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To the Editor: In their Rational Clinical Examination article, Dr Ford and colleagues¹ considered history and physical examination in establishing irritable bowel syndrome (IBS) as a cause of a patient's lower gastrointestinal symptoms. In their discussion, they stated that current guidelines for the management of IBS do not recommend routine screening for celiac disease.

I disagree with this approach. Tests for celiac disease should be made in any patients who fulfill Rome criteria with diarrhea-predominant IBS.² Such a syndrome is associated with poorly responsive celiac disease and one of the indications for serological screening of celiac disease.³ Even in a population with low prevalence of celiac disease, it can be cost-effective to screen for this disorder in patients with suspected IBS.⁴

Financial Disclosures: None reported.

Weekitt Kittisupamongkol, MD
weekitti@gmail.com
Hua Chiew Hospital
Bangkok, Thailand

1. Ford AC, Talley NJ, Veldhuyzen van Zanten SJ, Vakil NB, Simel DL, Moayyedi P. Will the history and physical examination help establish that irritable bowel syndrome is causing this patient's lower gastrointestinal tract symptoms? JAMA. 2008;300(15):1793-1805. FREE FULL TEXT 2. Mayer EA. Clinical practice: irritable bowel syndrome. N Engl J Med. 2008;358(16):1692-1699. FREE FULL TEXT 3. Green PH, Cellier C. Celiac disease. N Engl J Med. 2007;357(17):1731-1743. FREE FULL TEXT 4. Mein SM, Ladabaum U. Serological testing for coeliac disease in patients with symptoms of irritable bowel syndrome: a cost-effectiveness analysis. Aliment Pharmacol Ther. 2004;19(11):1199-1210. FULL TEXT | ISI | PUBMED

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2009;301(11):1126.

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RELATED ARTICLE

Will the History and Physical Examination Help Establish That Irritable Bowel Syndrome Is Causing This Patient's Lower Gastrointestinal Tract Symptoms?
Alexander C. Ford, Nicholas J. Talley, Sander J. O. Veldhuyzen van Zanten, Nimish B. Vakil, David L. Simel, and Paul Moayyedi
JAMA. 2008;300(15):1793-1805.
ABSTRACT | FULL TEXT  

RELATED LETTER

Testing for Celiac Disease in Patients With Symptoms of Irritable Bowel Syndrome—Reply
Alexander C. Ford, Nicholas J. Talley, and Paul Moayyedi
JAMA. 2009;301(11):1126.
EXTRACT | FULL TEXT