Celiac Disease Is Highly Prevalent in Lymphocytic Colitis

Abstract

A high frequency of celiac disease is reported in patients with collagenous colitis. Limited information is available on the frequency of celiac disease in lymphocytic colitis. The aim of our study was to determine the prevalence of celiac disease in microscopic colitis (collagenous and lymphocytic colitis). Patients were identified from a pathology registry of microscopic colitis from 1987 to 1999. Pathology reports and medical records were reviewed for previous small bowel biopsies and/or celiac serology. We identified 113 patients with microscopic colitis, and 46 patients underwent a small bowel biopsy and/or celiac serology. Of these, 27 patients had lymphocytic colitis (63% female; age, 58.6 +/- 16.2 years) and 19 patients had collagenous colitis (79% female; age, 61.8 +/- 13.6 years). Small bowel biopsy alone was performed in 28 of 46 patients, celiac serology alone was performed in 10, and both small bowel biopsy and celiac serology were performed in 8. Celiac disease was identified in 4 patients by small bowel histology; all had lymphocytic colitis (4 of 27 patients, 15%). This frequency of celiac disease is significantly higher than the highest reported U.S. prevalence of celiac disease (4/1,000 individuals; p < 0.01). There is a high frequency of celiac disease in patients with lymphocytic colitis. Given the importance of the early detection of celiac disease, it should be excluded in all patients with lymphocytic colitis, particularly if diarrhea does not respond to conventional treatment.

Collagenous and Lymphocytic Colitis: Systematic Review and Update of the Literature

“…Serological testing to exclude concomitant coeliac disease is recommended when the diagnosis of CC or LC is confirmed [27] . Stool samples should be obtained in all patients and tested for ova, parasites (e.g.…”

“…Coeliac disease commonly co-exists in patients with MC, occurring in 15-20% of patients [27][28] . It is therefore reasonable to screen patients for coeliac disease, especially in LC.…”

Differences in the T-bet and GATA-3 expression patterns between lymphocytic colitis and coeliac disease

“…In contrast to CD with a clear cut correlation between antigen and morphological as well as clinical outcome, the pathomechanism of LC is unclear. Gluten is only in some cases responsible for the manifestation of the disease [17,18], and drugs as well as other food components than gluten are under discussion. Furthermore, the therapy differs from that to coeliac disease.…”

Biopsy interpretation of colonic biopsies when inflammatory bowel disease is excluded

“…Celiac disease patients may have up to a 70-fold increase in the risk for MC compared to the general population [65]. The association of gluten sensitivity with LC is stronger than with CC [66]. Given this association, exclusion of celiac disease in patients with MC and vice versa should be considered, particularly in cases that remain symptomatic despite treatment [65][66][67].…”