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International Journal of Colorectal Disease

, Volume 22, Issue 6, pp 565–570 | Cite as

Does coeliac disease affect colorectal practice?

  • David S. SandersEmail author
  • David P. Hurlstone
  • Steve Brown
Review

Abstract

Introduction

Screening studies of healthy volunteers have determined that coeliac disease affects 1% of the adult European population. Despite this, the majority of cases are unrecognised. Coeliac disease often presents in adults with non-specific gastrointestinal symptoms. This may suggest that unrecognised cases are being seen in colorectal clinics with vague gastrointestinal symptoms, iron deficiency anaemia or irritable bowel syndrome. In addition, cases of coeliac disease may also be presenting as an emergency admission with non-specific abdominal pain.

Objective

This review provides an update of the published data on case finding for coeliac disease, with the aim of improving the recognition of this disease in clinical practice.

Keywords

Coeliac disease Abdominal pain Iron deficiency anaemia Irritable bowel syndrome Case-finding 

References

  1. 1.
    Green PH, Jabri B (2003) Celiac disease. Lancet 362:383–391PubMedCrossRefGoogle Scholar
  2. 2.
    Fasano A, Catassi C (2001) Current approaches to diagnosis and treatment of celiac disease: an evolving spectrum. Gastroenterology 120:636–651PubMedCrossRefGoogle Scholar
  3. 3.
    Davidson LSP, Fountain JR (1950) Incidence of the sprue syndrome. BMJ 1:1157–1161PubMedGoogle Scholar
  4. 4.
    Johnston SD, Watson RGP, McMillan SA et al (1997) Prevalence of coeliac disease in Northern Ireland. Lancet 350:1370PubMedCrossRefGoogle Scholar
  5. 5.
    West J, Logan RF, Hill PG et al (2003) Seroprevalence, correlates, and characteristics of undetected coeliac disease in England. Gut 52(7):960–965PubMedCrossRefGoogle Scholar
  6. 6.
    Sanders DS, Patel D, Stephenson TJ et al (2003) A primary care cross-sectional study of undiagnosed adult coeliac disease. Eur J Gastroenterol Hepatol 4:407–413CrossRefGoogle Scholar
  7. 7.
    Fasano A, Berti I, Geraduzzi T et al (2003) Prevalence of celiac disease in at-risk and not-at-risk groups in the United States. Arch Intern Med 163:286–292PubMedCrossRefGoogle Scholar
  8. 8.
    Maki M, Mustalahti K, Kokkonen J et al (2003) Prevalence of celiac disease among children in Finland. N Eng J Med 348:2517–2524CrossRefGoogle Scholar
  9. 9.
    Ferguson A, Arranz E, O’Mahony S (1993) Clinical and pathological spectrum of coeliac disease—active, silent, latent, potential. Gut 34:150–151PubMedGoogle Scholar
  10. 10.
    Fasano A (2003) Celiac disease—how to handle a clinical chameleon. N Eng J Med 348:2568–2570CrossRefGoogle Scholar
  11. 11.
    Hill PG, McMillan SA (2006) Anti-tissue transglutaminase antibodies and their role in the investigation of coeliac disease. Ann Clin Biochem 43:105–117PubMedCrossRefGoogle Scholar
  12. 12.
    Marsh MN (1995) The natural history of gluten sensitivity: defining, refining and re-defining. Q J Med 85:9–13Google Scholar
  13. 13.
    Oberhuber G, Granditsch G, Vogelsang H (1999) The histopathology of coeliac disease: time for a standardized report scheme for the pathologists. Eur J Gastroenterol Hepatol 11:1185–1194PubMedCrossRefGoogle Scholar
  14. 14.
    Wahab PJ, Crusius JB, Meijer JW et al (2001) Gluten challenge in borderline gluten-sensitive enteropathy. Am J Gastroenterol 96:1464–1469PubMedCrossRefGoogle Scholar
  15. 15.
    Sanders DS, Hurlstone DP, Stokes RO et al (2002) The changing face of coeliac disease: experience of a single University Hospital in South Yorkshire. Postgrad Med J 78:31–33PubMedCrossRefGoogle Scholar
  16. 16.
    Green PHR, Stavropoulos SN, Panagi SG et al (2001) Characteristics of adult celiac disease in the USA: results of a national survey. Am J Gastroenterol 96:126–131PubMedCrossRefGoogle Scholar
  17. 17.
    Hin H, Bird G, Fisher P et al (1999) Coeliac disease in primary care: case finding study. BMJ 318:164–167PubMedGoogle Scholar
