Risk of Morbidity in Contemporary Celiac Disease

Nina R Lewis; Geoffrey KT Holmes

Disclosures

Expert Rev Gastroenterol Hepatol. 2010;4(6):767-780. 

In This Article

Inflammatory Bowel Diseases

Celiac disease may occur in association with ulcerative colitis and Crohn's disease. Furthermore, these three disorders can be present in different members of the same family. The prevalence of ulcerative colitis (five out of 455) and Crohn's disease (five out of 455) was found significantly higher in celiac disease than in the general population with ratios of 3.56 (95% CI: 1.48–8.56) and 8.49 (95% CI: 3.53–20.42), respectively.[151] The prevalence of inflammatory bowel disease comprising of five patients with ulcerative colitis and five with lymphocytic colitis was ten-times higher in a celiac group (ten out of 305; 3.3%) than in a control group (two out of 601; 0.33%).[152] If only ulcerative colitis were considered, the result still remained significantly higher. The prevalence of celiac disease in inflammatory bowel disease did not differ from the control group. No cases of Crohn's disease were identified among the celiac patients. In 90% of instances, celiac disease is the first diagnosis to be made. A multicenter study found no risk of inflammatory bowel disease in celiac disease, but when it does occur, ulcerative colitis is more common than Crohn's disease.[153] Microscopic colitis is also more common in celiac disease with a prevalence in one series of 44 out of 1009 patients (4.3%).[154]

These additional diagnoses need to be considered in patients with celiac disease who do not show the expected responses to gluten-free diet or unaccountably deteriorate, particularly with regard to bowel disturbance, because specific treatments will be required to restore good health.[155]

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