| Irritable bowel syndrome is the most common | | | | symptoms suggestive of IBS before that diagnosis is |
| gastrointestinal diagnosis yet it is not really a disease | | | | established.More recently, food intolerance other than |
| nor does it have confirmatory diagnostic tests. Rather, | | | | gluten or wheat have been suggested as a treatable |
| it is diagnosed based on a constellation of symptoms | | | | cause of IBS. Blood tests for a type of antibody |
| and the absence of other diagnoses. Common | | | | known as IgG have been advocated by several |
| symptoms attributed to IBS are abdominal pain, | | | | researchers as being helpful for advising people about |
| cramping, diarrhea, bloating and excess gas. Celiac | | | | eliminating or avoiding certain foods as a treatment of |
| disease or gluten sensitivity is a common but | | | | IBS. Recent evidence suggests that a significant |
| frequently missed gastrointestinal diagnosis. Ingestion of | | | | reduction of IBS symptoms can be achieved in people |
| gluten containing foods in affected individuals | | | | who avoid foods based on elevated IgG antibodies to |
| commonly causes symptoms attributed to IBS that are | | | | foods. Atkinson et. al 2004 reported 10-26% |
| relieved with gluten-free diet in at least 10-20% of | | | | improvement in symptoms in patients compared with |
| people misdiagnosed with IBS. Other food intolerances | | | | controls. Deterioration was noted in those who relaxed |
| are also a likely a cause of IBS symptoms that may | | | | their dietary restriction of foods they had avoided |
| improve with avoidance of certain foods.IBS is a | | | | because of elevated antibody levels. These findings |
| diagnosis of exclusion. Other causes of symptoms of | | | | require further validation and are facing significant |
| abdominal pain, diarrhea, constipation, or alternating | | | | resistance to acceptance by many in the medical |
| constipation and diarrhea should be excluded by | | | | community, especially in the U.S. However, elimination |
| doctor's review of medical history, a physical exam | | | | diets have long been reported effective by many |
| and some screening laboratory tests and arguably a | | | | people. The possibility of food intolerance as a |
| colonoscopy. The other conditions that traditionally | | | | reversible cause of symptoms attributed to a |
| doctors are most concerned about excluding include | | | | syndrome with little other effective treatments except |
| inflammatory bowel diseases (ulcerative colitis, Crohn's | | | | mostly ineffective treatments in the past and very |
| disease) and cancer. Less worrisome but treatable | | | | new medications with limited efficacy and unproven |
| conditions that need to be excluded include lactose | | | | long term safety should prompt further studies and an |
| intolerance, intestinal infections especially parasites like | | | | openness to dietary trials.If you have been diagnosed |
| giardia, and food intolerance. Celiac disease though | | | | with irritable bowel syndrome I recommend you |
| now known to be very common, affecting | | | | confirm that Celiac disease has been excluded. Food |
| approximately one percent of the U.S. population, has | | | | intolerance should also be considered though testing |
| been largely ignored as a possible cause of IBS | | | | may not be covered by your insurance and/or |
| symptoms. Most primary care physicians are aware | | | | accepted by your doctor as valid. Elimination of |
| that diarrhea is a common symptom of Celiac disease | | | | common foods and their proteins causing intolerance, |
| but not that it may present in adults and be associated | | | | wheat, barley and rye (gluten); cow's milk protein |
| with constipation. Most doctors are unaware that the | | | | (casein); soy; and peanuts is worth a try. Be sure to |
| prevalence of Celiac disease in IBS patients may be | | | | keep a food-symptom diary and re-introduce one food |
| as high as 20%.Typical lab tests ordered by doctors | | | | or food protein back into your diet at a time. One diet |
| screening for more serious intestinal diseases that may | | | | that effectively eliminates all the major food proteins |
| mimick IBS include a complete blood count (CBC) | | | | causing intolerances but may be difficult to follow is the |
| looking for signs of blood loss or anemia (low | | | | paleo diet ( Hoey. "Irritable Bowel Syndrome: Could it |
| hemoglobin or hematocrit), signs of inflammation or | | | | be Celiac Disease?" Can Med J. 2002; 166:479-802. |
| infection (high white blood cell count and/or platelet | | | | Sander et al, "Association of Adult Coeliac Disease |
| count) and stool tests for blood (fecal occult blood test | | | | with Irritable Bowel Syndrome: A Case-Control Study |
| or FOBT) or white blood cells (WBCs or fecal | | | | in Patients Fulfilling Rome II Criteria Referred to |
| leukocytes). The stool tests are looking for signs of | | | | Secondary Care." Lancet. 2001; 358:1504-82. Atkinson |
| bleeding, infection or inflammation of the intestine. IBS | | | | W; Sheldon TA; Shaath N; Wharwell PJ. "Food |
| does not cause bleeding or intestinal inflammation | | | | elimination bsed on IgG antibodies in irritable bowel |
| whereas inflammatory bowel disease, infection or | | | | syndrome; a randomised controlled trial." Gut 2004; |
| cancer may. Normal tests are reassurring though do | | | | 53:1459-1464.3. Isolauri E; Rautava S; Kalliamaki M. |
| not exclude more serious disease. Most | | | | "Food allergy in irritable bowel syndrome: new facts |
| gastroenterologists believe a colonoscopy should be | | | | and old fallacies." Gut 2004; 53:1391-3.Dr. Scot Lewey is |
| performed.However, most doctors, even many | | | | a physician who is subspecialty trained and board |
| gastroenterologists, fail to test for Celiac disease | | | | certified in gastroenterology (diseases of the digestive |
| though it is common and screening blood tests exist. | | | | tract) that has over 20 years of experience as an |
| The reasons for this are many and are more fully | | | | expert clinician, researcher, lecturer and author of more |
| explained elsewhere. However, the common incidence, | | | | than twenty articles, book chapters, and scientific |
| presence of screening tests and available treatment | | | | abstracts. His special interests include Celiac disease, |
| should make screening for Celiac disease part of the | | | | food intolerance and allergies, colitis, Crohn's disease, |
| standard evaluation of all patients presenting with | | | | irritable bowel syndrome & reflux. |