Abstract
Purpose: ACG guidelines recommend CD serologic screening in diarrhea predominant IBS. We aim to establish the prevalence of CD in patients diagnosed with IBS utilizing the “Explorys” platform from 1999-2013. Methods: Patients with a diagnosis of IBS were identified by ICD-9 code. Prevalence of abnormal serologic tests for CD within 3 years of IBS diagnosis was determined, including abnormal values for Tissue Transglutaminase IgA, Gliadin IgG, and Endomysium IgA. We evaluated the number of patients checked for CD with IBS with either iron deficiency anemia (IDA) or osteoporosis. Both are commonly associated with CD. Exclusions: GI hemorrhage, menorrhagia, hematochezia, alcoholism, IBD, premature menopause, male hypogonadism, and pre-existing CD. Results: 221,740 patients had a diagnosis of IBS. CD screening was performed in 5,470 with 4,440 (81%) having abnormal serology. 16,470 (7.4%) patients had osteoporosis, IDA, or both. 760 were screened for CD, and 600 (79%) had positive CD serology. The majority of patients were white females. Conclusion: CD prevalence in the general population is ˜1%. Prior studies determined CD prevalence in IBS to be 4-fold higher. Our findings suggest CD prevalence in those with IBS is higher than this and CD screening is underutilized. CD can lead to many complications (e.g., anemia, cancer, and impaired quality of life). CD screening needs to be improved in IBS labeled patients, especially those with high risk features such as IDA or osteoporosis. Our data reveal a high likelihood of a positive test in these groups especially in older Caucasian females. Limitations: 1. Accuracy of records depends on accurate coding. 2. Unclear if patients with CD were initially misdiagnosed with IBS, or if both diagnoses are truly separate, as they can present similarly. 3. Explorys detects lab values flagged as “abnormal.” Absolute values were not available. 4. There may have been selection bias, with celiac serologies ordered in patients that had a higher risk for CD (i.e. thyroid disease, difficult to treat IBS, family history etc).TableFigureFigure
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