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Characteristics of IBD/coeliac children seropositivity

Journal of Pediatric Gastroenterology and Nutrition

Physician’s Weekly – 22/12/2022 – Coeliac disease (CD) autoimmunity and coexisting inflammatory bowel disease (IBD) present a diagnostic dilemma. The goals were to describe the phenotype of children with IBD who were positive for CD antibodies and to find out how confident providers were that they could diagnose CD in this group. Researchers did a single-centre retrospective cohort study of people with IBD and CD seropositivity younger than 18 years old between 2006 and 2020. Subjects were thought to have IBD-CD if they were diagnosed with CD by serology and histology, as recommended by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition, and if providers thought they might have CD based on a survey. In the IBD-only cohort, some seropositive people did not meet the criteria for CD. The Fisher exact test was used to compare demographic, histologic, gross endoscopic, and laboratory characteristics.

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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