Seroprevalence of Celiac Disease in Patients with Presumed Diagnosis of Diarrhea Predominant Irritable Bowel Disease

Öz

Amaç: Diyare ağırlıklı irritabl barsak sendromu (İBS-D) hastalarında çölyak hastalığı (ÇH) seroprevalansının belirlenmesi
Yöntem Bu kesitsel tek-merkezli çalışmaya, İBS-D tanısı konulmuş 100 hasta (ort(SS) yaş: 42.8(16.8) yıl, %64.0’ü kadın) dahil edildi. Hastaların
demografik özellikleri, sigara içme durumu, eş-zamanlı psikiyatrik hastalık varlığı ve kan biyokimyası sonuçları kaydedildi. Anti-doku
transglutamaz(anti-tTG) antikorları (anti-tTG IgA ve anti-tTG IgG) ve endomisyum antikoru (anti-EMA) temelinde ÇH seroprevalansı
belirlenerek; seropozitif ve seronegatif hastalar demografik özellikler ve laboratuvar bulguları açısından karşılaştırıldı.
Bulgular Hastaların %17’sinde anti-tTG IgG, %12.0’sinde anti-EMA ve %7’sinde anti-tTG IgA antikoru pozitif olarak saptandı. Hastaların
17(%17.0)’sinde en az bir antikor pozitifliği mevcut olup, bu hastaların 3(%3.0)‘ünde tek değer, 9 (9.0%)’unda iki değer [2(%2.0)
hastada anti- tTG IgA + anti-tTG IgG, 7(%7.0) hastada anti-tTG IgG + anti-EMA] ve 5(%5.0) ‘inde ise üç değer (anti-tTG IgA + anti-tTG
IgG + anti-EMA) üzerinden pozitiflik saptandı. ÇH seronegatif ve seropozitif hastalar arasında cinsiyet, aktif sigara içiciliği, eş-zamanlı
psikiyatrik hastalık varlığı ve laboratuvar bulgular açısından anlamlı bir farklılık gözlenmedi.
Sonuç Sonuç olarak, bulgularımız ÇH serolojik bulgularının İBS-D hastalarının önemli bir kısmında pozitif olduğunu göstermekte ve dolayısıyla
IBS-D hastalarında ÇH için “test ve tedavi et” stratejisinin faydalı olabileceğine işaret etmektedir

Anahtar Kelimeler

• Diyare ağırlıklı irritabıl bağırsak hastalığı,çölyak hastalığı,seroloji,dokutransglutaminaz antikorları,antiendomisium antikorları

Seroprevalence of Celiac Disease in Patients with Presumed Diagnosis of Diarrhea Predominant Irritable Bowel Disease

Abstract

Object This study aims to determine seroprevalence of celiac disease (CD) in patients with presumed diarrhea predominant irritable bowel
disease (IBS-D).
Methods A total of 100 patients with presumed IBS-D (mean(SD) age: 42.8(16.8) years, 64.0% were females) were included in this crosssectional single-centre study. Data on patient demographics, smoking status, co-morbid psychiatric disorders and blood biochemistry
were recorded. Seroprevalence of CD specific anti-tissue transglutaminase (anti-tTG) antibodies (anti-tTG IgA and anti-tTG IgG) and
endomysial (EMA) antibody were determined, while demographic characteristics and laboratory findings were compared between CD
seronegative and seropositive patients.
Results Anti-tTG IgG antibody was positive in 17.0% of patients, as followed by anti-tTG IgA antibody positivity in 7.0% and anti-EMA antibody
positivity in 12.0% of patients. Positive findings for at least one antibody was noted in 17(17.0%) patients including positivity for single
antibody in 3(3.0%) patients, two antibodies in 9(9.0%) patients and three antibodies in 5 (5.0%) patients. No difference was noted
between seropositive and seronegative patients in terms of gender, active smoking, co-morbid psychiatric disorder and laboratory
findings.
Conclusion In conclusion, our findings revealed that non-negligible percentage of patients with suspected IBS-D had positive serological findings
for CD and thereby emphasize that “test and treat” strategy for CD in patients with presumed IBS-D may be worthwhile.

