Skip to main content

Advertisement

SpringerLink
Log in

Prodromal Irritable Bowel Syndrome May Be Responsible for Delays in Diagnosis in Patients Presenting with Unrecognized Crohn’s Disease and Celiac Disease, but Not Ulcerative Colitis

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Introduction

We aimed to determine the prevalence and duration of prodromal periods in patients with celiac disease and inflammatory bowel disease (Crohn’s disease and ulcerative colitis). Furthermore, we explored to what extent vague abdominal symptoms consistent with both disorders were attributed to irritable bowel syndrome (IBS) and if the presence of prodromal IBS (P-IBS) had an impact on prodrome duration.

Methods

In the study, 683 biopsy-proven patients (celiac n = 225, ulcerative colitis n = 228, Crohn’s disease n = 230) completed a postal survey including an assessment of prodromal periods and IBS symptoms during both the prodrome and at present (achieved by completion of the ROME II criteria). Results were compared to age/sex-matched controls (n = 348).

Results

Crohn’s disease patients had the highest prevalence of prodromes (94%) in comparison to ulcerative colitis (48%) and celiac disease (44%). However, Crohn’s disease patients have the lowest prevalence of P-IBS (29%) in comparison to ulcerative colitis (38%) and celiac disease (67%). Prodrome duration in patients with P-IBS Crohn’s disease was 4 years in comparison to 2 years without (p = 0.018). Prodrome duration in P-IBS celiac disease was 10 years in comparison to 7 years without (p = 0.046). Prodrome duration in patients with ulcerative colitis was not affected by P-IBS (p ≥ 0.05). Age and sex were not confounding factors.

Conclusions

This is the first study to make direct comparisons of prodrome periods between celiac disease and IBD. Prodrome duration in celiac disease is significantly longer and more often characterized by P-IBS than IBD. In celiac disease and CD, P-IBS increases prodrome duration. This may represent a failure to understand the overlap between IBS and celiac disease/IBD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Sanders DS, Hurlstone D, Stokes R, Rashid F, Milford-Ward A, Hadjivassiliou M. Changing face of adult celiac disease: experience of a single university hospital in South Yorkshire. Postgrad Med J. 2002;78:31–33.

    Article  PubMed  CAS  Google Scholar 

  2. Cranney A, Zarkadas M, Graham ID, et al. The Canadian Celiac Health Survey. Dig Dis Sci. 2007;52:1087–1095.

    Article  PubMed  Google Scholar 

  3. Pimentel M, Chang M, Chow E, et al. Identification of a prodrome period in Crohn’s disease but not ulcerative colitis. Am J Gastroenterol. 2000;95:3462–3558.

    Google Scholar 

  4. Pieper C, Haag S, Gesenhues S, Gerken G, Jockel K. Guideline adherence, patient satisfaction in IBD—an evaluation study. BMC Health Serv Res. 2009;27:9–17.

    Google Scholar 

  5. Burgmann T, Clara I, Graff L, et al. The Manitoba Inflammatory Bowel Disease Cohort Study: prolonged symptoms before diagnosis—how much is irritable bowel syndrome? Clin Gastroenterol Hepatol. 2006;4:614–662.

    Article  PubMed  Google Scholar 

  6. Dickey W, McConnel J. How many hospital visits does it take before celiac sprue is diagnosed? J Clin Gastroenterol. 1996;23:21–23.

    Article  PubMed  CAS  Google Scholar 

  7. Lo W, Sano K, Lebwohl B, Diamond B, Green PH. Changing presentation of adult celiac disease. Dig Dis Sci. 2003;48:395–398.

    Article  PubMed  Google Scholar 

  8. Hauser W, Gold J, Stallmach A, Caspary WF, Stein J. Health-related quality of life in adult celiac disease in Germany: results of a national survey. Euro J Gastroenterol Hepatol. 2006;18:747–754.

    Article  Google Scholar 

  9. Hopper A, Hadijvassilou M, Butt S, Sanders DS. Adult celiac disease. BMJ. 2007;335:558–562.

    Article  PubMed  Google Scholar 

  10. Xavier R, Podolsky D. Unravelling the pathogenesis of IBD. Nature. 2007;427–435.

  11. Thompson WG, Longstreth GF, Drossman DA. Functional bowel disorders and functional abdominal pain. GUT. 1999;45:1143–1147.

    Google Scholar 

  12. Corazza GR, Brusco G, Andreani ML, Biagi F, Stefano MD, Gasbarrini G. Previous misdiagnosis, diagnostic delay in adult celiac sprue. J Clin Gastroenterol. 1996;22:324–325.

    Article  PubMed  CAS  Google Scholar 

  13. Mearin F, Badia X, Balboa A, et al. IBS prevalence varies enormously depending on the employed diagnostic criteria: comparison of ROME II versus previous criteria in a general population. Scand J Gastroenterol. 2001;36:1155–1161.

    Article  PubMed  CAS  Google Scholar 

  14. Kumar P, Clarke M. Clinical Medicine. 5th ed. London: Churchill Livingstone.

  15. Zipser R, Farid M, Baisch D, Patel B, Patel D. Physician awareness of celiac disease: a need for further education. J Gen In Med. 2005;20:644–646.

    Google Scholar 

  16. O’Leary C, Wieneke P, Buckley S, O’Regan P, Cronin P, Quigley E. Celiac disease and irritable bowel-type symptoms. Am J Gastro. 2002;97:1463–1467.

    Article  Google Scholar 

  17. Keohane J, O’Mahony C, O’Mahony L, O’Mahony S, Quigley EM, Shanahan F. Irritable bowel syndrome-type symptoms in patients with inflammatory bowel disease: a real association or a reflection of occult inflammation? Am J Gastroenterol. 2010;105:1789–1794.

    Article  Google Scholar 

  18. Long MD, Drossman DA. Inflammatory bowel disease, irritable bowel syndrome, or what? A challenge to the functional-organic dichotomy. Am J Gastroenterol. 2010;105:1789–1794.

    Article  Google Scholar 

  19. Mein SM, Ladabaum U. Serological testing for coeliac disease patients with symptoms of irritable bowel syndrome: a cost effectiveness analysis. Aliment Pharmacol Ther. 2004;19:1–12.

    Article  Google Scholar 

  20. Biesiekieski TR, Newnham ED, Irving PM, et al. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomised placebo-controlled trial. Am J Gastroenterol. 2011;106:508–514.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Gastroenterology & Liver Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK

    S. M. Barratt, J. S. Leeds, K. Robinson, A. J. Lobo, M. E. McAlindon & D. S. Sanders

Authors
  1. S. M. Barratt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. S. Leeds
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Robinson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. J. Lobo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. E. McAlindon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. S. Sanders
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. M. Barratt.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Barratt, S.M., Leeds, J.S., Robinson, K. et al. Prodromal Irritable Bowel Syndrome May Be Responsible for Delays in Diagnosis in Patients Presenting with Unrecognized Crohn’s Disease and Celiac Disease, but Not Ulcerative Colitis. Dig Dis Sci 56, 3270–3275 (2011). https://doi.org/10.1007/s10620-011-1783-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-011-1783-y

Keywords

Search

Navigation