Coeliac Proctitis

Abstract

An increased association of ulcerative colitis and coeliac disease has been reported, as have the results of several small-bowel biopsy studies in ulcerative colitis. Forty-two patients from a population of 438 patients with coeliac disease had rectal biopsies. Fourteen of these showed inflammation of various degrees of severity, including three compatible with a diagnosis of ulcerative colitis. The presenting complaint in 34 of these patients was diarrhoea or steatorrhoea. Twenty-seven patients had coeliac disease diagnosed at the same time or after their rectal biopsy. The other 15 were previously diagnosed coeliacs. Twelve of the 14 patients with abnormal rectal biopsy specimens were known to have subtotal/total villous atrophy at the time of rectal biopsy. Proctitis as seen in these coeliac patients had no unique features to differentiate it from proctitis caused by other disorders. The diarrhoea/steatorrhoea stopped in all patients on commencement of a gluten-free diet, except in those with ulcerative colitis. Proctitis is common in patients with coeliac disease presenting with diarrhoea/steatorrhoea. This study supports the finding of an increased association of coeliac disease and ulcerative colitis and is, to our knowledge, the first rectal biopsy study of a coeliac population.

Clinical and subclinical intestinal inflammation assessed by the mucosal patch technique: studies of mucosal neutrophil and eosinophil activation in inflammatory bowel diseases and irritable bowel syndrome

“…31 32 Cellier et al found that a gluten free diet induced regression but not normalisation of T cell activation in the rectal mucosa of patients with coeliac disease. 32 Their report together with our present results suggests a non-gluten related increase in the inflammatory propensity of the gut mucosa in this disease.…”

Distinct δ T cell receptor repertoires in monozygotic twins concordant for coeliac disease

“…Although based strictly on the twin pair studied herein, this finding is nonetheless of interest in light of prior reports indicating that coeliac disease patients also have increased numbers of / IEL in the rectal mucosa [46]. Although mucosal damage in coeliac disease is generally confined to the proximal small intestine [3], proctitis and lymphocytic colitis have been noted in some coeliac disease patients [47,48] and, compared with healthy individuals, the rectal mucosa of coeliac disease patients has been reported to respond abnormally to experimental gluten challenge [49,50]. Thus, taken together, these studies suggest an underlying abnormality may affect the entire intestinal mucosa in coeliac disease.…”

High frequency of antigliadin antibodies and absence of antireticulin and antiendomysium antibodies in patients with ulcerative colitis

“…The coexistence of CD with Crohn's disease and UC has since been described in several case reports. 6,12,13 In 1987, Breen et al 7 reviewed 42 rectal biopsies from a population of 438 patients with CD and found 3 patients with abnormal rectal biopsy results who had histopathologic and clinical features of UC. An epidemiological survey of IBD in the firstdegree relatives of 162 celiac patients showed the relative risk of IBD to be five times greater for firstdegree relatives than for the general population.…”

“…2,3 The first association of celiac disease (CD) and UC was reported over 30 years ago by Salem and Truelove. 4 Since that publication, several authors have described an association of CD and UC, [5][6][7][8][9][10][11][12][13] although most of the reports are simply case reports; accordingly the clinical significance of this association is not yet established.…”