Background and Aim: There is a definite relation between irritable bowel syndrome (IBS) and celiac disease (CD), also, IBS patients have sensitivity to certain dietary components. This study aimed to reveal the prevalence of celiac disease among Egyptian patients with IBSusing anti-endomysial Ab IgA.
Patients and Methods: This study included 80 Egyptian patients who were diagnosed as IBS according to Rome III criteria. All participants were subjected to: complete clinical evaluation, routine laboratory investigations, serological tests (total IgA and anti-endomysial antibody IgA), and upper gastrointestinal endoscopy with 4 biopsies from second part of duodenum. Video capsule endoscopy (VCE) was performed only to proven cases with CD.
Results: All included patients (100%) presented with abdominal pain, 72 patients (90%) had bloating, and 12(15%) had diarrhea. Eight patients (10%) had positive anti-endomysial antibody. Among them, only two patients had confirmed CD by histopathological examination of duodenal biopsy; one of them matched March Grade II and the other one matched March Grade IIIc. Among patients with negative anti-endomysial antibody (n=72), one patient was proved to have CD by histopathological examination of duodenal biopsy corresponding to March Grade II. Thus, the prevalence of CD in the current study was 3.75% (3 out of 80 patients). VCE showed associated distal enteropathy in one patient with March Grade IIIc criteria. Anti-endomysial antibody showed sensitivity, specificity, positive predictive and negative predictive values of 66.7%, 92.2%, 25% and 98.6% respectively in the diagnosis of CD.
Conclusion: Screening for CD among Egyptian patients with IBS by anti-endomysial antibody alone is not enough as it showed relatively low sensitivity and positive predictive value. Other more sensitive serological markers as anti-tissue transglutaminase (anti-tTG) Ab together with VCE may be beneficial in this setting.