  18. 18.
    Peters U, Askling J, Gridley G et al (2003) Causes of death in patients with celiac disease in a population-based Swedish cohort. Arch Intern Med 163:1566–1572PubMedCrossRefGoogle Scholar
  19. 19.
    Heaton KW, O’Donnell LD, Braddon FM et al (1992) Symptoms of irritable bowel syndrome in a British urban community: consulters and nonconsulters. Gastroenterology 102:1962–1967PubMedGoogle Scholar
  20. 20.
    Taub E, Cuevas JL, Cook EW et al (1995) Irritable bowel syndrome defined by factor analysis. Gender and race comparisons. Dig Dis Sci 40:2647–2655PubMedCrossRefGoogle Scholar
  21. 21.
    Talley NJ, Zinsmeister AR, Van Dyke C et al (1991) Epidemiology of colonic symptoms and the irritable bowel syndrome. Gastroenterology 101:927–934PubMedGoogle Scholar
  22. 22.
    Thompson WG, Heaton KW, Smyth GT et al (2000) Irritable bowel syndrome in general practice: prevalence, characteristics, and referral. Gut 46(1):78–82PubMedCrossRefGoogle Scholar
  23. 23.
    Manning AP, Thompson WG, Heaton KW et al (1978) Towards positive diagnosis of the irritable bowel. BMJ 2:653–654PubMedCrossRefGoogle Scholar
  24. 24.
    Drossman DA, Thompson WG, Talley NJ et al (1990) Identification of sub-groups of functional gastrointestinal disorders. Gastroenterol Int 3:159–172Google Scholar
  25. 25.
    Thompson WG, Longstreth GF, Drossman DA et al (1999) Functional bowel disorders and functional abdominal pain. Gut 45:II43–II47PubMedCrossRefGoogle Scholar
  26. 26.
    Thompson WG (1997) Gender differences in irritable bowel symptoms. Eur J Gastroenterol Hepatol 9:299–302PubMedGoogle Scholar
  27. 27.
    Longstreth GF (1997) Irritable bowel syndrome. Diagnosis in the managed care era. Dig Dis Sci 42:1105–1111PubMedCrossRefGoogle Scholar
  28. 28.
    Harvey RF, Mauad EC, Brown AM (1987) Prognosis in the irritable bowel syndrome. A 5-year prospective study. Lancet 1:963–965PubMedCrossRefGoogle Scholar
  29. 29.
    Whitehead WE, Cromwell MD, Bosmajian L et al (1990) Existence of irritable bowel syndrome defined by factor analysis of symptoms in two community samples. Gastroenterology 98:336–340PubMedGoogle Scholar
  30. 30.
    Hamm LR, Sorrells SC, Harding JP et al (1999) Additional investigations fail to alter the diagnosis of irritable bowel syndrome in subjects fulfilling the Rome Criteria. Am J Gastroenterol 94:1279–1282PubMedCrossRefGoogle Scholar
  31. 31.
    Tolliver BA, Herrera JL, Dipalma JA (1994) Evaluation of patients who meet clinical criteria for irritable bowel syndrome. Am J Gastroenterol 89:176–178PubMedGoogle Scholar
  32. 32.
    American Gastroenterology Association (1997) Irritable bowel syndrome: a technical review for practice guideline development. Gastroenterology 112:2118–2137CrossRefGoogle Scholar
  33. 33.
    Jones J, Boorman J, Cann P et al (2000) The British Society of Gastroenterology guidelines for the management of irritable bowel syndrome. Gut 47(Suppl 11):ii1–ii19PubMedGoogle Scholar
  34. 34.
    Sanders DS, Carter MJ, Hurlstone DP et al (2001) Association of adult coeliac disease with irritable bowel syndrome: a case-control study in patients fulfilling the Rome 2 criteria referred to secondary care. Lancet 358:1504–1508PubMedCrossRefGoogle Scholar
  35. 35.
    Sanders DS (2002) There is a relationship between celiac disease and patients with symptoms of irritable bowel syndrome. Gastroenterology 123:1408PubMedCrossRefGoogle Scholar
  36. 36.
    Shahbazkhani B, Forootan M, Merat S et al (2003) Coeliac disease presenting with symptoms of irritable bowel syndrome. Aliment Pharmacol Ther 18:231–235PubMedCrossRefGoogle Scholar
  37. 37.
    Wahnschaffe U, Ullrich R, Riecken EO, Schulzke JD (2001) Celiac disease-like abnormalities in a sub-group of patients with irritable bowel syndrome. Gastroenterology 121:1329–1338PubMedCrossRefGoogle Scholar
  38. 38.
    Mein SM, Ladabaum U (2004) Serological testing for coeliac disease in patients with symptoms of irritable bowel syndrome: a cost effective analysis. Aliment Pharmacol Ther 19:1–12CrossRefGoogle Scholar
