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It is very important to have an accurate diagnosis, as the two conditions are very different in their origins and treatments. Celiac disease affects around 1% of the population, while IBS is estimated to affect between 15% and 20% of the population. Anywhere from 5% to 15% of celiac disease sufferers are incorrectly diagnosed with IBS.  

Similarities in symptoms 

Celiac disease is an autoimmune disorder in which ingestion of gluten leads to damage in the small intestine. IBS is digestive disorder that causes pain and discomfort. IBS symptoms may come and go, but celiac disease symptoms and intestinal damage occur every time the person eats gluten. The two conditions are very different, but they have similar symptoms that flare up after eating certain types of food. 

The symptoms of celiac disease vary, but may include stomach cramping, bloating, diarrhoea, constipation, nausea, or chronic fatigue, as well as psychological symptoms like anxiety and depression. Common IBS symptoms also include stomach cramping, bloating, diarrhoea, and constipation. People with IBS tend to have episodes around six times a year or more. Whether these flare-ups last a few days or weeks depends on the person and may be different from one episode to the next.  

Differences between IBS and celiac disease

Celiac disease is an autoimmune disorder triggered by gluten ingestion, which is a protein present in wheat, barley and rye. In people with celiac disease, gluten causes the immune system to attack the cells lining the wall of the small intestine. This damage prevents the body from properly digesting and utilizing nutrients, which in addition to digestive symptoms, can lead to a whole host of other health problems, including anemia, malnutrition, or poor growth in children. 

IBS is a functional bowel disorder, meaning it is a problem with how your gut works. IBS problems occur in the middle and lower intestinal tract and typically include uncomfortable gas, bloating, and abdominal pain.

The underlying causes

Scientists are not sure what causes celiac disease or IBS. There may be a hereditary component to both conditions which interacts with environmental factors to trigger disease onset. 

Around 99% of people with celiac disease have specific variants in their HLA genes - which help the immune system distinguish between proteins that belong in our body and those made by foreign invaders. But just having one of these variants does not mean a person will develop celiac disease. In fact, around 30% of the population have at-risk genes, but only 3% of them will develop celiac disease. 

IBS also seems to run in families, but in some cases,  this is not the case. Some research suggests that the strength of the muscles in the digestive tract may affect the speed at which food passes through the system – either too slowly or too quickly. Abnormalities in the nerves in the digestive system can trigger symptoms, as can inflammation, infection, and changes to the microflora in the digestive tract. Symptoms of IBS may also be triggered by certain foods, stress, and hormonal fluctuations. 

What about non-celiac gluten intolerance or sensitivity?

Gluten intolerance, or non-celiac gluten sensitivity, describes individuals who cannot tolerate gluten and experience symptoms similar to those who have celiac disease – but who do not carry the gene for celiac disease. Again, the key is diagnosis. If gluten seems to be triggering symptoms, it is important to have a test for celiac disease. If this is negative, it may be that you have non-celiac gluten sensitivity, which is also treated with the gluten-free diet. 

How are celiac disease and IBS treated?

Celiac disease has a specific and effective treatment, which is to adopt a strict gluten free diet. If gluten is avoided, the damaging autoimmune reaction does not occur and symptoms subside. 

IBS treatment is more complex and individualized. There is no cure for IBS, but there are diet and lifestyle changes that may reduce symptoms. A doctor may also prescribe medications to help alleviate certain symptoms, such as diarrhoea or constipation. 

The vast majority of people with IBS say that certain foods trigger their symptoms. Common ‘trigger’ foods include dairy products, garlic, onions, alcohol, and some fruits, like apples. A gluten free diet can also help IBS sufferers. FODMAPs are short-chain carbohydrates that are poorly absorbed in the small intestine and have been linked to IBS symptoms. If you have IBS, speak to a doctor and/or dietitian about identifying which foods may be triggering or worsening your symptoms. 

Getting the right diagnosis

For celiac disease diagnosis, a simple blood test can indicate the presence of the antibodies associated with the condition. Usually, a biopsy taken from the small intestine will be analysed as well to confirm the diagnosis. First-degree relatives of individuals with celiac disease should be screened for the condition.  

There is no specific test for IBS, so diagnosis is based on symptom-related criteria. It is important to keep track of your symptoms and work with your doctor to address each one of them appropriately.  

It is important to speak with a doctor if you have any of the symptoms associated with IBS or celiac. Family history may be relevant and keeping track of food intake and can also be helpful. Both conditions can be difficult to manage, but both have treatments that can help you live life to the fullest.