seidita A, La Chiusa SM, Iacono G, Sprini D. A comparison between two different in vitro basophil activation tests for gluten- and cow’s milk protein sensitivity in irritable bowel syndrome (IBS)-like patients. Clin Chem Lab Med. 2013 Jun;51(6):1257-63. doi: 10.1515/cclm-2012-0609. [↩] [↩]
14. Mein SM, Ladabaum U. Serological testing for coeliac disease in patients with symptoms of irritable bowel syndrome: a cost-effectiveness analysis. Alimentary Pharmacology and Therapeutics. Jun 1, 2004;19(11):1199-210. [↩] [↩]
15. Lu W, Gwee KA, Siah KT, Kang JY, Lee R, Ngan CC. Prevalence of Anti-deamidated Gliadin Peptide Antibodies in Asian Patients With Irritable Bowel Syndrome. J Neurogastroenterol Motil. 2014 Apr 30;20(2):236-41. doi: 10.5056/jnm.2014.20.2.236. [↩]
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