Risk of pancreatic cancer in patients with cystic fibrosis: Table 1

Furthermore, the association of coeliac disease and IBS symptoms is biologically plausible with many mechanisms being reported-for example, autonomic dysfunction, intussusception, exocrine pancreatic disease, small intestinal ulceration, and associated microscopic colitis.Our own group found an increased prevalence of coeliac disease in patients referred with surgical abdominal pain, notably in those with unexplained or non-specific abdominal pain.9 The association between IBS and coeliac disease appears to operate in both directions, as patients with coeliac disease (on a gluten-free diet) may describe IBS symptoms.10 Similarly, abdominal pain, diarrhoea, or constipation were associated with an increased risk of coeliac disease in a large multicentre study.11 All of these symptoms can overlap with IBS.From a clinical perspective, is investigating IBS patients for coeliac disease a valid approach?It is recognised that the majority of patients with coeliac disease have significant delays in diagnosis and once established on the gluten-free diet they derive symptomatic benefit.Case finding for coeliac disease in patients with IBS symptoms is both cost-effective and beneficial in terms of quality of life years gained, even at prevalence values of 1.1-2%.12 We accept that further multicentre studies in both primary and secondary care are required to resolve this debate.In such studies assessment of quality of life and symptom resolution (when individuals are established on a glutenfree diet) is imperative.Despite the existing evidence, investigating for coeliac disease in patients fulfilling the Rome II criteria is still not widely accepted (although recommended in UK guidelines).Why should this be?Is this a clash of ideological dogma when considering possible mechanisms for IBS?