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P200 Celiac disease (CD) and CHRONIC INFLAMMATORY BOWEL DISEASE (IBD) association

Hmimass, S.(1);benelbarhdadi, I.(1);lagdali, N.(1);borahma, M.(1);ajana, F.Z.(1);

(1)Mohammed V University- Ibn Sina Hopital, gastroenterology C, Rabat, Morocco

Background

Association Celiac disease (CD) and CHRONIC INFLAMMATORY BOWEL DISEASE (IBD) is rare. the aim of the study is to determine the frequency as well as the anatomical and evolutionary characteristics of this association.

Methods

This is a retrospective descriptive and analytical study of 10 patients between 2005 and 2020. The diagnosis of CD was established after careful clinical examination and questioning, on the determination of specific auto antibodies against transglutaminase type Ig A and endomysium and on the histological study of duodenal biopsies showing a IEL> 30%. And that of IBD was based on a range of clinical, endoscopic, histological and radiological arguments

Results

10 cases of association CD and IBD were diagnosed in a cohort of 267 CD, 960 Crohn's disease and 520 Haemorrhagic rectocolitis. The frequency of association was 3.7% in the cohort of CD, 0.9% In the Crohn's disease cohort and 0.2% in the cohort of Haemorrhagic rectocolitis. Predominantly female, 80% female and 20% male. The diagnosis of CD preceded that of Crohn's disease in 80% (n=8), with an average delay of 32 months (12-72 months). All patients were put on a gluten-free diet (GFD). Despite good therapeutic compliance for at least 18 months, the evolution was marked by the persistence of anaemic syndrome and dysenteric syndrome in six cases (60%), diarrhoea and colic-type abdominal pain in four cases (40%). And an occurrence of rectorragie, anaemic syndrome and dysenteric syndrome in two cases (20%). In front of the persistence of symptoms, we first eliminated a resistance to GFD. Then an upper and lower digestive, radiological and histological endoscopic assessment concluded that there was an isolated colonic crohn's disease in five (50%) of the patients; gastric and colonic in three (30%). 60% (n=6) of the patients had luminal and stenotic involvement in two patients. The diagnosis of IBD preceded that of celiac disease in 20% (n=2), one patient had luminal colonic Crohn's disease and one patient had left Haemorrhagic rectocolitis. The diagnosis of CD was clinically retained by the appearance of an associated anemic syndrome in one case with atypical abdominal pain, and with dysenteric syndrome in the other case. Serologically, one was positive for anti transglutaminase type Ig A and the other was seronegative. Histologically, both patients had a IEL >30% with subtotal atrophy. The evolution was favourable on the GFD, which was always followed up alongside the treatment of IBD, with good clinical and endoscopic improvement


Conclusion

The association between CD and IBD is possible, albeit rare. It is necessary to think about the search for it whenever there is a persistence or appearance of other evocative symptoms despite good therapeutic compliance.

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