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Volume 8 Journal of Gastrointestinal & Digestive System Gastro Meet 2018
August 06-07, 2018
August 06-07, 2018 Abu Dhabi, UAE
Gastroenterology and Digestive
Disorders
16th International Conference on
Screening of celiac disease in irritable bowel syndrome by routine endoscopic duodenal biopsy: Review
of literature and opinion
Mohan Khadka
ADK hospital, Maldives
Statement of the Problem: Celiac Disease (CD) screening test in patients with Irritable Bowel Syndrome (IBS) symptoms is
recommended by many international society guidelines including American College of Gastroenterology, given the higher
global prevalence of CD approximately 4 times higher in IBS than in the general population of <1%. Though, screening of CD
by serological test is preferred, duodenal biopsy is the gold standard for the definitive diagnosis of CD. In practice, most IBS
patients undergo upper gastrointestinal endoscopy sooner or later for evaluation of high associated conditions like dyspepsia
and or Gastroesophageal Reflux Symptoms (GERD). So, taking routine duodenal biopsy to screen CD looks reasonable.
Methodology: Medline, PubMed and EMBASE were searched for the keywords irritable bowel syndrome, celiac disease,
routine endoscopic duodenal biopsy (1991 to 2018).
Findings: When the pretest probability of CD is perceived to be low (<5%), serologic study with IgA anti tTG (immunoglobulin
A anti tissue transglutaminase) is the initial preferred test in excluding the diagnosis. Patients with a high probability of CD
(>5%), regardless of the serology, should undergo an upper endoscopy with small bowel biopsy to confirm the diagnosis of
celiac. As per most of the studies, pretest probability of CD in IBS is close to 3%. Different studies have shown that routine
endoscopic duodenal biopsy in presumed IBS have diagnostic yield of CD from 2.4 % to 5%. In contrast to 99-100% yield
of sero-positivity in classical CD, in atypical CD like IBS, the sero-positivity is only 40 -70%. There is high association of
dyspepsia (27-87%) and GERD (42%) in patients with IBS. By doing routine duodenal biopsy, other associations of IBS such
as giardiasis, collagenous sprue etc could also be ruled out.
Conclusion: Though pretest probability of CD in IBS may be <5%, it seems logical to perform routine endoscopic duodenal
biopsy in patients with IBS to screen for CD as practiced in many centers in USA, Europe and Asia.
Biography
Mohan Khadka has gained close experiences of medical education and state of art training from Nepal, India and China. He was also certified by ECFMG (USA) in
2006 for passing USMLE. In 2009, he got special training of wireless video capsule endoscopy from a pioneer institute Chongqing medical university, China and in
2015 also had opportunity to get advanced level of training from a tertiary referral gastroenterology center at GB Pant Hospital, Delhi, India. In the period of 2011 to
2016, he has attended, chaired and presented in many national and international conferences, seminars and endoscopy workshops. He has published more than
half dozen papers in national and international peer reviewed journals and is also reviewer and editor of some international journals. His interest is exploring novice
in Irritable bowel syndrome, Celiac disease and Video capsule endoscopy.
Mohan Khadka, J Gastrointest Dig Syst 2018, Volume 8
DOI: 10.4172/2161-069X-C3-070