IBS vs Celiac Disease: The Differences

Introduction

Irritable bowel syndrome (IBS) and celiac disease are two different gastrointestinal disorders that share some common symptoms. This can make it hard for people and healthcare providers to differentiate between them. While both conditions affect the digestive system and can cause significant discomfort, they have different underlying causes, methods to diagnose, and treatment strategies.

IBS is a functional gastrointestinal disorder which causes chronic abdominal pain, bloating, and altered bowel habits, without any structural or biochemical abnormalities [1,2]. It is a common condition, affecting about 10-15% of the global population, and is more common in women [3,4].

On the other hand, celiac disease is an autoimmune disorder triggered by gluten, a protein found in wheat, barley, and rye. When people with celiac disease consume gluten, their immune system attacks the small intestine, leading to inflammation, damage to the small intestine, and poor nutrient absorption [5,6].

Understanding the differences between IBS and celiac disease is important for accurate diagnosis and effective management. Misdiagnosis or delayed diagnosis can lead to unnecessary suffering, complications, and lower quality of life.

In the following sections, we will delve into the specific characteristics of IBS and celiac disease, looking at their definitions, symptoms, causes, risk factors, diagnostic methods, and treatment approaches.

Definition and Symptoms of IBS

Definition of IBS

IBS is a functional gastrointestinal disorder that causes chronic abdominal pain and changing bowel habits, but there aren’t any structural problems or markers that a test can detect [1,2]. It disrupts the normal functioning of the gastrointestinal (GI) tract, leading to a range of symptoms that can vary in severity and pattern.

The Rome IV criteria, the most widely accepted diagnostic criteria for IBS, define the condition as recurrent abdominal pain, on average, at least 1 day per week in the last 3 months, associated with two or more of the following [9]:

1. Related to defecation
2. Associated with a change in frequency of stool
3. Associated with a change in form (appearance) of stool

These criteria must be met for the last 3 months, with symptoms starting at least 6 months before diagnosis.

Symptoms of IBS

The primary symptoms of IBS include abdominal pain or discomfort, changing bowel habits (diarrhea, constipation, or alternating), bloating, gas, and changes in the appearance and frequency of your stool [1,2]. These symptoms can be triggered by different factors, such as stress, certain foods, and changes in gut microbiome composition [7,8].

IBS has four different types based on the predominant bowel habit:

1. IBS with constipation (IBS-C): Hard or lumpy stools more than 25% and loose or watery stools less than 25% of bowel movements [9].
2. IBS with diarrhea (IBS-D): Loose or watery stools more than 25% and hard or lumpy stools less than 25% of bowel movements [9].
3. Mixed IBS (IBS-M): Hard or lumpy stools more than 25% and loose or watery stools more than 25% of bowel movements [9].
4. Unclassified IBS (IBS-U): Doesn’t meet any of the criteria for IBS-C, IBS-D, or IBS-M [9].

Other common symptoms associated with IBS include:

• Mucus in the stool
• Urgency to defecate
• Feeling of incomplete evacuation
• Fatigue
• Nausea
• Backache
• Psychological symptoms such as anxiety and depression [1,2]

The range of IBS symptoms and the lack of biomarkers make diagnosis challenging. Healthcare providers must use a combination of patient history, physical examination, and the exclusion of other conditions that may look similar to IBS symptoms. The Rome IV criteria are a valuable tool for standardizing the diagnosis of IBS.

People with IBS often have significant issues in daily functioning, work productivity, and social interactions [10]. The chronic and unpredictable nature of symptoms can lead to anxiety, depression, and a sense of helplessness. It is important to provide comprehensive care that addresses both physical and psychological aspects of the condition.

The role of dietary factors, such as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols), in triggering IBS symptoms has led to the creation of specialized diets that may help symptoms in some people [11]. The gut-brain connection and the effect of psychological factors on IBS are important as well.

Definition and Symptoms of Celiac Disease

Definition of Celiac Disease

Celiac disease is a lifelong, immune disorder of the small intestine that is caused by exposure to dietary gluten [9,10]. People with the disease have specific antibodies and there are biological markers that can be detected in the small intestine [11,12].

Gluten, a protein found in wheat, barley, and rye, triggers an abnormal immune response in individuals with celiac disease. When gluten is ingested, the immune system mistakenly identifies it as a harmful substance and attacks the small intestine, leading to inflammation and damage to the intestinal villi, the finger-like projections responsible for nutrient absorption [9,10]. This damage can cause poor absorption of nutrients, leading to gastrointestinal and other symptoms.

