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The connection between IBS and Celiac Disease

What is Celiac Disease?

Celiac disease is an autoimmune disorder. The disease is triggered by eating gluten in genetically susceptible people.1 Symptoms or characteristics of celiac disease include the following:1,2

  • Chronic diarrhea
  • Failure to thrive, such as growth problems, found mainly in children
  • Fatigue
  • Bloating and constipation
  • Recurrent abdominal pain
  • Iron deficiency
  • Osteoporosis
  • Neurological or psychiatric problems
  • Infertility
  • Vitamin deficiencies

Symptoms of celiac disease may mimic the symptoms of IBS.3 Increased intestinal permeability may be the reason for both IBS and celiac disease.4 It is unclear if eating gluten will result in IBS symptoms in the absence of celiac disease.5 Eating a gluten-restricted diet is not an appropriate test for celiac disease because people with IBS may show temporary improvement on the diet even if they do not have celiac disease.3

Sources of gluten commonly found in the diet1

Primary sources

  • Wheat
  • Rye
  • Barley (malt)

Hidden sources

  • Oats (unless harvested separately from wheat)
  • Sauces (marinades, soy sauce)
  • Drug fillers (prescription and over the counter items, including dietary supplements)
  • Shared food preparation equipment (pasta pot, toaster, deep fryer)
  • Processed meats

How common is celiac disease?

Prevalence of celiac disease is about four times higher in people with IBS compared with people without IBS.2 There is a 4% overlap between celiac disease and IBS.5 Celiac disease is more common in people with diarrhea-predominant or mixed presentation IBS compared with constipation-predominant IBS. Doctors may consider a diagnosis of celiac disease in people with diarrhea-predominant or mixed presentation IBS. Routine and laboratory testing will be needed for a diagnosis of celiac disease.6

Written by: Truc Thanh | Last reviewed: June 2016.
  1. Lebwohl B, Ludvigsson JF, Green PHR. Celiac disease and non-celiac gluten sensitivity. BMJ. 2015;351:h4347.
  2. World Gastroenterology Organisation Global Guidelines. Irritable Bowel Syndrome: a Global Perspective. Accessed 1/7/16 at:
  3. Heizer WD, Southern S, McGovern S. The role of diet in symptoms of irritable bowel syndrome in adults: a narrative review. J Am Diet Assoc. 2009;109:1204-1214.
  4. Camilleri M, Lasch K, Zhou W. Irritable bowel syndrome: methods, mechanisms, and pathophysiology. The confluence of increased permeability, inflammation, and pain in irritable bowel syndrome. Am J Physiol Gastrointest Liver Physiol. 2012;303:G775-G785.
  5. Sayuk GS, Gyawali CP. Irritable bowel syndrome: modern concepts and management options. Am J Med. 2015;128:817-827.
  6. Wilkins T, Pepitone C, Alex B, Schade RR. Diagnosis and management of IBS in adults. Am Fam Physician. 2012;86:419-426.