Title : Is the association of celiac disease and chronic inflammatory bowel disease so common in our practice?
Abstract:
Background/aims: The association of chronic inflammatory bowel disease (IBD) and celiac disease (CD) has been exceptionally described in the literature.
These are two chronic digestive diseases with complex etiopathogeny; their association in the same patient is rare, posing a diagnostic, therapeutic, and etiopathogenic problem.The aim of this study is to highlight the clinical, evolutionary, and therapeutic particularities of this association.
Methods: This is a retrospective and descriptive study spread over a period of six years between July 2016 and September 2022, carried out in the gastroenterology department of the CHU Ibn Rochd of Casablanca and including all patients with IBD. The diagnosis of IBD was based on clinical, biological, endoscopic, histological, imaging, and disease progression data. The diagnosis of celiac disease was based on clinical, serological (IgA anti-transglutaminase antibodies), histological (villus atrophy), and evolutionary criteria.Patients were treated with a gluten-free diet (GFD) and specific IBD treatments.
Results: This study involved 487 patients with IBD. The diagnosis of CD-IBD association was found in 5 patients, a prevalence of 1.02%.The mean age of the patients was 35.5+/-9.74 years, and the sex ratio F/H was 1.5.All the patients with the CD-ICD association had Crohn's disease. The disease was ileocolic in 2 cases, ileo-caecal in one case, ileo-colic associated with duodenal involvement in 1 case, and left colic in 1 case. The average duration of IBD was 22 months. All these patients were receiving azathioprine as maintenance therapy. The diagnosis of Crohn's disease was concomitant with that of celiac disease in 2 cases, preceded that of celiac disease in 2 cases, and occurred after that of celiac disease in 1 case. The clinical manifestations most often encountered were chronic diarrhea in 60% of cases, and all patients had iron deficiency anemia. All patients had positive anti-transglutaminase antibodies; the endoscopic appearance was suggestive of CD in 60% of the cases, and the histological study of duodenal biopsies revealed a Marsh Oberhuber stage IIIa or IIIb, respectively, in 40% and 60% of the cases.All our patients were put on a gluten-free diet associated with IBD treatment with a good evolution.
Conclusion: Through this study, we underline the rarity of this CD-IBD association, which is 1.02%, and we insist on the complexity of the etiopathogeny of celiac disease, which can present similarities with that of Crohn's disease. It should be suspected in patients with IBD in whom diarrhea persists despite endoscopic remission of the IBD.