Symptoms of Celiac Disease

The symptoms of celiac disease can vary greatly in both type and severity, and can affect different parts of the body [9,10]. Common symptoms include:

• Gastrointestinal symptoms:
• Abdominal pain
• Bloating
• Diarrhea
• Constipation
• Nausea
• Vomiting
• Malabsorption
• Nutrient deficiencies
• Extraintestinal symptoms:
• Fatigue and weakness
• Weight loss or failure to gain weight (in children)
• Anemia
• Osteoporosis or osteopenia
• Skin rashes
• Neurological symptoms
• Dental enamel defects
• Infertility
• Recurrent miscarriages

Some people may have no symptoms or have only mild symptoms, making diagnosis difficult [11].

In children, celiac disease causes classic symptoms such as diarrhea, abdominal distension (swollen appearance), and difficulty growing and thriving. However, the frequency of non-classical symptoms, such as anemia, short stature, and neurological symptoms, has been increasing in recent years [13]. This shift can lead to delayed diagnosis and possible long-term complications.

Diagnostic Challenges and Tools

Diagnostic delays are common in celiac disease [13]. Tests look for certain disease markers. [13].

Other conditions

Celiac disease is associated with an increased risk of other autoimmune conditions, such as sarcoidosis and inflammatory bowel disease [17,18]. Children with inflammatory bowel disease have a higher risk of developing celiac disease and other autoimmune disorders [18]. People with celiac disease carry a higher risk of developing other conditions, such as osteoporosis, infertility, and certain cancers, particularly if the disease is left untreated or if a gluten-free diet is not followed [19].

Dietary Management and Quality of Life

It is necessary to follow a strict gluten-free diet to manage celiac disease and prevent long-term complications [9,10]. Maintaining a gluten-free diet improves quality of life, particularly in people with other conditions like type 1 diabetes [25]. However, following a gluten-free diet can be hard, as gluten is in many common food products and cross-contamination can happen during food preparation and manufacturing processes.

People with celiac disease may experience social isolation, stigma, and difficulties in dining out or attending social events [20]. Children and adolescents with celiac disease face unique challenges, such as feeling different from their peers and struggling with following the diet [21]. Support from family, friends, and healthcare providers, as well as access to reliable information and resources, can help people with celiac disease work through these challenges and maintain a high quality of life.

Causes and Risk Factors of IBS

Causes of IBS

The exact causes of IBS are not fully understood, but several factors contribute to its development and symptoms:

• Gastrointestinal motility dysfunction: Abnormalities in the contractions of the intestinal muscles can lead to changing bowel habits and abdominal pain [1,2]. Studies have shown that patients with IBS may have increased or decreased motility, leading to diarrhea or constipation, respectively [22].
• Visceral hypersensitivity: Increased sensitivity of the gut nerves to normal stimuli can lead to pain and discomfort [1,2]. This heightened sensitivity may be because of changes in the way the brain processes sensory information from the gut [23].
• Gut microbiome imbalances: Certain gut microbes are linked to IBS risk [9]. Changes in the gut microbiome, such as reduced diversity or an overgrowth of certain bacteria, may cause IBS symptoms [24].
• Psychological factors: Stress, anxiety, and depression affect the brain-gut axis and IBS symptoms. The communication between the brain and the gut can affect intestinal motility, secretion, and immune function [25].
• Chronic inflammation: Low-grade inflammation in the gut may contribute to IBS symptoms [1,2].
• Post-infectious IBS: In some cases, IBS develops after a gastrointestinal infection [1,2]. Approximately 10% of individuals who experience a bacterial gastroenteritis may develop IBS, possibly because of persistent low-grade inflammation or changes in the gut microbiome [27].

Risk Factors for IBS

There are several risk factors for the development of IBS:

• Age and gender: Higher risk in women and ages 20-50 [1,2]. The prevalence of IBS is about 1.5 to 2 times higher in women compared to men [28].
• Genetics and family history: Genetic factors may contribute to developing IBS [1,2]. Studies have shown that people with a family history of IBS are more likely to develop the condition [29].
• Diet and nutrition: High-fat foods, caffeine, alcohol, and food intolerances [11]. Certain dietary components, such as FODMAPs, may make IBS symptoms worse in some people [30].
• Stress and trauma: Psychological stress and traumatic experiences can trigger or worsen IBS symptoms [1,2]. Early life stress, such as childhood trauma or abuse, has been associated with an increased risk of developing IBS [31].
• Gastrointestinal infections: Prior gastrointestinal infections can increase the risk of developing IBS [1,2]. Bacterial, viral, and parasitic infections can all cause post-infectious IBS [27].
• Medications: Antibiotics and opioids may disrupt gut microbiome and contribute to IBS development [1,2]. Prolonged use of certain medications, such as proton pump inhibitors, has also been associated with an increased risk of IBS [32].

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