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Systematic Review and Meta-analysis

Alexander C. Ford, MBChB, MD, MRCP; William D. Chey, MD; Nicholas J. Talley, MD, PhD; Ashish Malhotra, MD; Brennan M. R. Spiegel, MD, MSHS; Paul Moayyedi, PhD, FRCP

Arch Intern Med. 2009;169(7):651-658.

Background  Individuals with irritable bowel syndrome (IBS) report abdominal pain, bloating, and diarrhea, symptoms similar to those in celiac disease. Studies suggest that the prevalence of celiac disease is increased in individuals with IBS; however, evidence is conflicting, and current guidelines do not always recommend screening for celiac disease in these individuals.

Methods  We conducted a systematic review and meta-analysis to estimate prevalence of celiac disease in unselected adults who met diagnostic criteria for IBS. MEDLINE (1950 to May 31, 2008) and EMBASE (1980 to May 31, 2008) were searched. Case series and case-control studies that used serologic tests for celiac disease were eligible for inclusion. Prevalence of positive serologic indications of celiac disease and biopsy-proved celiac disease were extracted and pooled for all studies and were compared between cases and controls using an odds ratio and 95% confidence interval.

Results  Fourteen studies were identified comprising 4204 individuals, of whom 2278 (54%) met diagnostic criteria for IBS. Pooled prevalence of positive IgA-class antigliadin antibodies, either positive endomysial antibodies or tissue transglutaminase, and biopsy-proved celiac disease were 4.0% (95% confidence interval, 1.7-7.2), 1.63% (0.7-3.0), and 4.1% (1.9-7.0), respectively. Pooled odds ratios (95% confidence intervals) for positive IgA-class antigliadin antibodies, either positive endomysial antibodies or tissue transglutaminase, and biopsy-proved celiac disease in cases meeting diagnostic criteria for IBS compared with controls without IBS were 3.40 (1.62-7.13), 2.94 (1.36-6.35), and 4.34 (1.78-10.6).

Conclusion  Prevalence of biopsy-proved celiac disease in cases meeting diagnostic criteria for IBS was more than 4-fold that in controls without IBS.

Author Affiliations: Gastroenterology Division, McMaster University, Health Sciences Centre, Hamilton, Ontario, Canada (Drs Ford and Moayyedi); Division of Gastroenterology, Department of Medicine, University of Michigan Medical Center, Ann Arbor (Dr Chey); Department of Medicine, Mayo Clinic Florida, Jacksonville (Dr Talley); Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota (Dr Malhotra); and VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA, UCLA School of Public Health, UCLA/VA Center for Outcomes Research and Education, Los Angeles, California (Dr Spiegel).

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Arch Intern Med. 2009;169(7):648.
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