| Irritable bowel syndrome is the most common | | | | common incidence, presence of screening tests, |
| gastrointestinal diagnosis yet it is not really a | | | | and available treatment should make screening for |
| disease nor does it have confirmatory diagnostic | | | | Celiac disease part of the standard evaluation of |
| tests. Rather, it is diagnosed based on a | | | | all patients presenting with symptoms suggestive |
| constellation of symptoms and the absence of | | | | of IBS before that diagnosis is established. |
| other diagnoses. Common symptoms attributed | | | | More recently, food intolerance other than gluten |
| to IBS are abdominal pain, cramping, diarrhea, | | | | or wheat have been suggested as a treatable |
| bloating and excess gas. Celiac disease or gluten | | | | cause of IBS. Blood tests for a type of antibody |
| sensitivity is a common but frequently missed | | | | known as IgG have been advocated by several |
| gastrointestinal diagnosis. Ingestion of gluten | | | | researchers as being helpful for advising people |
| containing foods in affected individuals commonly | | | | about eliminating or avoiding certain foods as a |
| causes symptoms attributed to IBS that are | | | | treatment of IBS. Recent evidence suggests that |
| relieved with gluten-free diet in at least 10-20% of | | | | a significant reduction of IBS symptoms can be |
| people misdiagnosed with IBS. Other food | | | | achieved in people who avoid foods based on |
| intolerances are also a likely a cause of IBS | | | | elevated IgG antibodies to foods. Atkinson et. al |
| symptoms that may improve with avoidance of | | | | 2004 reported 10-26% improvement in |
| certain foods. | | | | symptoms in patients compared with controls. |
| IBS is a diagnosis of exclusion. Other causes of | | | | Deterioration was noted in those who relaxed |
| symptoms of abdominal pain, diarrhea, | | | | their dietary restriction of foods they had avoided |
| constipation, or alternating constipation and | | | | because of elevated antibody levels. These |
| diarrhea should be excluded by doctor's review of | | | | findings require further validation and are facing |
| medical history, a physical exam and some | | | | significant resistance to acceptance by many in |
| screening laboratory tests and arguably a | | | | the medical community, especially in the U.S. |
| colonoscopy. The other conditions that traditionally | | | | However, elimination diets have long been |
| doctors are most concerned about excluding | | | | reported effective by many people. The possibility |
| include inflammatory bowel diseases (ulcerative | | | | of food intolerance as a reversible cause of |
| colitis, Crohn's disease) and cancer. Less | | | | symptoms attributed to a syndrome with little |
| worrisome but treatable conditions that need to | | | | other effective treatments (except mostly |
| be excluded include lactose intolerance, intestinal | | | | ineffective treatments in the past and very new |
| infections especially parasites like giardia, and food | | | | medications with limited efficacy and unproven |
| intolerance. Celiac disease though now known to | | | | long term safety) should prompt further studies |
| be very common, affecting approximately one | | | | and an openness to dietary trials. |
| percent of the U.S. population, has been largely | | | | If you have been diagnosed with irritable bowel |
| ignored as a possible cause of IBS symptoms. | | | | syndrome I recommend you confirm that Celiac |
| Most primary care physicians are aware that | | | | disease has been excluded. Food intolerance should |
| diarrhea is a common symptom of Celiac disease | | | | also be considered though testing may not be |
| but not that it may present in adults and be | | | | covered by your insurance and/or accepted by |
| associated with constipation. Most doctors are | | | | your doctor as valid. Elimination of common foods |
| unaware that the prevalence of Celiac disease in | | | | and their proteins causing intolerance, wheat, |
| IBS patients may be as high as 20%. | | | | barley and rye (gluten); cow's milk protein (casein); |
| Typical lab tests ordered by doctors screening for | | | | soy; and peanuts is worth a try. Be sure to keep |
| more serious intestinal diseases that may mimick | | | | a food-symptom diary and re-introduce one food |
| IBS include a complete blood count (CBC) looking | | | | or food protein back into your diet at a time. One |
| for signs of blood loss or anemia (low hemoglobin | | | | diet that effectively eliminates all the major food |
| or hematocrit), signs of inflammation or infection | | | | proteins causing intolerances but may be difficult |
| (high white blood cell count and/or platelet count) | | | | to follow is the paleo diet ( |
| and stool tests for blood (fecal occult blood test | | | | 1. Hoey. "Irritable Bowel Syndrome: Could it be |
| or FOBT) or white blood cells (WBCs or fecal | | | | Celiac Disease?" Can Med J. 2002; 166:479-80 |
| leukocytes). The stool tests are looking for signs | | | | 2. Sander et al, "Association of Adult Coeliac |
| of bleeding, infection or inflammation of the | | | | Disease with Irritable Bowel Syndrome: A |
| intestine. IBS does not cause bleeding or intestinal | | | | Case-Control Study in Patients Fulfilling Rome II |
| inflammation whereas inflammatory bowel | | | | Criteria Referred to Secondary Care." Lancet. |
| disease, infection or cancer may. Normal tests are | | | | 2001; 358:1504-8 |
| reassurring though do not exclude more serious | | | | 2. Atkinson W; Sheldon TA; Shaath N; Wharwell |
| disease. Most gastroenterologists believe a | | | | PJ. "Food elimination bsed on IgG antibodies in |
| colonoscopy should be performed. | | | | irritable bowel syndrome; a randomised controlled |
| However, most doctors, even many | | | | trial." Gut 2004; 53:1459-1464. |
| gastroenterologists, fail to test for Celiac disease | | | | 3. Isolauri E; Rautava S; Kalliamaki M. "Food allergy |
| though it is common and screening blood tests | | | | in irritable bowel syndrome: new facts and old |
| exist. The reasons for this are many and are | | | | fallacies." Gut 2004; 53:1391-3. |
| more fully explained elsewhere. However, the | | | | |