Abstract
IntroductionIrritable bowel syndrome (IBS) and fibromyalgia syndrome (FMS) are two common central sensitization disorders frequently associated in the same patient, and some of these patients with IBS plus FMS (IBS/FMS) could actually be undiagnosed of coeliac disease (CD). The present study was an active case finding for CD in two IBS cohorts, one constituted by IBS/FMS subjects and the other by people with isolated IBS.MethodsA total of 104 patients (89.4% females) fulfilling the 1990 ACR criteria for FMS and the Rome III criteria for IBS classification and 125 unrelated age- and sex-matched IBS patients without FMS underwent the following studies: haematological, coagulation and biochemistry tests, serological and genetic markers for CD (i.e., tissue transglutaminase 2 (tTG-2) and major histocompatibility complex HLA-DQ2/HLA-DQ8), multiple gastric and duodenal biopsies, FMS tender points (TPs), Fibromyalgia Impact Questionnaire (FIQ), Health Assessment Questionnaire (HAQ), 36-Item Short Form Health Survey (SF-36) and Visual Analogue Scales (VASs) for tiredness and gastrointestinal complaints.ResultsAs a whole, IBS/FMS patients scored much worse in quality of life and VAS scores than those with isolated IBS (P < 0.001). Seven subjects (6.7%) from the IBS/FMS group displayed HLA-DQ2/HLA-DQ8 positivity, high tTG-2 serum levels and duodenal villous atrophy, concordant with CD. Interestingly enough, these seven patients were started on a gluten-free diet (GFD), showing a remarkable improvement in their digestive and systemic symptoms on follow-up.ConclusionsThe findings of this screening indicate that a non-negligible percentage of IBS/FMS patients are CD patients, whose symptoms can improve and in whom long-term CD-related complications might possibly be prevented with a strict lifelong GFD.
Highlights
Irritable bowel syndrome (IBS) and fibromyalgia syndrome (FMS) are two common central sensitization disorders frequently associated in the same patient, and some of these patients with IBS plus FMS (IBS/FMS) could be undiagnosed of coeliac disease (CD)
With the aim of estimating the prevalence of CD masquerading as IBS and/or FMS, a specific protocol for active case-finding of CD was applied to an IBS/FMS population from Asturias (Cantabrian coast, northern Spain) and to a sex, age- and size-matched cohort of IBS patients without FMS to establish comparisons
Ten patients from the FMS/IBS group classified as Marsh stage 1 and two classified as Marsh stage 3 had a total of 12 first-degree relatives previously diagnosed with CD
Summary
Irritable bowel syndrome (IBS) and fibromyalgia syndrome (FMS) are two common central sensitization disorders frequently associated in the same patient, and some of these patients with IBS plus FMS (IBS/FMS) could be undiagnosed of coeliac disease (CD). Several comorbidities which may occur more often than expected by chance in IBS patients have been identified, including fibromyalgia syndrome (FMS), chronic fatigue syndrome (CFS), gastro-oesophageal reflux disease, headache, backache, genitourinary symptoms, temporomandibular joint disorder, anxiety and depression [4,5]. With the aim of estimating the prevalence of CD masquerading as IBS and/or FMS, a specific protocol for active case-finding of CD was applied to an IBS/FMS population from Asturias (Cantabrian coast, northern Spain) and to a sex-, age- and size-matched cohort of IBS patients without FMS to establish comparisons
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