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P206 Celiac disease and inflammatory bowel disease, a rare association

Boutaleb A.*1, Saoula H.1, Aissaoui M.1, Hamidouche D.1, Aissat Y.1, Mahiou H.1, Osmane R.1, Zmiri Y.1, Mitiche A.1, Nakmouche M.1, Hamchaoui F.2

1CHU of Bab El Oued, Gastroenterology, Algiers, Algeria 2CHU of Bab El Oued, Epidemiology, Algiers, Algeria

Background

Celiac disease (CD) and inflammatory bowel disease (IBD) association is rarely described in the litterature. In this study, we propose to determine the prevalence of IBD in a population of celiac patients monitored in our hospital structure. We will also specify the clinical, evolutionary and therapeutic characteristics of the IBD during this association.

Methods

This is an open prospective study, patient were recruited between January 2009 and January 2015. The diagnosis of CD is based on clinical, serological (anti-endomysium and/or anti-transglutaminase antibody), histological (villous atrophy) and evolutionary criteria. The diagnosis of IBD is based on the clinic, biology (CRP), endoscopy, histology and progression of the disease. Patients are treated with the gluten-free diet (GFD) and the specific treatment of IBD.

Results

Of the 357 celiac patients followed, there are 5 IBDs, a prevalence of 1.4% of which 4 women and 1 man (M/F: 0.25). Their mean age is 40.8 years (22–61 years). These are 4 Crohn's disease and 1 ulcerative colitis (UC). The diagnosis of Crohn's disease is concomitant with CD in 1 case, it precedes that of CD in 2 cases and it occurs after CD in 1 case. The diagnosis of UC precedes that of CD. The 4 Crohn's diseases are stenosing, fistulating and operated, including one in the emergency for perforation on megacolon after failure of Infliximab. The latter also had severe ano-perineal lesions. The other patients are in remission treated with Azathioprine for one patient and fail to immunosuppressants for both the two others (one of whom died as a result of an infectious complication). For UC, it is a corticoresistant form treated with Infliximab but it had to be stopped following a serious pulmonary complication. These 5 patients were also placed under GFD, of which 3 patients correctly follow the GFD.

Conclusion

IBD is rarely associated with CD (1.4%). In our study, it is most often Crohn's disease. It is also noted that whatever the nature of the IBD, this one is severe; in contrast, the CD is relegated to the second plane.