Keywords

• diarrhea predominant IBS,celiac disease,serology,anti-tissue transglutaminase antibody,endomysial antibody

Kaynakça

1. 1. Bellini M, Tosetti C, Costa F, Biagi S, et al. The general practitioner’s approach to irritable bowel syndrome: from intention to practice. Dig Liver Dis 2005;37:934-39.
2. 2. Videlock EJ, Chang L. Irritable bowel syndrome: current approach to symptoms, evaluation, and treatment. Gastroenterol Clin North Am 2007;36:665-85.
3. 3. Longstreth GF, Thompson WG, Chey WD, Houghton LA, et al. Functional bowel disorders. Gastroenterology 2006;130:1480-91.
4. 4. Talley NJ. Irritable bowel syndrome. Intern Med J 2006;36:724–8.
5. 5. Mayer EA. Irritable bowel syndrome. N Engl J Med 2008;358:1692–9.
6. 6. Kellow JE. Introduction: a practical evidence based approach to the diagnosis of functional gastrointestinal disorders. Am J Gastroenterol 2010;105:743–6.
7. 7. Ozden A. Irritable bowel syndrome. 2nd ed. Ankara: Turkish Gastroenterology Foundation Publications; 2006. [in Turkish]
8. 8. Sertbas Y. Prevalence and clinical characteristics of irritable bowel syndrome (IBS) in police officers in Istanbul. Sci Res Essays 2014;9:535-9.

