The Association of Inflammatory Bowel Disease with Coeliac Disease and Coeliac Autoimmunity in Children and Adults: A Nationwide Study from the epi-IIRN

Abstract

Background and Aims Given the paucity of population-based data on the association between inflammatory bowel diseases (IBD), celiac disease (CeD) and celiac autoimmunity (CeA) we aimed to study the associations in a nationwide study. Methods Utilizing health administrative data for all four health maintenance organizations in Israel, covering 98% of the population, we explored the prevalence of CeD in children and adults with IBD versus non-IBD matched controls. CeD was defined by three ICD-9 codes and CeA by positivity for tissue transglutaminase antibodies. Results In total, 34,375 IBD patients (56% Crohn's disease [CD] and 44% ulcerative colitis [UC]) were compared with 93,603 non-IBD controls. Among IBD patients, 319 (0.93%) had CeD versus 294 (0.31%) non-IBD controls (odds ratio [OR]=2.97 [95%CI 2.54-3.48]; p<0.001). CeA was identified in 575 (1.67%) IBD patients vs. 158 (0.17%) controls (OR=10.06 [95%CI 8.43-12], p<0.001). The prevalence of CeD was higher in pediatric-onset IBD (87/5,243 [1.66%]) than adult-onset IBD (232/29,132 [0.79%]; p<0.001). CD patients had a higher prevalence of CeD (229/19,264 [1.19%]) than UC patients (90/15,111 [0.56%]; OR=2.01 [95%CI 1.57-2.56]; p<0.001). The diagnosis of CeD preceded the diagnosis of IBD in 241/319 cases (76%). The time to treatment escalation was shorter in patients with both IBD and CeD than in patients with IBD without CeD (p=0.017). Conclusion CeD and CeA are more prevalent in IBD patients, especially in pediatric-onset IBD and in CD. The diagnosis of CeD usually precedes that of IBD. Having CeD is associated with more intensified treatment for IBD.

Prevalence of IgA Anti-tissue Transglutaminase Antibody in a Cohort of Iranians Patients with Inflammatory Bowel Disease

“…The association between celiac disease and IBD has been reported in several studies, 18 19 20 and a wide range of celiac disease prevalence (0.3%-14%) was noted among IBD patients. 21 22 The prevalence rate of celiac disease has been reported from 0.6% to 0.96% in the Iranian IBD populations.…”

“…However, anti-tTG levels showed no significant relationships with age categories, underlying diseases, diagnosis types, extraintestinal manifestations, and surgical history. The association between celiac disease and IBD has been reported in several studies, [18][19][20] and a wide range of celiac disease prevalence (0.3%-14%) was noted among IBD patients. 21,22 The prevalence rate of celiac disease has been reported from 0.6% to 0.96% in the Iranian IBD populations.…”

“…Among IBD patients, 0.93% of the cases had celiac disease. 20 Nurmi et al examined 629 newly diagnosed positive IgA anti-tTG cases between 1976 and 2012. The results indicate that IBD prevalence has increased among patients with high IgA anti-tTG from 0% to 4.4%, whereas clinically diagnosed celiac disease has declined from 2.6% to 0.6%.…”

A Case of Ulcerative Colitis Induced by Paraneoplastic Syndrome?

“…15,16 Compared with adult patients, UC with childhood onset progresses more rapidly, has a wider range of lesions, and is at higher risk of serious complications and colectomy than in adults. 17,18 The child has no genetic background, has an insidious onset, progresses rapidly, and UC symptoms resolve rapidly after resection of the sacrococcygeal tumor, we propose to explain this case with paraneoplastic syndrome. Instead of pathological changes caused by the tumor itself or metastases, paraneoplastic syndromes are pathological changes of single or multiple systems brought on by tumor products, abnormal immune responses, or other unknown causes.…”