Out of 475 children with IBD, 8 also had CD, 5 had tissue transglutaminase (tTG) immunoglobulin A (IgA) more than 10x upper limit of normal (ULN, P=0.006), and 8 had villous atrophy (VA, P=0.003), compared to 17 seropositive participants with IBD-only. No IBD-CD children had eosinophilia in the oesophagus, duodenal cryptitis, duodenal ulceration, or faecal calprotectin levels higher than 250 µg/g. There were things like the lack of VA and intraepithelial lymphocytes, neutrophilic and eosinophilic duodenitis, diffuse ulceration, high inflammatory markers, and immunosuppression therapy that made it hard for providers to diagnose CD in IBD.
It is still hard to figure out if a child with IBD has CD. Even though high levels of tTG IgA and VA gave providers more confidence in diagnosing CD in IBD, evidence-based guidelines still need to be made. They should do a better job of figuring out how important things that aren’t typical of concomitant CD but add to uncertainty are.
Source: J Pediatr Gastroenterol Nutr. 2022;75(6):737-742. DOI: 10.1097/MPG.0000000000003613
Originally Published By Physician’s Weekly. Reused by Medicom Medical Publishers with permission.
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