Is it worth investigating splenic function in patients with celiac disease?

Abstract

Celiac disease, an immune-mediated enteropathy induced in genetically susceptible individuals by the ingestion of gluten, is the most frequent disorder associated with splenic hypofunction or atrophy. Defective splenic function affects more than one-third of adult patients with celiac disease, and it may predispose to a higher risk of infections by encapsulated bacteria and thromboembolic and autoimmune complications, particularly when celiac patients have concomitant pre-malignant and malignant complications (refractory celiac disease, ulcerative jejunoileitis and enteropathy-associated T-cell lymphoma). However, the clinical management of patients with celiac disease does not take into account the evaluation of splenic function, and in patients with high degree of hyposplenism or splenic atrophy the prophylactic immunization with specific vaccines against the polysaccharide antigens of encapsulated bacteria is not currently recommended. We critically re-evaluate clinical and diagnostic aspects of spleen dysfunction in celiac disease, and highlight new perspectives in the prophylactic management of infections in this condition.

Extraintestinal manifestations of coeliac disease

“…8,28,122 However, vaccination against influenza and pneumonia is generally advised and evaluation should be considered in patients with coeliac disease and a history of major infections. 119 …”

“…119 Potential aetiologies of this manifestation include haemodyamic changes, such as higher blood velocity and flow after a meal and generally lower intrasplenic resistance indexes, 120 or might be a sign of general r eticularendothelia l dysfunction, especially as the coexistence of other autoimmune disorders increases the risk of impaired spleen function. 119 Impaired spleen function is also assumed to result in an elevated risk of infectious complications, in particular involving encapsulated microorganisms, which are often found in untreated or newly diagnosed patients with coeliac disease. 121 Currently, none of the clinical guidelines recommend the evaluation of spleen function in patients with coeliac disease.…”

Determination of normal splenic volume in relation to age, gender and body habitus: a stereological study on computed tomography

“…In addition, splenic enlargement can be the result of a number of disorders, such as infections, storage and connective tissue diseases and malignant conditions. Splenic atrophy also occurs in adult coeliac disease [28]. Accurate assessment of spleen volume (SV) is used in the clinical treatment of patients with these diseases.…”

Age-related differences in celiac disease: Specific characteristics of adult presentation

“…Based on these associated factors, splenic function may be determined in a selected group of adult CD patients: Older patients at diagnosis, those with concomitant autoimmune or premalignant disorders, and patients with a previous history of major infections or thromboembolism. As a diagnostic tool, pitted red cell counting remains an accurate, quantitative and inexpensive method [40] .…”