Response to ‘Remarkable prevalence of celiac disease in patients with irritable bowel syndrome plus fibromyalgia in comparison with those with isolated irritable bowel syndrome: a case-finding study’ – authors’ reply

  • Luis Rodrigo1Email author,

    Affiliated with

    • Ignacio Blanco2,

      Affiliated with

      • Julio Bobes3 and

        Affiliated with

        • Frederick J de Serres4

          Affiliated with

          Arthritis Research & Therapy201416:403

          DOI: 10.1186/ar4488

          Published: 17 February 2014

          We greatly appreciate Sherry’s comments [1] on our recent article published in Arthritis Research & Therapy [2], and we agree with him that, although the majority of patients with celiac disease (CD) and fibromyalgia syndrome (FMS) may improve with a gluten-free diet (GFD), this may not be a uniform phenomenon. However, we believe that his observations in children [3] cannot be extrapolated to adults, such as those comprising our target population.

          Globally, the seven adult females with screening-detected CD, also categorized in our series as patients with severe irritable bowel syndrome (IBS) and FMS, significantly improved after 1 year on a GFD, with a decrease of 51% to 60% in tender points, Fibromyalgia Impact Questionnaire, Health Assessment Questionnaire, and visual analog scales as well as in the number of drugs prescribed, accompanied by an increase of 48% to 60% in Short-Form Health Survey (SF-36) physical and mental scores and a reduction of tissue transglutaminase 2 to normal values [3]. However, we observed that some important items of the SF-36 (including social functioning, role emotional, and mental health) were almost unchanged. Therefore, although in general a significant improvement was seen in all outcome measures with CD treatment, the improvement was not uniform but was much more obvious in some cases than in others. The improvement was statistically significant but always partial, since the total disappearance of all symptoms was not achieved by any of the patients [4].

          Since treatment with a GFD is a reasonable and relatively easy therapeutic measure that can significantly increase the quality of life (though not entirely relieve symptoms) of many patients with both FMS and CD, it seems advisable in our opinion to investigate CD with serology and genetic markers and, if these turn out to be positive, to perform an upper gastrointestinal endoscopy in conjunction with several duodenal biopsies. This will enable the selection of patients with IBS and FMS who are likely to respond to a GFD.

          Abbreviations

          CD: 

          Celiac disease

          FMS: 

          Fibromyalgia syndrome

          GFD: 

          Gluten-free diet

          IBS: 

          Irritable bowel syndrome

          SF-36: 

          Short-Form Health Survey.

          Declarations

          Authors’ Affiliations

          (1)
          Gastroenterology, Central University Hospital of Asturias (HUCA), Principality of Asturias
          (2)
          Biomedical Research Office of the Principality of Asturias – FICYT, Principality of Asturias
          (3)
          Medicine Department, Psychiatry Area, University of Oviedo, Principality of Asturias
          (4)
          National Institute of Environmental Health Sciences

          References

          1. Sherry DD: Response to ‘Remarkable prevalence of celiac disease in patients with irritable bowel syndrome plus fibromyalgia in comparison with those with isolated irritable bowel syndrome: a case-finding study’. Arthritis Res Ther 2014, 16:402.PubMedView Article
          2. Rodrigo L, Blanco I, Bobes J, de Serres FJ: Remarkable prevalence of celiac disease in patients with irritable bowel syndrome plus fibromyalgia in comparison with those with isolated irritable bowel syndrome: a case-finding study. Arthritis Res Ther 2013, 15:R201.PubMedView Article
          3. Taubman B, Mamula P, Sherry DD: Prevalence of asymptomatic celiac disease in children with fibromyalgia: a pilot study. Pediatr Rheumatol Online J 2011, 9:11.PubMed CentralPubMedView Article
          4. Rodrigo L, Blanco I, Bobes J, de Serres FJ: Clinical impact of a gluten-free diet on health-related quality of life in seven fibromyalgia syndrome patients with associated celiac disease. BMC Gastroenterol 2013, 13:157.PubMed CentralPubMedView Article

          Copyright

          © BioMed Central Ltd 2014

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