Celiac disease, collagenous sprue and microscopic colitis in IBD. Observations from a population-based cohort of IBD (ICURE)

Abstract

Objective. Inflammatory bowel disease (IBD), microscopic colitis and celiac disease are all diseases with worldwide distribution and increased incidence has been reported from many areas. There is a shortage of studies investigating the occurrence of these diseases in the same individual and whether those affected demonstrate any particular phenotype. The aim of the study was to describe the concomitant incidence of microscopic colitis and celiac disease in a population-based IBD cohort. Methods. All 790 individuals in a prospective population-based cohort included 2005–09 from Uppsala region, Sweden, were reviewed regarding the appearance of microscopic or celiac disease before or after IBD diagnosis. Results. Fifty percent (396/790) of the patients had been examined for the possibility of celiac disease. Seventeen patients with celiac disease were found, representing 2.2% of the cohort. Patients with celiac disease were younger compared to the non-celiac patients and those with colitis had more often an extensive inflammation of the colon. Seventy-one percent (12/17) were women. The majority of the patients were diagnosed with celiac disease before IBD. Five patients with IBD had an earlier diagnosis of microscopic colitis or developed it after the IBD diagnosis. One teenager developed collagenous sprue, misinterpreted as a severe relapse of ulcerative colitis (UC) resulting in colectomy. Conclusions. The risk for celiac disease seems not to be increased in IBD, but those affected by both diseases seem to be predominantly women with extensive UC. There is a potential association between microscopic colitis and IBD.

Key Words:

• celiac disease
• collagenous sprue
• epidemiology
• inflammatory bowel diseases
• microscopic colitis

Acknowledgements

The study was supported by grant from the Uppsala University Hospital Research Foundation and the Centre for Clinical Research Dalarna. The founders had no role in the design and conduct of the study, collection, management, analysis or interpretation of the data or decision to submit the manuscript. Dr Lars Holmquist, A-L Nielsen and M Larsson have contributed in finding patients for the study. AR and DS carried out the study and drafted the manuscript. DS performed the statistical analysis. AW performed the pathological analysis. AR, DS, AW, TH and HT conceived of the study, scrutinized medical records and helped to draft the manuscript. All authors read and approved the final manuscript.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.