Prevalence of Celiac Disease in Patients with Irritable Bowel Syndrome in Kerman, Iran


1 Assistant Professor, Department of Internal Medicine, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

2 Lecturer, Department of Anatomy, School of Medicine, Bam University of Medical Sciences, Bam, Iran


Background & Aims: Celiac disease or gluten-sensitive enteropathy is a relatively uncommon digestive disease. Moreover, irritable bowel syndrome (IBS) is a common functional bowel disorder. Some IBS patients have celiac disease, with similar IBS symptoms in addition to some serious complications. The only possible treatment for this condition is changing the patients diet (gluten free diet). Given the importance of celiac disease and the similarity of its symptoms with IBS, this study aimed to determine the prevalence of celiac disease in patients with irritable bowel syndrome in Kerman, Iran. Methods: This was a cross-sectional study performed during 8 months on patients of 15-84 years of age diagnosed with IBS in Kerman in 2013. Serological test of immunoglobulin A anti-tissue transglutaminase (IgA anti tTG ) was request in all IBS patients for the diagnosis of celiac disease and bulb and duodenal (second part) biopsy and pathologic findings were used for definite diagnosis in seropositive patients. Results: The study included 143 patients with irritable bowel syndrome [57 males (39.86%) and 86 females (60.14%)] with a mean age of 34.57 ± 1.24. Serological tests showed that 8 (5.59%) patients were seropositive for celiac disease and duodenal biopsy showed 4 (2.79%) patients were seropositive and ( 2 males (Marsh2) and 2 females (Marsh1)) were positive for serologic and pathologic celiac disease. Among these patients, 1 patient (male) had constipation–predominant IBS, and 3 patients (1 male and 2 females) had diarrhea-predominant IBS. Conclusion: This study indicated a 5.59% prevalence of positive serologic and 2.79% prevalence of positive serologic-pathologic celiac disease in patients with IBS in Kerman. This was lower in comparison with similar studies in other regions of the country. This difference may be due to the effects of demographic, genetic, and environmental factors of each region.


