Evidence Against Routine Testing of Patients With Functional Gastrointestinal Disorders for Celiac Disease: A Population-based Study
Evidence Against Routine Testing of Patients With Functional Gastrointestinal Disorders for Celiac Disease: A Population-based Study
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DOI：
10.1016/j.cgh.2015.05.014
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发表时间：
2015-11-01
影响因子：
12.6
通讯作者：
Murray, Joseph A.
中科院分区：
文献类型：
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作者：
Choung, Rok Seon;Rubio-Tapia, Alberto;Murray, Joseph A.
背景与目的：在门诊中，乳糜泻与肠易激综合征（IBS）样症状有关。指南建议所有有IBS样症状的患者接受乳糜泻的血清学检测，但乳糜泻是否在有IBS样症状的人群中更普遍存在争议。我们的目的是确定是否阳性结果乳糜泻血清学试验与IBS和其他功能性胃肠道疾病（FGIDs）在一个大的美国白色population.METHODS：验证，自我报告的肠道疾病问卷（BDQs）被发送到随机选择的队列奥姆斯特德县，明尼苏达州的居民。在不同的方案中，从超过47，000名事先未诊断出乳糜泻的奥姆斯特德县居民中收集了血清样本;我们对完成BDQ的居民的储存血清样本进行了乳糜泻血清学检测。Logistic回归被用来测试乳糜泻的血清学标志物（阳性与阴性）和个人FGIDs.RESULTS之间的关联：共3202例受试者完成了BDQ和血清可用于测试。在这些受试者中，13.6%（95%置信区间[CI]，12.4%-14.8%）发现了IBS，55.2%（95% CI，53.5%-56.9%）发生了任何胃肠道症状。基于血清学标志物的乳糜泻患病率为1.0%（95%CI，0.7%-1.4%）。IBS在乳糜泻患者中的患病率（3%）低于无乳糜泻患者（14%），尽管差异无统计学意义（比值比，0.2; 95%CI，0.03-1.5）。腹痛，便秘，体重减轻，消化不良是最常见的症状组的受试者血清阳性的乳糜泻，但没有胃肠道症状或疾病显着相关的乳糜泻serology.CONCLUSIONS：症状提示FGIDs和血清阳性乳糜泻是相对常见的在美国白色社区。在美国，社区IBS患者的乳糜泻检测可能不会比基于人群的筛查显着增加产量。
BACKGROUND & AIMS: Celiac disease has been linked to irritable bowel syndrome (IBS)-like symptoms in outpatient clinics. Guidelines recommend that all patients with IBS-like symptoms undergo serologic testing for celiac disease, but there is controversy over whether celiac disease is more prevalent in populations with IBS-like symptoms. We aimed to determine whether positive results from serologic tests for celiac disease are associated with IBS and other functional gastrointestinal disorders (FGIDs) in a large U.S. white population.METHODS: Validated, self-report bowel disease questionnaires (BDQs) were sent to randomly selected cohorts of Olmsted County, Minnesota residents. In separate protocols, serum samples were collected from more than 47,000 Olmsted County residents without a prior diagnosis of celiac disease; we performed serologic tests for celiac disease on stored serum samples from residents who completed the BDQ. Logistic regression was used to test for the association between serologic markers of celiac disease (positive vs negative) and individual FGIDs.RESULTS: A total of 3202 subjects completed the BDQ and had serum available for testing. IBS was identified in 13.6% of these subjects (95% confidence interval [CI], 12.4%-14.8%), and any gastrointestinal symptom occurred in 55.2% (95% CI, 53.5%-56.9%). The prevalence of celiac disease on the basis of serologic markers was 1.0% (95% CI, 0.7%-1.4%). IBS was less prevalent in patients with celiac disease (3%) than patients without celiac disease (14%), although the difference was not statistically significant (odds ratio, 0.2; 95% CI, 0.03-1.5). Abdominal pain, constipation, weight loss, and dyspepsia were the most frequent symptom groups in subjects who were seropositive for celiac disease, but none of the gastrointestinal symptoms or disorders were significantly associated with celiac disease serology.CONCLUSIONS: Symptoms indicative of FGIDs and seropositive celiac disease are relatively common in a U.S. white community. Testing for celiac disease in patients with IBS in the community may not have a significantly increased yield over population-based screening in the United States.