What condition is most commonly associated with celiac disease?

Irritable Bowel Syndrome is Most Commonly Associated with Celiac Disease

Based on the most recent and high-quality evidence, irritable bowel syndrome (IBS) is the condition most commonly associated with celiac disease among the options provided. 1

Association Between Celiac Disease and Other Conditions

The American Gastroenterological Association guidelines clearly identify irritable bowel syndrome as a condition where testing for celiac disease should be selectively considered during medical evaluation, especially when symptoms compatible with celiac disease are present 1. This association is significant enough to be specifically mentioned in their conclusion section alongside other important associations.

Prevalence of Associated Conditions:

1. Irritable Bowel Syndrome (IBS):

   • Specifically listed in the AGA guidelines as a condition where celiac disease testing should be considered 1
   • Many patients with undiagnosed celiac disease are initially misdiagnosed with IBS due to symptom overlap
   • The symptoms described in the case (diarrhea, abdominal discomfort, bloating) are consistent with both conditions

2. Infertility:

   • Prevalence of celiac disease in women with unexplained infertility ranges between 2.1% and 4.1% 1
   • While significant, this association is less common than IBS
   • Recent meta-analysis found undiagnosed celiac disease is a risk factor for infertility with OR 3.09 (95% CI 1.74-5.49) 2

3. Chronic Fatigue:

   • While fatigue is a common symptom in celiac disease, chronic fatigue syndrome is not specifically highlighted in the guidelines as having a strong association 1

4. Pulmonary Hemosiderosis:

   • Not mentioned in the AGA guidelines as having a significant association with celiac disease 1
   • This is a rare condition and not commonly associated with celiac disease

Clinical Implications

When evaluating a patient with symptoms suggestive of IBS (as in this case presentation with diarrhea, abdominal discomfort, and bloating), clinicians should consider celiac disease in the differential diagnosis. The patient's description of "loose, greasy stools" is particularly concerning for malabsorption, which is characteristic of celiac disease.

Diagnostic Approach:

• IgA tissue transglutaminase antibody (tTGA) is the recommended initial serologic test for suspected celiac disease 1
• Testing should be performed while the patient is on a gluten-containing diet 1
• Duodenal biopsy remains the gold standard for diagnosis

Common Pitfalls:

• Initiating a gluten-free diet before diagnostic testing can lead to false-negative results
• Assuming IBS without ruling out celiac disease in patients with chronic diarrhea and abdominal symptoms
• Failing to recognize that celiac disease can present with extraintestinal manifestations

Treatment Considerations

If celiac disease is diagnosed, a strict gluten-free diet is the only effective treatment 1. This typically leads to symptom improvement and reduces the risk of complications associated with untreated celiac disease, including those related to fertility and pregnancy outcomes 2, 3.

In patients presenting with IBS-like symptoms, especially with features suggestive of malabsorption (weight loss, greasy stools), celiac disease testing should be part of the initial workup before confirming an IBS diagnosis.