Impact of Coexistent Celiac Disease on Phenotype and Natural History of Inflammatory Bowel Diseases

Abstract

Introduction Inflammatory bowel disease (IBD) and celiac disease are the two most common immune-mediated gastrointestinal diseases. There is limited knowledge regarding the course of IBD in those with co-existing celiac disease. We conducted this study to determine whether patients with co-existing celiac disease present a unique phenotype of IBD and to examine the frequency of co-occurrence of celiac disease and IBD in comparison to other autoimmune disorders. Methods This was a case-control study performed at two tertiary referral centers. Cases comprised of patients with known diagnoses of celiac disease and IBD. Two random IBD controls without celiac disease were selected for each case after matching for IBD type. Disease phenotype and natural history for both CD and UC were noted from medical record review, and were compared between IBD patients with and without celiac disease. Results We identified a total of 51 patients with IBD [22 ulcerative colitis (UC), 1 indeterminate colitis, 28 Crohn’s disease (CD)] and celiac disease. There was no significant difference in the age, gender, or ethnicity between celiac-IBD and controls. Pancolitis was more common in celiac-UC patients as compared to controls (odds ratio 3.30, 95% confidence interval 1.05–21.50). There was also a trend towards increased use of immunomodulators among celiac-UC patients than in non-celiac UC controls (OR 2.83, CI 95% 0.95 – 8.48). No phenotypic differences were found in celiac-CD patients. There were no significant differences in IBD-related medication usage, hospitalizations, or surgeries. Conclusion Patients with UC and celiac disease were more likely to have pancolitis and had a trend towards greater use of immunomodulators. Co-existing celiac disease did not influence natural history of CD.

New onset idiosyncratic liver enzyme elevations with biological therapy in inflammatory bowel disease

“…The use of this data repository in has been described in previous publications from our centre. [24][25][26][27] For this study, we adopted a casecontrol design. We first identified all potential IBD patients with at least one ICD-9-CM code for CD (555.x) or UC (556.x).…”

Co-Occurrence of Celiac Disease and Ulcerative Colitis in a 12-Year-Old Girl

“…On the other hand, coexisting CD did not influence natural history of Crohn's disease. These results suggest more aggressive phenotype in case of CD and UC co-occurrence [4].…”

“…The comorbidity between CD and other autoimmune disorders has been clearly established [3]. However, the associated occurrence of CD and ulcerative colitis (UC) in children has been very rarely reported until today, referring only to four case reports with confirmed diagnosis [4]. Distinguishing both diseases in one patient could be difficult due to the overlapping symptoms, but it is very important considering completely different therapeutic approaches.…”

Gluten-free Diet for Refractory Inflammatory Bowel Disease; A Case Report

“…The symptoms appear within hours or days following gluten ingestion, disappear with gluten withdrawal, and relapse following gluten challenge [7].…”

“…The majority of patients with IBD believe that diet has continuing effect on worsening the natural course of their disease, exacerbating clinical symptoms, and reducing the quality of life [7,8].…”