  1. Gudmand-Høyer E. The clinical significance of disaccharide maldigestion. Am J Clin Nutr 1994; 59(3): 735S-41S.
  2. Farrell RJ, Kelly CP. Celiac sprue. N Engl J Med 2002; 346(3): 180-8.
  3. Malekzadeh R, Sachdev A, Fahid AA. Coeliac disease in developing countries: Middle East, India and North Africa. Best Pract Res Clin Gastroenterol 2005; 19(3): 351-8.
  4. Houshiyar A, Fouladi N, Amani F, Alimohammadi Asl H, Ghorbani F. Prevalence of celiac disease in patients with irritable bowel syndrome in Ardabil-Iran (2009-10). J Gorgan Univ Med Sci 2012; 14(4): 125-9. [In Persian].
  5. Emami MH, Kouhestani S, Gholamrezaei A, Hashemi M, Mahzouni P, Raeisi M, et al. Prevalence of celiac disease in patients with irritable bowel syndrome. Govaresh 2008; 13(3): 192-7. [In Persian].
  6. Green PH. The many faces of celiac disease: clinical presentation of celiac disease in the adult population. Gastroenterology 2005; 128(4 Suppl 1): S74-S78.
  7. Chang HJ, Burke AE, Golub RM. Celiac disease. JAMA 2011; 306(14): 1614.
  8. Shakeri R, Malekzadeh R, Sachdof A, Fahid-Ali E. Celiac disease in developing countries: Middle East, India and North Africa. Govaresh 2004; 9(4): 242-7. [In Persian].
  9. Masoodi M, Sadeghi S, Moosavi A. Celiac disease in patients with irritable bowel syndrome. Govaresh 2007; 12(3): 200-7 [In Persian].
  10. Quigley EM. Changing face of irritable bowel syndrome. World J Gastroenterol 2006; 12(1): 1-5.
  11. Fauci A, Braunwald E, Kasper D, Hauser S, Longo D, Jameson J, et al. Harrison's principles of internal medicine. 17 th ed. New York, NY: McGraw-Hill; 2008.
  12. Wu J, Xia B, von Blomberg BM, Zhao C, Yang XW, Crusius JB, et al. Coeliac disease in China, a field waiting for exploration. Rev Esp Enferm Dig 2010; 102(8): 472-7.
  13. Sulkanen S, Halttunen T, Laurila K, Kolho KL, Korponay-Szabo IR, Sarnesto A, et al. Tissue transglutaminase autoantibody enzyme-linked immunosorbent assay in detecting celiac disease. Gastroenterology 1998; 115(6): 1322-8.
  14. Leffler DA, Edwards George JB, Dennis M, Cook EF, Schuppan D, Kelly CP. A prospective comparative study of five measures of gluten-free diet adherence in adults with coeliac disease. Aliment Pharmacol Ther 2007; 26(9): 1227-35.
  15. Whitehead WE. Patient subgroups in irritable bowel syndrome that can be defined by symptom evaluation and physical examination. Am J Med 1999; 107(5A): 33S-40S.
  16. Arranz E, Ferguson A. Intestinal antibody pattern of celiac disease: occurrence in patients with normal jejunal biopsy histology. Gastroenterology 1993; 104(5): 1263-72.
  17. Trier JS. Diagnosis of celiac sprue. Gastroenterology 1998; 115(1): 211-6.
  18. Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol 1999; 11(10): 1185-94.
  19. Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS. Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis. Gastroenterology 2004; 126(7): 1721-32.
  20. Catassi C, Kryszak D, Louis-Jacques O, Duerksen DR, Hill I, Crowe SE, et al. Detection of Celiac disease in primary care: a multicenter case-finding study in North America. Am J Gastroenterol 2007; 102(7): 1454-60.
  21. Shahbazkhani B, Forootan M, Merat S, Akbari MR, Nasserimoghadam S, Vahedi H, et al. Coeliac disease presenting with symptoms of irritable bowel syndrome. Aliment Pharmacol Ther 2003; 18(2): 231-5.
  22. Akhondi-Meybodi M, Rabei A, Salehi S. Frequency of Celiac Disease in Irritable Bowel Syndrome Patients with Predominant Diarrhea Referred to Gastroenterology Clinics in Yazd, Iran. J Shaheed Sadoughi Univ Med Sci 2011; 19(5): 637-43. [In Persian].
  23. Bakhshipour A, Nezam SK, Zakeri Z, Gharibi R, Bahari A, Kaykhaei MA. Coeliac disease in irritable bowel syndrome (Rome III) in Southeast Iran. Arab J Gastroenterol 2012; 13(1): 24-7.
  24. Jafri Haidarlo A, Mahmodi A, Yasemi M, Baziar A, Ehsan Bakhsh S, Rashid Begi M. Frequency of Celiac Disease in Patients with Diarrhea Predominant Irritable Bowel Syndrome Referred to Gastroenterology Clinics in Ilam During 2008 to 2012. J Ilam Univ Med Sci 2013; 21(4): 191-8. [In Persian].
  25. Tirgar-Fakheri H, Malekzadeh R, Akbari MR, Sotoudeh M. Prevalence of Celiac disease in north of Iran: Screening of an adult population in Sari. J Gorgan Univ Med Sci 2004; 6(1-2): 94-100. [In Persian].
  26. Akbari MR, Mohammadkhani A, Fakheri H, Javad ZM, Shahbazkhani B, Nouraie M, et al. Screening of the adult population in Iran for coeliac disease: comparison of the tissue-transglutaminase antibody and anti-endomysial antibody tests. Eur J Gastroenterol Hepatol 2006; 18(11): 1181-6.
  27. Jadallah KA, Khader YS. Celiac disease in patients with presumed irritable bowel syndrome: a case-finding study. World J Gastroenterol 2009; 15(42): 5321-5.
  28. Cash BD, Rubenstein JH, Young PE, Gentry A, Nojkov B, Lee D, et al. The prevalence of abnormal celiac antibodies and celiac disease in patients with suspected irritable bowel syndrome: a prospective multi-center US study. Gastroenterology 2011; 141(4): 1187-93.
  29. Ladabaum U, Boyd E, Zhao WK, Mannalithara A, Sharabidze A, Singh G, et al. Diagnosis, comorbidities, and management of irritable bowel syndrome in patients in a large health maintenance organization. Clin Gastroenterol Hepatol 2012; 10(1): 37-45.