Difficulties of differential diagnosis of IBS (Irritable Bowel Syndrome) and celiac disease. Given the similarity of clinical symptoms, differential diagnosis and CRK gluten enteropathy becomes most relevant when the patient holds diarrhea. According to US experts, the key points that help to identify the functional nature of diarrhea – a symptom duration longer than 1 year, while the absence of weight loss, diarrhea at night, need for straining during bowel movements. However, the prevalence of constipation (IBS-C) does not rule out the possible presence of celiac disease. There is no reason to believe that “under the guise of” IBS (Irritable Bowel Syndrome) is an accumulation of undetected cases of serious organic diseases, including celiac disease.
At the same time, the results of other studies conflict with the above. The problem of studying the possible course of celiac disease “under the guise of” IBS (Irritable Bowel Syndrome) is dedicated to systematic review, which analyzed 14 studies of the type “series of events” and “case-control”, which included a total of 4204 patients. In 2278 (54%) cases on the basis of the relevant diagnostic criteria for the diagnosis of IBS. Compared the frequencies of different serological and histological markers of celiac disease in this group and the control group.
Thus, there remains a widely discussed issue of the possible cases of undetected celiac disease hiding “under the guise of” IBS diagnosis, if the latter is established only on the basis of the Rome criteria and exclusion of “symptoms of anxiety.” Continued research on this issue and the long-term observation of the course of IBS and its outcomes.
In this regard, the American scientists have wondered whether economically justified examination of all patients diagnosed with IBS (Irritable Bowel Syndrome) in order to exclude celiac disease. Estimated “price-efficiency” of this survey compared with the empirical treatment of patients with IBS. The analysis showed that the active search tactic celiac justified from an economic standpoint only the high-risk groups, in which the incidence of hypersensitivity to gluten can be more than 8%. Researchers make a reservation, that in every situation on the doctor’s decision about the need for additional research is influenced by such factors as the prevalence of celiac disease among the local population, the cost of treatment of these patients, the quality of laboratory studies.
According to the American College of Gastroenterology, Group IBS patients with diarrhea (IBS-D) and IBS mixed type (IBS-M) is desired to screen for celiac disease in a study of highly specific anti-tTG and EMA (recommendation level 1B) . The need for biopsy of the horizontal branch of the duodenum in all patients with suspected celiac disease remains controversial. Most researchers are inclined to believe that a biopsy should be performed in all patients who have already been identified antibodies that are typical for celiac disease, or there are clinical signs suspicious of the possible presence of the disease, such as anemia, osteomalacia, vitamin deficiencies, “unexplained” weight loss and others. (even in the absence of antibody). If the patient is at high risk of hypersensitivity to gluten, histological examination showed well even in the absence of specific antibodies.
Probably in the near future more widespread genetic testing of patients. Identify specific to celiac disease haplotypes DQ2 and DQ8 will greatly facilitate the task of differential diagnosis.
The seriousness of late detection of celiac disease is the possible development of the tragic consequences – severe and sometimes refractory to treatment of malabsorption, profound anemia and osteoporosis, dysfunctions of the reproductive system, the probability of reducing the quality of life of malignant neoplasms. According to US researchers, from the period of the first signs of celiac disease until a correct diagnosis is an average of 11 years . The main reason for delays in the recognition of celiac disease, apparently, is that the classical form of the disease began to occur much less frequently; doctors often underestimate the extra-intestinal manifestations of the disease, and links with other autoimmune syndromes remains unrecognized. By the probable causes of errors in diagnosis can be attributed to the use of insufficiently sensitive methods of serological diagnosis, underestimating the capabilities of histological examination.