Inflammatory Bowel Disease, Celiac Disease, and Primary Sclerosing Cholangitis: Is There a Link?

Abstract

We read with great interest Pinto-Sanchez et al.'s 1 meta-analysis, which found a bidirectional association between inflammatory bowel disease (IBD) and celiac disease. We would like to point out the importance of another immune-mediated disease that may have a immunogenetic and environmental connection with these gastrointestinal diseases: primary sclerosing cholangitis (PSC), which most often occurs in association with IBD, particularly ulcerative colitis. 2 Population studies have also found an increased risk of PSC among patents with celiac disease. 3 Our group, in a retrospective matched case-control study, found a 4fold increased risk of PSC among patients with IBD and comorbid celiac disease compared with IBD patients without celiac disease. 4 Large-scale genetic studies have found overlapping genetic risk loci for PSC, IBD, and celiac disease, 5 with the strongest association residing within the HLA complex. 6 Common genetic risk loci, dysregulated immunologic pathways, and environmental factors should be explored in the gut-liver relationships between IBD, celiac disease, and PSC.

A prospective pilot study of a gluten‐free diet for primary sclerosing cholangitis and associated colitis

“…An association between PSC‐IBD and celiac disease was first described by Hay presenting three patients with typical biliary lesions on endoscopic retrograde cholangiography, colitis, severe steatorrhea and total villous atrophy 27 . An increased risk for PSC in celiac disease patients has since been confirmed by population studies 28,29 and large‐scale genetic studies have found a striking overlap in genetic risk loci within the human leukocyte antigen (HLA) complex 30 . However, the effects of a wheat (gluten)‐free diet (GFD) on outcomes of PSC‐IBD are unknown.…”