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High prevalence of celiac disease in psoriasis

the bacterial overgrowth. Although superficially it might seem that this study argues against bacterial overgrowth in IBS, the data actually support the notion. Even if Simren et al. are correct and only 12% of IBS subjects have upper gut bacterial overgrowth, this warrants attention. There is more attention to ruling out celiac disease in IBS sufferers, with a reported prevalence of only 4.6% (14). Given their single location sampling for bacteria, it is also likely that if more of the small bowel were cultured more cases would have been detected. Furthermore, the low eradication rate with antibiotics was identical to our study (2), and the group confirmed our recent finding that the lack of phase III might play a role in these IBS cases (15). With all the difficulties mentioned above, whether bacterial overgrowth or some enteric bacterial aberration is contributing to IBS symptoms is likely to be debated for some time. However, in the examination of IBS and the possible role of enteric bacteria, the clinical response and dependence on the lactulose breath test after antibiotic treatment needs to be the focus. With the lack of better tests or even a reliable gold standard, no test can be accurately trusted, only the clinical response. What Dr. Parisi fails to explain is the 75% clinical improvement seen in IBS subjects with normalization of lactulose breath test after antibiotics in a controlled, published, peer-reviewed study (2). Dr. Parisi and colleagues might want to consider a follow-up study with adequate controls. Subsequently, they should submit any new data as an original research submission for peer review and publication rather than in a letter in which the methodologic details leading to their results and conclusions cannot be evaluated.