PTU-117 Screening for Coeliac Disease in Irritable Bowel Syndrome Is Still Worthwhile: An Updated Systematic Review and Meta-Analysis

Abstract

Introduction Coeliac disease (CD) and irritable bowel syndrome (IBS) may share similar symptoms, including bloating, abdominal pain, and diarrhoea. A previous meta-analysis demonstrated the prevalence of CD was higher in patients with IBS than controls without IBS, but recent studies have cast doubt on this. We therefore updated our previous meta-analysis. Methods MEDLINE and EMBASE were searched from 2008 (the date of a previous meta-analysis) up to February 2016. Relevant case series and case-control studies with unselected adults with IBS (+/- controls) were reviewed. IBS diagnosis was based on specific symptom-based criteria, physician’s opinion, or questionnaire data. Tests for CD included IgA antigliadin antibodies (AGA), tissue transglutaminase antibodies (tTG), endomysial antibodies (EMA), or dudoenal (D2) biopsies after positive IgA AGA, tTG, or EMA. The proportion of individuals meeting criteria for IBS testing positive for CD was combined, to give a pooled prevalence in all studies. For case-control studies the prevalence of a positive test for CD in both cases with IBS and controls without IBS were compared using odds ratios (OR) with a 95% confidence interval (CI). Results 10 studies used IgA AGAs to screen for CD in 4525 subjects, 2094 of whom had IBS. Pooled prevalence of positive IgA AGAs in IBS subjects was 5.7% (95% CI 1.7% to 11.8%). 7 of these were case-control studies and the odds ratio for a positive IgA AGA in 1530 IBS cases, compared with 2430 controls, was 2.97 (95% CI 1.42 to 6.18). 32 studies used EMA or tTG in 14150 subjects, 8219 of whom had IBS. Pooled prevalence of positive EMA or tTG was 2.6% (95% CI 1.6% to 3.8%). 12 of these were case-control studies and the odds ratio for a positive EMA or tTG in the 2677 IBS cases compared with 5931 controls was 2.60 (95% CI 1.41 to 4.79). 23 studies followed positive coeliac serology of any type with the offer of duodenal biopsy in 9784 individuals, 6991 of whom met criteria for IBS. Pooled prevalence of biopsy-proven CD in these studies was 3.3% (95% CI 2.3% to 4.5%). 8 of these were case-control studies and the odds ratio for biopsy-proven CD in 2025 IBS subjects compared with 2793 controls was 3.96 (95% CI 2.06 to 7.59). Conclusion Screening for CD in people with symptoms compatible with IBS is still worthwhile. Between 2.6% and 5.7% will have a positive serological test for CD, and 3.3% will have biopsy-proven CD. In all instances, the prevalence was significantly higher than in controls without IBS-type symptoms. Disclosure of Interest None Declared