  39. 39.
    Hobbs R (1995) Rising emergency admissions. BMJ 310:207–208PubMedGoogle Scholar
  40. 40.
    Decadt B, Sussman L, Lewis MPN et al (1999) Randomized clinical trial of early laparoscopy in the management of acute non-specific abdominal pain. Br J Surg 86:1383–1386PubMedCrossRefGoogle Scholar
  41. 41.
    De Dombal FT (1979) Acute abdominal pain—an OGME survey. Scand J Gastroenterol 14(Suppl):29–43Google Scholar
  42. 42.
    Irvin TT (1989) Abdominal pain: a surgical audit of 1,190 emergency admissions. Br J Surg 76:1121–1125PubMedCrossRefGoogle Scholar
  43. 43.
    De Dombal FT, Matharu SS, Staniland JR et al (1980) Presentation of cancer to hospital as ‘acute abdominal pain’. Br J Surg 67:413–416PubMedCrossRefGoogle Scholar
  44. 44.
    Doshi M, Heaton KW (1994) Irritable bowel syndrome in patients discharged from surgical wards with non-specific abdominal pain. Br J Surg 81:1216–1218PubMedCrossRefGoogle Scholar
  45. 45.
    Ciacci C, Cavallaro R, Romano R et al (2001) Increased risk of surgery in undiagnosed coeliac disease. Dig Dis Sci 46:2206–2208PubMedCrossRefGoogle Scholar
  46. 46.
    Sanders DS, Hopper AD, Azmy IAF et al (2005) Association of adult coeliac disease with surgical abdominal pain: a case control study in patients referred to secondary care. Ann Surg 242:201–207PubMedCrossRefGoogle Scholar
  47. 47.
    Fitzpatrick KP, Sherman PM, Ipp M et al (2001) Screening for celiac disease in children with recurrent abdominal pain. J Pediatr Gastroenterol Nutr 33:250–252PubMedCrossRefGoogle Scholar
  48. 48.
    Saltik IN, Kocak N, Yuce A et al (2002) Celiac disease screening of Turkish children with recurrent abdominal pain. J Pediatr Gastroenterol Nutr 34:424–425PubMedCrossRefGoogle Scholar
  49. 49.
    Hamilton I, Axon ATR (1982) Abdominal pain in celiac disease. Br J Clin Pract 36:280–281PubMedGoogle Scholar
  50. 50.
    (No authors listed) (2001) Case-records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 5-2001. A 52-year-old man with chronic anemia and sudden severe abdominal pain. N Eng J Med 344:1950–1951Google Scholar
  51. 51.
    Patel RS, Johlin FC, Murray JA (1999) Celiac disease and recurrent pancreatitis. Gastrointest Endosc 50:823–827PubMedCrossRefGoogle Scholar
  52. 52.
    Cohen MD, Lintott DJ (1978) Transient small bowel intussusception in adult celiac disease. Clin Radiol 29:529–534PubMedCrossRefGoogle Scholar
  53. 53.
    Opekun AR, Graham DY (2003) Endoscopic demonstration of transient small bowel intussusception in a patient with adult celiac disease. Gastrointest Endosc 57:626–627PubMedCrossRefGoogle Scholar
  54. 54.
    Sanders DS, Azmy IAF, Kong SC et al (2004) Symptomatic small bowel intussusception: a surgical opportunity to diagnose adult celiac disease? Gastrointest Endosc 59:161–162PubMedCrossRefGoogle Scholar
  55. 55.
    Usai P, Usai Satta P, Lai M et al (1997) Autonomic dysfunction and upper digestive functional disorders in untreated adult celiac disease. Eur J Clin Invest 27:1009–1015PubMedCrossRefGoogle Scholar
  56. 56.
    Unsworth DJ, Lock RJ, Harvey RF (2000) Improving the diagnosis of coeliac disease in anaemic women. Br J Haematol 111:898–901PubMedCrossRefGoogle Scholar
  57. 57.
    Rostom A, Dube C, Craney A et al (2005) The diagnostic accuracy of serologic tests for celiac disease: a systematic review. Gastroenterology 128:S38–S46PubMedCrossRefGoogle Scholar
  58. 58.
    Sanders DS (2003) Coeliac disease: is case-finding the correct ethical and logistical approach? Gut 52:1070–1071PubMedCrossRefGoogle Scholar
  59. 59.
    Dickey W, Hughes DF (2004) Histology of the terminal ileum in coeliac disease. Scand J Gastroenterol 39(7):665–667PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • David S. Sanders
    • 1
    Email author
  • David P. Hurlstone
    • 1
  • Steve Brown
    • 1
  1. 1.Departments of General Surgery and GastroenterologyRoyal Hallamshire HospitalSheffieldUK

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