Irritable Bowel Syndrome and Gluten Sensitivity Without Celiac Disease: Separating the Wheat From the Chaff

Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, USA.
Gastroenterology (Impact Factor: 16.72). 03/2012; 142(3):664-6. DOI: 10.1053/j.gastro.2012.01.020
Source: PubMed
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    ABSTRACT: Unexpected, urgent, sometimes painful bowel movements after eating are common complaints among adults. Without a clear etiology, if pain is present and resolves with the movements, this is usually labeled "irritable bowel syndrome-diarrhea" based solely on symptoms. If this symptom-based approach is applied exclusively, it may lead physicians not to consider treatable conditions: celiac disease, or maldigestion due to bile acid malabsorption, pancreatic exocrine insufficiency, or an a-glucosidase (sucrase, glucoamylase, maltase, or isomaltase) deficiency. These conditions can be misdiagnosed as irritable bowel syndrome-diarrhea (or functional diarrhea, if pain is not present). Limited testing is currently available to confirm these conditions (antibody screens for celiac disease; fecal fat as a surrogate marker for pancreatic function). Therefore, empirical treatment with alpha amylase, pancreatic enzymes, or a bile acid-binding agent may simultaneously treat these patients and serve as a surrogate diagnostic test. This review will summarize the current evidence for bile acid malabsorption, and deficiencies of pancreatic enzymes or a-glucosidases as potential causes for postprandial diarrhea, and provide an algorithm for treatment options.
    The American journal of medicine 06/2012; 125(6):538-44. DOI:10.1016/j.amjmed.2011.11.006 · 5.00 Impact Factor

  • BMJ (online) 11/2012; 345(nov30 1):e7907. DOI:10.1136/bmj.e7907 · 17.45 Impact Factor
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    ABSTRACT: This patient reflects on his 20 years of unexplained ill health with multiple symptoms before a chance conversation in an internet chat room led to his initial self diagnosis.
    BMJ (online) 11/2012; 345(nov30 1):e7982. DOI:10.1136/bmj.e7982 · 17.45 Impact Factor
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