Impact of celiac disease on the clinical course of inflammatory bowel disease: CEL_EII study by GETECCU.

内容摘要

Inflammatory bowel disease (IBD) and celiac disease (CeD) are immune-mediated digestive disorders with shared genetic, immunological, and environmental risk factors. This study aimed to assess whether the coexistence of CeD and IBD is associated with a differential IBD disease course. Multicenter case-control study. This study included patients with both CeD and IBD, and controls with IBD alone in a 1:2 ratio, matched by sex, IBD type, and year of diagnosis. CeD was diagnosed based on a Marsh score >1. Data on IBD phenotype and treatment, mortality and neoplasm development were collected from medical records. The study included 66 celiac-IBD patients (30 ulcerative colitis, 6 indeterminate colitis, 30 Crohn's disease; mean age 30 ± 14 years) and 132 non-celiac-IBD patients (68 ulcerative colitis, 4 indeterminate colitis, 60 Crohn's disease; mean age 32 ± 14 years). Among patients with CeD, Marsh type 3 was the most frequently observed lesion. No significant differences were observed between celiac and non-celiac-IBD patients in terms of IBD extension, extraintestinal manifestations, or coexisting autoimmune diseases. Similarly, no differences were found in outcomes including perianal disease, use of mesalamine, immunomodulators, biologics, need for surgery, or development of neoplasms. No deaths occurred in either group. In this large multicenter cohort, the concurrent diagnosis of CeD and patients with IBD was not associated with a different IBD phenotype or worse outcomes compared to non-celiac-IBD patients. The coexistence of CeD does not appear to alter the natural history of IBD. Does celiac disease influence the course of inflammatory bowel disease? What was already known? Inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, and celiac disease, are digestive disorders caused by an abnormal immune response. Both conditions share some genetic and environmental risk factors and can sometimes occur in the same person. However, it was unclear whether having celiac disease in addition to IBD could make IBD more severe or change its course. What did we want to study? We aimed to compare the course of IBD in patients who also had celiac disease with that of patients with IBD alone, to determine whether the coexistence of both conditions influenced the type of IBD, its severity, or the treatments required. How was the study performed? We conducted a multicenter study including 66 patients with both IBD and celiac disease and compared them with 132 similar patients with IBD without celiac disease. The groups were matched by sex, type of IBD, and year of diagnosis. Medical records were reviewed to collect information on disease extent, symptoms outside the intestine, treatments received, need for surgery, development of cancer, and survival. What did we find? No important differences were observed between patients with and without celiac disease. Both groups showed similar IBD characteristics, including disease extent and behavior. There were also no differences in complications such as perianal disease, use of immunosuppressive or biologic drugs, need for surgery, development of tumors, or mortality. What do these results mean? Having celiac disease in addition to IBD does not appear to worsen the course of IBD or modify its natural history. This information can help reassure patients and clinicians that the coexistence of celiac disease is unlikely to negatively affect IBD outcomes.