Celiac disease (CD) can occur concomitantly in patients with inflammatory bowel disease (IBD); however, there is limited data regarding both of these diseases occurring in children. The authors of this study performed a multi-center, retrospective, observational study to evaluate such patients using data from the IBD Registry of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP). All patients were 17 years of age or younger, and IBD was diagnosed using the Porto criteria while CD was diagnosed using standard antibody tests for CD in addition to findings of villous atrophy on duodenal biopsy per the guidelines of the European Society of Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN). Patients with IBD and CD were compared to a control group of 98 patients with the sole diagnosis of IBD.
Patients with both IBD and CD comprised 49 patients from an eligible pool of 2,800 patients. Crohn disease was present in 26 patients (53.1%) while ulcerative colitis was present in 23 patients (46.9%). Females made up 53.1% of the study subjects. CD was diagnosed before IBD in 75.5% of patients (median interval 4.2 years). The median age at diagnosis for CD was 7.5 years while the median age at diagnosis for IBD was 11.5 years. When compared to patients with IBD alone, patients with CD and IBD were statistically more likely to have other associated autoimmune disease mainly consisting of thyroiditis (OR, 2.81; 95% CI, 0.97–8.37; P = 0.04). No difference was present between patients with IBD and CD versus IBD alone regarding immune suppression treatment regimens, surgery, or hospitalizations. Ileocolonic disease was less common in patients with CD and Crohn disease compared to control patients solely with Crohn disease. The risk of colectomy was significantly higher in patients with CD and ulcerative colitis compared to patients with ulcerative colitis alone (P=0.03). Growth delay was present at time of diagnosis in 7 patients (14.3%) with CD and IBD compared to 16 patients just with IBD (16.3%) (OR, 0.72; 95% CI, 0.26–1.98; P = 0.53). There was no statistical difference in reaching pubertal age between patients with CD and IBD compared to patients with IBD alone; however, patients with CD and IBD were significantly more likely to have pubertal delay (3.2%; OR, 5.24; 95% CI, 1.13–33.0; P = 0.02). Univariate analysis determined that growth delay and a younger age at IBD diagnosis were associated with pubertal delay. CD associated with IBD, intestinal surgery, and a higher number of hospitalizations also were associated with pubertal delay. Although pubertal delay was present, final heights of both male and female patients were similar between patients in the two groups
This study describes a unique phenotype in pediatric patients with CD and IBD and understanding the risk factors for development of other autoimmune disease as well as growth delay / pubertal delay is important, especially when explaining health outcomes to such patients and their families.
Bramuzzo M, Lionetti P, Miele E, Romano C, Arrigo S, Cardile S, Di Nardo G, Illiceto M, Pastore M, Felici E, Fuoti M, Banzato C, Citrano M, Congia M, Norsa L, Pozzi E, Zuin G, Agrusti A, Bianconi M, Grieco C, Guidici F, Aloi M, Alvisi P, on the behalf of the SIGENP IBD Group. Phenotype and Natural History of Children with Coexistent Inflammatory Bowel Disease and Celiac Disease. Inflammatory Bowel Diseases 2021; 27: 1881-1888.