Is It IBS or Celiac Disease?

As many as 20% of North Americans have the painful and debilitating symptoms of irritable bowel syndrome (IBS) - abdominal pain, cramping, diarrhea, bloating with excess gas, and diarrhea or constipation (or both). But it’s important to remember that some cases of IBS may be due to celiac disease, a different cat altogether. To make things more complicated, one of the treatments for IBS is a high fiber diet, which includes whole grains and certain cereals. But the only treatment for celiac disease is a gluten-free diet for life, and gluten is commonly found in wheat, rye and barley. This clearly makes it essential to ensure that anyone with IBS has been tested for celiac disease.

The British Medical Journal has recently published an article on the diagnosis of celiac disease. Patients at high risk include those with iron deficiency anemia, first-degree relatives with the disease, type 1 diabetes, autoimmune thyroid disease, and infertility. There is a wide range of symptoms – abdominal pain, chronic diarrhea, bloating, weight loss, tiredness, depression, and decreased bone mineral density, amongst others.

The best means of diagnosis are biopsy of the duodenal wall (collection of a sample of tissue for analysis) and measurement of an antibody to tissue transglutaminase (tTG) in the blood. Canada has an at-home test kit that measures tTG antibody from a fingertip blood sample.

IBS is a diagnosis of exclusion. Other causes of the symptoms should be excluded by a doctor's review of medical history, a physical exam, some lab tests and, maybe, a colonoscopy. Doctors are most concerned about excluding inflammatory bowel diseases (ulcerative colitis, Crohn's disease) and cancer. But they shouldn’t forget celiac disease – especially since one treatment for IBS may exacerbate the symptoms of celiac disease.