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March 18, 2009

Testing for Celiac Disease in Patients With Symptoms of Irritable Bowel Syndrome—Reply

JAMA. 2009;301(11):1126. doi:10.1001/jama.2009.273

In Reply: Our systematic review focused on the role of the history and physical examination in making a diagnosis of IBS. It was not intended to be a guideline on how to manage IBS, so the issue of testing for celiac disease was not addressed in detail. We agree, however, that testing for celiac disease, with tissue transglutaminase (tTG) or anti-endomysial antibodies (EMAs), followed by distal duodenal biopsy for those testing positive, is useful in individuals presenting with symptoms suggestive of IBS. In another systematic review and meta-analysis that examined the yield of testing for celiac disease in patients meeting diagnostic criteria for IBS, the pooled prevalence of positive tTG or EMA in 13 studies containing 2021 individuals with symptoms suggestive of IBS was 1.6%, and the pooled prevalence of biopsy-proven celiac disease in 7 studies containing 1464 patients meeting diagnostic criteria for IBS was 4.1%.1 The odds ratio for biopsy-proven celiac disease in patients with symptoms suggestive of IBS compared with healthy controls was 4.34 (95% confidence interval, 1.78-10.6).

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