Celiac disease-like abnormalities in a subgroup of patients with irritablebowel syndrome

Background & Aims: Abdominal symptoms in the absence of mucosal abnormaliti es are features of both the irritable bowel syndrome (IBS) and latent/poten tial celiac disease (cd). To identify a possible subgroup of IBS patients w ith latent/potential cd, surrogate markers of cd were investigated in IBS p atients. Methods: IBS patients suffering from diarrhea (n = 102), and patie nts with active cd (n = 10), treated cd (n = 26), and latent cd (n = 5) wer e included in the study. We measured serum immunoglobulin (Ig) A against gl iadin and tissue-transglutaminase, and IgA and IgM against gliadin, tissue- transglutaminase (intestinal cd-associated antibodies), and the dietary pro teins beta -lactoglobulin and ovalbumin in duodenal aspirate by enzyme-link ed immunosorbent assay. Intraepithelial lymphocytes (IELs) were counted in histology sections, and the expression of HLA-DQ2 (A1*0501/B1*0201) was inv estigated by polymerase chain reaction. In 26 IBS patients, the effect of 6 months of gluten withdrawal was examined. Results: Most cd patients expres sed HLA-DQ2 and had increased intestinal cd-associated antibodies, whereas cd-associated serum IgA and IEL counts were increased in active cd in contr ast to treated or latent cd. In IBS patients, 35% were HLA-DQ2-positive, 23 % had increased IEL counts, and 0% and 30% had increased cd-associated anti bodies in serum and duodenal aspirate, respectively. Furthermore, stool fre quency and intestinal IgA decreased significantly under a gluten-free diet in the subgroups of HLA-DQ2-positive and intestinal antibody-positive IBS p atients when compared with IBS patients without these markers. Conclusions: HLA-DQ2 expression and increased intestinal cd-associated antibodies are m arkers that can identify latent/potential cd in a subgroup of IBS patients who consequently appear to profit from a gluten-free diet.