hematocrit), signs of inflammation or infection (high white blood cell count and/or platelet count) and stool tests for blood (fecal occult blood test or FOBT) or white blood cells (WBCs or fecal leukocytes). The stool tests are looking for signs of bleeding, infection or inflammation of the intestine. IBS does not cause bleeding or intestinal inflammation whereas inflammatory bowel disease, infection or cancer may. Normal tests are reassurring though do not exclude more serious disease. Most gastroenterologists believe a colonoscopy should be performed.

However, most doctors, even many gastroenterologists, fail to test for Celiac disease though it is common and screening blood tests exist. The reasons for this are many and are more fully explained elsewhere. However, the common incidence, presence of screening tests and available treatment should make screening for Celiac disease part of the standard evaluation of all patients presenting with symptoms suggestive of IBS before that diagnosis is established.

More recently, food intolerance other than gluten or wheat have been suggested as a treatable cause of IBS. Blood tests for a type of antibody known as IgG have been advocated by several researchers as being helpful for advising people about eliminating or avoiding certain foods as a treatment of IBS. Recent evidence suggests that a significant reduction of IBS symptoms can be achieved in people who avoid foods based on elevated IgG antibodies to foods. Atkinson et. al 2004 reported 10-26% improvement in symptoms in patients compared with controls. Deterioration was noted in those who relaxed their dietary restriction of foods they had avoided because of elevated antibody levels. These findings require further validation and are facing significant resistance to acceptance by many in the medical community, especially in the U.S. However, elimination diets have long been reported effective by many people. The possibility of food intolerance as a reversible cause of symptoms attributed to a

syndrome with little other effective treatments except mostly ineffective treatments in the past and very new medications with limited efficacy and unproven long term safety should prompt further studies and an openness to dietary trials.

If you have been diagnosed with irritable bowel syndrome I recommend you confirm that Celiac disease has been excluded. Food intolerance should also be considered though testing may not be covered by your insurance and/or accepted by your doctor as valid. Elimination of common foods and their proteins causing intolerance, wheat, barley and rye (gluten); cow's milk protein (casein); soy; and peanuts is worth a try. Be sure to keep a food-symptom diary and re-introduce one food or food protein back into your diet at a time. One diet that effectively eliminates all the major food proteins causing intolerances but may be difficult to follow is the paleo diet (www.thepaleodiet.com).

1. Hoey. "Irritable Bowel Syndrome: Could it be Celiac Disease?" Can Med J. 2002; 166:479-80

2. Sander et al, "Association of Adult Coeliac Disease with Irritable Bowel Syndrome: A Case-Control Study in Patients Fulfilling Rome II Criteria Referred to Secondary Care." Lancet. 2001; 358:1504-8

2. Atkinson W; Sheldon TA; Shaath N; Wharwell PJ. "Food elimination bsed on IgG antibodies in irritable bowel syndrome; a randomised controlled trial." Gut 2004; 53:1459-1464.

3. Isolauri E; Rautava S; Kalliamaki M. "Food allergy in irritable bowel syndrome: new facts and old fallacies." Gut 2004; 53:1391-3.

Dr. Scot Lewey is a physician who is subspecialty trained and board certified in gastroenterology (diseases of the digestive tract) that has over 20 years of experience as an expert clinician, researcher, lecturer and author of more than twenty articles, book chapters, and scientific abstracts. His special interests include Celiac disease, food intolerance and allergies, colitis, Crohn's disease, irritable bowel syndrome & reflux.