Fatigue, neurological symptoms and  bowel symptoms: Is it ME/CFS or coeliac disease?
4. april 2005 

MAY BE REPOSTED

Some doctors still believe that coeliac disease is uncommon and only seen in
children.  They therefore fail to consider it as a diagnostic possibility in
people who have ME/CFS-like fatigue, especially when this is also accompanied
by irritable bowel symptoms - ie abdominal pain, change in bowel habit -
or signs of food malabsorption such as weight loss.

Diagnosing ME/CFS when someone really has coeliac disease is unfortunate to
say the least because treatment of coeliac disease with a gluten-free diet
can be extremely effective.  Yet this misdiagnosis continues to occur.

This week in the British Medical Journal there is a very helpful editorial
on the diagnosis of coeliac disease:

http://bmj.bmjjournals.com/cgi/content/full/330/7494/739?eaf

along with a further article on antibody-negative coeliac disease:

http://bmj.bmjjournals.com/cgi/content/full/330/7494/775?ehom

and case reports of aytpical presentations:

http://bmj.bmjjournals.com/cgi/content/full/330/7494/773?ehom


There is now a very strong case for using simple screening tests (eg
anti-endomysial antibodies ) to largely rule out coeliac disease in
people with ME/CFS like symptoms, especially when these are
accompanied by any type of irritable bowel symptomatology, signs of
malabsorption, or unexplained anaemia.

This is the policy adopted by the MEA in section 6.6 of our 'purple book'
guidelines for doctors.  This publication is available to download on the
MEA website at:
www.meassociation.org.uk >> medical information >> 'ME/CFS/PVFS - An
exploration of the key clinical issues'.

And as these three BMJ papers point out:

1  Weight loss is not always present - coeliac disease can sometimes occur
in people who are clinically obese.
2  Some people with coeliac disease have minimal or no gastrointestinal
symptoms.
3  There are rare instances where commonly used antibody screening tests
are negative.

Dr Charles Shepherd
Medical Adviser, ME Association