I was surprised to find that Dr Nicolette Price’s feature article, ‘Managing irritable bowel syndrome’ (GP, 8 December 2006), made no mention of coeliac disease.
Many patients with coeliac disease experience difficulty in being diagnosed and it is a common mistake for them to receive an initial diagnosis of IBS. There is peer-reviewed evidence to show that patients are misdiagnosed with IBS when, in fact, they are suffering from coeliac disease (Lancet 2001; 358: 1,504–8).
Dr Price refers to a number of differential diagnoses, including gastrointestinal malignancy and inflammatory bowel disorder. Yet, surely with studies showing that 1 in 100 people have coeliac disease, and just 1 in 8 being correctly diagnosed, it would be sensible to test for coeliac disease — if only to eliminate it. Indeed, NICE is currently working on guidance for primary care on the diagnosis and management of IBS, which will recommend that coeliac disease should be eliminated as part of the diagnosis process.
Kevin J Monks
External Relations Officer, Coeliac UK