Card Timothy R, Siffledeen Jesse, West Joe, Fleming Kate M
Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building Phase 2, Nottingham City Hospital, Nottingham, UK.
Scand J Gastroenterol. 2013 Jul;48(7):801-7. doi: 10.3109/00365521.2013.786130. Epub 2013 May 22.
It is recognized that celiac disease can present with symptoms characteristic of irritable bowel syndrome (IBS) and that a substantial proportion of patients referred to gastroenterologists with these symptoms may have celiac disease. The authors set out to discover how commonly those suffering with celiac disease are misdiagnosed as suffering from IBS and whether such misdiagnosis delays the correct diagnosis.
A case control study using computerized records from the General Practice Research Database was conducted. The authors compared the proportion of patients with celiac disease who had a diagnosis of or had undergone treatment for IBS over a variety of time periods before the diagnosis of celiac disease with the proportion of a matched group without celiac disease who were similarly diagnosed or treated.
It was found that 16% of celiac patients had such a prior diagnosis compared to 4.9% of controls (a threefold increased risk of prior IBS; OR = 3.8, 95% CI: 3.6-4.2), and that if one looked at typical treatment for IBS rather than diagnostic codes, 28% of celiac patients appeared to have been treated compared to 9% of controls. Many of the diagnoses of IBS occurred within the last year before diagnosis of celiac disease, but there was a clear excess of IBS even 10 years earlier.
In contemporary UK practice, it is likely that at least some patients with celiac disease spend many years being treated as having IBS. Following guidelines to test serologically for celiac disease will minimize this problem.
人们认识到乳糜泻可表现出肠易激综合征（IBS）的特征性症状，并且相当一部分因这些症状转诊至胃肠病专家处的患者可能患有乳糜泻。作者旨在发现乳糜泻患者被误诊为患有IBS的常见程度，以及这种误诊是否会延迟正确诊断。
利用全科医疗研究数据库的计算机记录进行了一项病例对照研究。作者比较了在乳糜泻诊断之前的不同时间段内被诊断为IBS或接受过IBS治疗的乳糜泻患者的比例，与未患乳糜泻的匹配组中被类似诊断或治疗的患者比例。
发现16%的乳糜泻患者有过这样的先前诊断，而对照组为4.9%（先前患IBS的风险增加了两倍；比值比=3.8，95%可信区间：3.6 - 4.2），并且如果查看IBS的典型治疗而非诊断编码，28%的乳糜泻患者似乎接受过治疗，而对照组为9%。许多IBS诊断发生在乳糜泻诊断前的最后一年，但即使在10年前IBS的诊断明显过多。
在当代英国的医疗实践中，很可能至少有一些乳糜泻患者多年来被当作患有IBS进行治疗。遵循对乳糜泻进行血清学检测的指南将使这个问题最小化。
