Global prevalence of celiac disease in patients with Rome III and Rome IV irritable bowel syndrome: a systematic review and meta-analysis

INTRODUCTION: Irritable bowel syndrome (IBS) and celiac disease (CeD) are common disorders that share overlapping symptoms. In this systematic review and meta-analysis, we aimed to provide up-to-date and comprehensive estimates of the prevalence of CeD in patients with IBS.

METHODS: We searched several databases through January 2025 for studies reporting the prevalence of CeD in patients with IBS. Eligible studies used Rome III or Rome IV criteria for IBS diagnosis and used serological screening with tissue transglutaminase, endomysial antibodies, or deamidated gliadin peptide, and/or confirmatory duodenal biopsies for CeD diagnosis. We used random-effects meta-analysis to estimate the pooled prevalence of seropositive and biopsy-proven CeD with 95% confidence intervals (CI). We calculated pooled odds ratios to compare the likelihood of CeD between patients with IBS and controls.

RESULTS: A total of 29 studies comprising 7,209 patients with IBS were included. The pooled seroprevalence of CeD in patients with IBS was 6% (95% CI, 5%–8%), and the pooled prevalence of biopsy-proven CeD was 2% (95% CI, 2%–3%). A significant proportion of seropositive patients (15%; 95% CI, 6%–24%) did not undergo endoscopy and biopsy. Patients with IBS had significantly higher odds of a positive serology than controls (odds ratio 4.42; 95% CI, 2.82–6.92). The odds of CeD were similar across genders and IBS subtypes. There was a limited number of studies from Europe and no studies from the United States.

DISCUSSION: CeD is highly prevalent in patients with IBS, according to the Rome III and Rome IV criteria. A positive diagnosis of IBS should not be made without excluding CeD.