Celiac Disease Patients 11 Times More Likely to Have Inflammatory Bowel Disease

  • The prevalence of inflammatory bowel disease (IBD) is 11 times higher in patients with celiac disease compared with the population at large, according to a meta-analysis of 27 studies published in the Journal of Clinical Gastroenterology. 1
  • Meanwhile, the prevalence of celiac disease is twice as high in patients with IBD than in those without IBD.
  • Wayne Kuznar, for MDLinx 2

“This suggests that there are distinct pathophysiological mechanisms exposing celiac disease patients to an increased risk of developing IBD,” wrote corresponding author Gerald J. Holtmann, MD, PhD, MBA, Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia, and colleagues.

  • “The mucosal inflammation caused by celiac disease may likely trigger a sequence of pathophysiological events that ultimately results in IBD,” they speculated.
  • Indeed, four shared risk loci between celiac disease and IBD suggest that the two diseases may have a common genetic pathway.

The meta-analysis included 17 studies involving 41,482 patients with IBD and 1,295 non-IBD controls, and 12 studies that included 2,769 patients with celiac disease and 4,854 controls. (Two studies reported on both the prevalence of IBD in celiac disease and on celiac disease in IBD.)

In IBD patients, the prevalence of celiac disease was 1.11% (1,110 per 100,000), in contrast to an expected prevalence of 0.3% to 1.0% (620 per 100,000) for celiac disease in these study populations.

This corresponds to a two-fold increase in celiac disease in patients with IBD (odds ratio [OR]: 2.23, 95% CI: 1.99-2.50). Standard tests did not reveal evidence for relevant publication bias while some heterogeneity was noted.

In patients with celiac disease, the prevalence of IBD was 2,130 per 100,000. This rate is significantly higher compared with the prevalence rates for the reference populations (260 per 100,000), corresponding to an OR of 11.10.

When analyzed separately, the risks for ulcerative colitis and Crohn’s disease were both increased in patients with celiac disease, with ORs of 6.98 for ulcerative colitis and 10.38 Crohn’s disease, indicating that celiac disease had no differential effect on these conditions. Standard tests did not reveal evidence for effects of publication bias and only moderate heterogeneity, while the Funnel plot suggested some degree of publication bias.

  • The authors reasoned that the link between celiac disease and IBD are due to common disease genetic risk factors. But, they stated, celiac disease is a specific risk factor for the manifestation of IBD.

“On the basis of animal studies, a combination of factors such as genetic susceptibility and environmental factors such as the microbiome (or GI microbiome) may define the risk to develop intestinal pathology,” they wrote. Other evidence suggests that IBD in the presence of celiac disease “may result in more severe disease manifestations.”

They added that earlier studies included in the meta-analysis may have underestimated the prevalence of celiac disease and IBD given the improvement in diagnostic sensitivity and specificity over time in currently available tests.