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Association of IBD With Coeliac Disease and Coeliac Autoimmunity in Children and Adults
TAKE-HOME MESSAGE
- This study evaluated the association between IBD, coeliac disease (CeD), and coeliac autoimmunity in children and adults. The prevalence of CeD and coeliac autoimmunity was higher among patients with IBD than among control individuals without IBD. The prevalence of CeD was higher among patients with paediatric-onset IBD and those with Crohn's disease. CeD diagnosis preceded IBD diagnosis in 76% of the cases. Time to treatment escalation was shorter in patients with both IBD and CeD than in those with IBD without CeD.
- CeD diagnosis usually predates Crohn's disease diagnosis in dual-diagnosed patients and may be associated with intensified advanced Crohn's disease therapy. Recognition of combination treatment's (diet and advanced immune modification) impact on Crohn's disease may improve outcomes for these patients and potentially other Crohn's disease phenotypes.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND AND AIMS
Given the paucity of population-based data on the association between inflammatory bowel diseases [IBD], coeliac disease [CeD], and coeliac autoimmunity [CeA] we aimed to study the associations in a nationwide study.
METHODS
Using health administrative data for all four health maintenance organisations 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% confidence interval [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 paediatric-onset IBD (87/5243 [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 paediatric-onset IBD and in CD. The diagnosis of CeD usually precedes that of IBD. Having CeD is associated with more intensified treatment for IBD.
Additional Info
Disclosure statements are available on the authors' profiles:
The Association of Inflammatory Bowel Disease with Coeliac Disease and Coeliac Autoimmunity in Children and Adults: A Nationwide Study from the epi-IIRN
J Crohns Colitis 2023 May 03;17(5)700-705, M Kori, Y Zamir, SO Yermiyahu, I Ainbinder, S Daichman, GD Pinto, Y Loewenberg Weisband, S Greenfeld, R Kariv, N Lederman, E Matz, R Shamir, I Dotan, D TurnerFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Coeliac disease (CeD) and IBD are chronic inflammatory diseases (CIDs) of the gastrointestinal tract that share several features, including some overlapping genetic risk loci,1 increased intestinal permeability,2 and an imbalanced microbiome.3,4 However, while the environmental trigger for CeD is known (gluten), it remains elusive what triggers the onset of IBD. CeD is often in co-morbidity with other CIDs. Kori et al report a comprehensive national survey study aimed at establishing the co-morbidity between CeD and CeD autoimmunity (presence of auto-antibodies but not coeliac enteropathy yet) and IBD, showing that both are more prevalent in patients with IBD, particularly in paediatric-onset IBD and in those affected by Crohn’s disease (CD). Also intriguing are the authors’ findings that the diagnosis of CeD preceded the diagnosis of IBD in three-fourth of the patients.
Combined, these data suggest that by creating conditions of break in mucosal tolerance, CeD can facilitate an exaggerated antigen trafficking, including endotoxins, that, on a specific genetic background, can lead to the onset of IBD. This would explain the predilection of this co-morbidity in paediatric cases, in CD over ulcerative colitis (UC), and the time to treatment escalation that was found to be shorter in patients with both IBD and CeD than in patients with IBD without CeD. The implications of these data could suggest that a prompt diagnosis of CeD with re-establishment to a gut mucosa homeostasis following implementation of a gluten-free diet may decrease the risk to develop secondary IBD, a possibility that should be thoroughly examined in prospective studies specifically designed to challenge this hypothesis.
References
1. Festen EA, Goyette P, Green T, et al. A meta-analysis of genome-wide association scans identifies IL18RAP, PTPN2, TAGAP, and PUS10 as shared risk loci for Crohn's disease and celiac disease. PLoS Genet. 2011;7(1):e1001283. https://journals.plos.org/plosgenetics/article?id=10.1371/journal.pgen.1001283
2. Camilleri M, Madsen K, Spiller R, et al. Intestinal barrier function in health and gastrointestinal disease. Neurogastroenterol Motil. 2012;24(6):503-512. https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2982.2012.01921.x
3. Lee M, Chang EB. Inflammatory Bowel Diseases (IBD) and the Microbiome-Searching the Crime Scene for Clues. Gastroenterology. 2021;160(2):524-537. https://www.gastrojournal.org/article/S0016-5085(20)35507-4/fulltext
4. Størdal K, Kahrs C, Tapia G, et al. Review article: exposure to microbes and risk of coeliac disease. Aliment Pharmacol Ther. 2021;53(1):43-62. https://onlinelibrary.wiley.com/doi/abs/10.1111/apt.16161