9. 9. Karaman N, Turkay C, Yonem O. Irritable bowel syndrome prevalence in city center of Sivas. Turk J Gastroenterol 2003;14:128–31.
10. 10. Drossman DA, Dumitrascu DL. Rome III: new standard for functional gastrointestinal disorders. J Gastrointestin Liver Dis 2006;15:237–41.
11. 11. Svendsen JH, Munck LK, Andersen JR. Irritable bowel syndrome: prognosis and diagnostic safety. A 5-year follow-up study. Scand J Gastroenterol 1985;20:415–8.
12. 12. Vanner SJ, Depew WT, Paterson W, DaCosta LR, et al. Predictive value of the Rome Criteria for diagnosing the irritable bowel syndrome. Am J Gastroenterol 1999;94:2912–7.
13. 13. Frissora CL, Koch KL. Symptom overlap and comorbidity of irritable bowel syndrome with other conditions. Curr Gastroenterol Rep 2005;7:264-71.
14. 14. Drossman DA. Irritable bowel syndrome: how far do you go in the workup? Gastroenterology 2002;121:1512–5.
15. 15. Burbige EJ. Irritable bowel syndrome: diagnostic approaches in clinical practice. Clin Exp Gastroenterol 2010;3:127-37.
16. 16. James MW, Scott BB. Coeliac disease: the cause of the various associated disorders? Eur J Gastroenterol Hepatol 2001;13:1119-21.
17. 17. Green PH, Jabri B. Coeliac disease. Lancet 2003;362:383-91.Review.
18. 18. Crowe SE. In the clinic. Celiac disease. Ann Intern Med 2011;154:ITC5- 1–ITC5-16, quiz ITC5-16.
19. 19. Tjon JML, van Bergen J, Konig F. Celiac disease: how complicated can it get? Immunogenetics 2010;62:641–51.
20. 20. Zipser RD, Patel S, Yahya KZ, Baisch DW, Monarch E. Presentations of adult celiac disease in a nationwide patient support group. Dig Dis Sci 2003;48:761–4.
21. 21. American College of Gastroenterology Task Force on Irritable BowelSyndrome, Brandt LJ, Chey WD, Foxx-Orenstein AE, Schiller LR, Schoenfeld PS, et al. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol 2009;104 (Suppl 1):S1–35.
22. 22. Rubio-Tapia A, Kyle RA, Kaplan EL, Johnson DR, et al. Increased prevalence and mortality in undiagnosed celiac disease. Gastroenterology 2009;137:88-93.
23. 23. Lohi S, Mustalahti K, Kaukinen K, Laurila K, et al. Increasing prevalence of coeliac disease over time. Aliment Pharmacol Ther 2007;26:1217-25.
24. 24. Vilppula A, Kaukinen K, Luostarinen L, Krekelä I, et al. Increasing prevalence and high incidence of celiac disease in elderly people: a population based study. BMC Gastroenterol 2009;9:49.
25. 25. Alavinejad P, Hajiani E, Masjedizadeh R, Hashemi SJ, et al. Epidemiologic and demographic survey of celiac disease in Khuzestan province. Middle East J Dig Dis 2014;6:98-103.
26. 26. Tatar G, Elsurer R, Simsek H, Balaban YH, et al. Screening of tissue transglutaminase antibody in healthy blood donors for Celiac Disease screening in the Turkish population. Dig Dis Sci 2004;49:1479-84.
27. 27. Gursoy S, Guven K, Simsek T, Yurci A, et al. The prevalence of unrecognized adult celiac disease in Central Anatolia. J Clin Gastroenterol 2005;39:508–11.
28. 28. Elsurer R, Tatar G, Simsek H, Balaban YH, et al. Celiac disease in the Turkish population. Dig Dis Sci 2005;50:136–42.
29. 29. 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;11:359–65.
30. 30. Sanders DS, Carter MJ, Hurlstone DP, Pearce A,et al. Association of adult coeliac disease with irritable bowel syndrome: a case-control study in patients fulfilling ROME II criteria referred to secondary care. Lancet 2001;358:1504–8.
31. 31. Ford AC, Chey WD, Talley NJ, Malhotra A, et al.Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and metaanalysis. Arch Intern Med 2009;169:651–8.
32. 32. Zwolińska-Wcisło M, Galicka-Latała D, Rozpondek P, Rudnicka-Sosin L, et al. Frequency of celiac disease and irritable bowel syndrome coexistence and its influence on the disease course. Przegl Lek 2009;66:126–9. [in Polish]
33. 33. Farrell RJ, Kelly CP. Celiac sprue. N Engl J Med 2002;346:180–8.
34. 34. Dieterich W, Laag E, Schöpper H, Volta U, , et al. Autoantibodies to tissue transglutaminase as predictors of celiac disease. Gastroenterology 1998;115:1317-21.
35. 35. Sulkanen S, Halttunen T, Laurila K, Kolho KL, et al. Tissue transglutaminase autoantibody enzyme-linked immunosorbent assay in detecting celiac disease. Gastroenterology 1998;115:1322-8.
36. 36. Ozdil K, Sokmen M, Ersoy O, Demirsoy H, et al. Association of gluten enteropathy and irritable bowel syndrome in adult Turkish population. Dig Dis Sci 2008;53:1852-5.
37. 37. Locke GR 3rd, Murray JA, Zinsmeister AR, Melton LJ 3rd, et al. Celiac disease serology in irritable bowel syndrome and dyspepsia: a population based case-control study. Mayo Clin Proc 2004;79:476-82.
38. 38. Bakhshipour A, Nezam SK, Zakeri Z, Gharibi R, et al. Coeliac disease in irritable bowel syndrome (Rome III) in Southeast Iran. Arab J Gastroenterol 2012;13:24-7.
39. 39. Korkut E, Bektas M, Oztas E, Kurt M, et al. The prevalence of celiac disease in patients fulfilling Rome III criteria for irritable bowel syndrome. Eur J Intern Med 2010;21:389-92.
40. 40. Cash BD, Rubenstein JH, Young PE, Gentry A, et al. The prevalence of celiac disease among patients with nonconstipated irritable bowel syndrome is similar to controls. Gastroenterology 2011;141:1187-93.
41. 41. Kuyumcu M. The seroprevalence of gluten enteropathy among irritable bowel syndrome patients. Unpublished PhD dissertation, Yuzuncu Yil University Faculty of Medicine. Van, Turkey; 2012. [in Turkish] References2001;358:1504–8.
42. 31. Ford AC, Chey WD, Talley NJ, Malhotra A, et al.Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and metaanalysis. Arch Intern Med 2009;169:651–8.
43. 32. Zwolińska-Wcisło M, Galicka-Latała D, Rozpondek P, Rudnicka-Sosin L, et al. Frequency of celiac disease and irritable bowel syndrome coexistence and its influence on the disease course. Przegl Lek 2009;66:126–9. [in Polish]
44. 33. Farrell RJ, Kelly CP. Celiac sprue. N Engl J Med 2002;346:180–8.
45. 34. Dieterich W, Laag E, Schöpper H, Volta U, , et al. Autoantibodies to tissue transglutaminase as predictors of celiac disease. Gastroenterology 1998;115:1317-21.
46. 35. Sulkanen S, Halttunen T, Laurila K, Kolho KL, et al. Tissue transglutaminase autoantibody enzyme-linked immunosorbent assay in detecting celiac disease. Gastroenterology 1998;115:1322-8.
47. 36. Ozdil K, Sokmen M, Ersoy O, Demirsoy H, et al. Association of gluten enteropathy and irritable bowel syndrome in adult Turkish population. Dig Dis Sci 2008;53:1852-5.
48. 37. Locke GR 3rd, Murray JA, Zinsmeister AR, Melton LJ 3rd, et al. Celiac disease serology in irritable bowel syndrome and dyspepsia: a population based case-control study. Mayo Clin Proc 2004;79:476-82.
49. 38. Bakhshipour A, Nezam SK, Zakeri Z, Gharibi R, et al. Coeliac disease in irritable bowel syndrome (Rome III) in Southeast Iran. Arab J Gastroenterol 2012;13:24-7.
50. 39. Korkut E, Bektas M, Oztas E, Kurt M, et al. The prevalence of celiac disease in patients fulfilling Rome III criteria for irritable bowel syndrome. Eur J Intern Med 2010;21:389-92.
51. 40. Cash BD, Rubenstein JH, Young PE, Gentry A, et al. The prevalence of celiac disease among patients with nonconstipated irritable bowel syndrome is similar to controls. Gastroenterology 2011;141:1187-93.
52. 41. Kuyumcu M. The seroprevalence of gluten enteropathy among irritable bowel syndrome patients. Unpublished PhD dissertation, Yuzuncu Yil University Faculty of Medicine. Van, Turkey; 2012. [in Turkish]