P160. Prevalence of IBD among celiacs in our celiac centre
D. Kocsis1, G. Veres2, E. Jocsak1, Z. Toth3, A. Csontos1, P. Miheller1, Z. Tulassay1, M. Juhasz1, 1Semmelweis University, 2nd Dept. Med., Budapest, Hungary, 2Semmelweis University, 1st. Department of Pediatrics, Budapest, Hungary, 3Peterfy S. u. Kh., Gastroenterology Unit, Budapest, Hungary
Celiac disease (CeD) and IBD are inflammatory disorders of the gastrointestinal tract with some common genetic, immunological and environmental factors involved in their pathogenesis. Several research shown that patients with CeD have a 10-fold risk of developing IBD when compared with that of the general population. The aim of this study is to determine the prevalence of IBD in our celiac patient cohort over a 15-year-long study period.
In order to diganose CeD, tissue transglutaminase antibody testing (tTG) and endomysium antibody tests (EMA) were used for serology, and duodenal biopsy samples were taken to determine the degree of mucosal injury described according to the modified Marsh classification. To set up the diagnosis of IBD, clinical parameters, imaging techniques, colonoscopy, video capsule endoscopy and histology were applied. Dual energy X-ray absorptiometry for measuring bone mineral density (BMD) was performed on every patient.
In our material, 8/245 (3.2%) CeD patients presented IBD (4 males, mean age 37, range 22–67), 6/8 Crohn (CD), and 2/8 ulcerative colitis (UC), retrospectively. In 5/8 patients the diagnosis of CeD was made first and IBD was identified during follow-up. The average time period during the set up of the two diagnosis was 10.7 years (median: 5 years, range 4–535 months). Serology for CeD was positive in all cases (2/8 tTG 6/8 EMA). The distribution of histology results according to Marsh classification: 1/8 M1, 2/8 M2, 3/8 M3a, 2/8 M3b. The distribution according to the Montreal classification: 4/6 CD patients are B1 (nonstricturing, nonpenetrating), 2/6 CD patients are B2 (stricturing), 1/2 UC patient is S2 (moderate UC) and one UC patient is S0 (clinical remission). Biological therapy (infliximab) was administered to 2/8 patients. Normal BMD was detected in 2/8 (25%) case, osteopenia in 4/8 (50%) patients, and osteoporosis in 2/8 (25%) patients, respectively. The mean BMI for males was 22.25 kg/m2, whereas the mean BMI for females was 20.74 kg/m2.
Within our cohort of patients with CeD, IBD was significantly more common (3.2%) than in the general population. Diagnosis of CeD mostly preceded the diagnosis of IBD. The dominant behaviour of IBD was of the inflammatory type. Interestingly, the loss on BMD for these patients with two different disease leading to malabsorption syndrome were not worse than for those suffering in only one of these disorders.