Prevalence of Celiac Disease in Children and Adolescents With Inflammatory Bowel Disease

Abstract

Introduction The association between inflammatory bowel disease (IBD) - particularly its two main subtypes, ulcerative colitis (UC) and Crohn’s disease (CD) - and celiac disease (CeD) has been attributed to an overlap in the mechanism of immune dysregulation that characterizes these conditions. Owing to the paucity of studies that have explored this condition in pediatric patients, we examined the prevalence of CeD in children with IBD. Materials and methods This is a cross-sectional study of children aged two to 18 years with IBD that were diagnosed between 2016 and 2018. Clinical, demographic, laboratory, and endoscopic data were analysed. Serology for CeD measured the immunoglobulin A tissue transglutaminase (IgA-tTG) antibodies, and the diagnosis was confirmed histologically through small bowel biopsies. Results The study included 101 patients with IBD (83.2% with UC and 16.8% with CD). The mean age was 8.7±4.0 years. Males constituted 59.4% of the cohort, and only 3% had perianal disease. Ileocolonic involvement was reported in 64.7% and non-stricturing and non-penetrating behaviour in 76.7% of CD patients. Pancolitis constituted 45.2% of UC patients. Ten patients (9.9%) had positive serology based on IgA-tTG antibodies, three (approximately 3%) had CeD based on biopsy findings, two patients (2%) had CD, and one patient (1%) had UC. Patients with confirmed CeD had a significantly higher frequency of symptoms of gaseous sensation and bloating (P=0.003) and abdominal distension (P=0.04). Conclusions The prevalence of CeD in Egyptian children with IBD is higher than previously reported in a number of similar studies. Abdominal bloating and gaseous sensation were identified as associated symptoms.

Celiac disease and ulcerative colitis as comorbid diseases – the diagnostic challenge

“…Although the combination of CeD and IBD has been reported in children, its nature remains unclear. A study of Egyptian children found a significantly higher prevalence of CeD in those with IBD than in the general population [7]. Similar results were presented by Canova et al, who found that the prevalence of both UC and CD were significantly higher in CeD patients compared with a reference group; however, the authors noted a possible bias associated with the recruitment algorithm described below, which may be connected with misclassification.…”

“…The genetic similarity of IBD and CeD was first postulated by the identification of 4 shared risk loci: interleukin 18 receptor accessory protein, protein tyrosine phosphatase non-receptor type 2, T-cell activation guanosine triphosphate phase activating protein, and pseudouridylate synthase 10 (PUS10) [7]. These shared genetic pathways may be the reason for their possible comorbidity.…”

“…However, due to the rarity of such co-occurrences, there is a lack of precise data suggesting a higher risk of IBD and CeD in children A lack of awareness regarding the overlapping clinical presentation of CeD and IBD plays a detrimental role in establishing a proper diagnosis. CeD may remain undiagnosed in cases where previously immunomodulatory treatment was implemented or a gluten-free diet was indicated [7].…”

“…Celiac disease presents with mucosal dysfunction in the small bowel caused by intake of gluten, a protein found in wheat, barley, rye, and other grains [6]. Patients who suffer from CeD have been shown to have a genetic susceptibility linked to the human leukocyte antigen (HLA)-DQ2 and HLA-DQ8 haplotypes [7,8].…”

“…However, other distinctive symptoms have been noted, such as abdominal pain, poor appetite, and weight loss [1]. While any site of the bowel can be affected by CD, UC is limited to the colon and rectum [7].…”