A Significant Bidirectional Association Between IBD and Celiac Disease: IBD Is More Common in Celiac Disease and Vice Versa
Monika Fischer, MD, reviewing Pinto-Sanchez MI, et al. Gastroenterology 2020 May 13.
A meta-analysis of low-risk bias studies found an increased likelihood of celiac disease in patients with IBD compared to controls (relative risk [RR], 3.96; 95% confidence interval [CI], 2.23-7.02; n=189,344 participants; n=5 studies). The risk was slightly higher in Crohn’s disease versus ulcerative colitis (RR, 4.43; 95% CI, 2.15-9.14 versus RR, 2.81; 95% CI, 1.82-4.36; n=60,443 participants; n=4 studies). The meta-analysis also found an even greater risk of IBD in patients with celiac disease compared to controls (RR, 9.88; 95% CI, 4.03-24.21; n=148,646 participants; n=5 studies).
COMMENTWhile this rigorous meta-analysis revealed a significant relationship between celiac disease and IBD, the conclusion was limited by the relatively low quality of the available evidence. The prevalence of celiac disease was likely underestimated in the control groups (0.3%; worldwide prevalence is 1%). High-quality studies are needed before universal screening of celiac patients for IBD and vice versa can be recommended. Nevertheless, patients with IBD who have poorly controlled symptoms should be tested for celiac disease, and patients with symptomatic celiac disease who adhere to a gluten-free diet deserve an evaluation for IBD.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Pinto-Sanchez MI, Seiler CL, Santesso N, et al. Association between inflammatory bowel diseases and celiac disease: a systematic review and meta-analysis. Gastroenterology 2020 May 13. (Epub ahead of print) (https://doi.org/10.1053/j.gastro.2020.05.016)
