A group of researchers recently published an article in the journal, Pediatrics, detailing the results of a nationwide study conducted in Sweden to examine the link between celiac disease and anorexia nervosa. Over the years, a relationship between the two diseases has been suggested, but analysis has been limited to case reports. This study was designed to take a broader approach to examining the possible link between these two conditions.
Sweden’s national patient registry was used to identify three types of individuals: 1) those with biopsy-diagnosed small intestinal villous atrophy; 2) those with small intestinal inflammation not severe enough to be deemed celiac disease; and 3) those with a positive blood test for celiac disease but normal intestinal mucosa. This dataset was then further limited to women residing in Sweden in 1987 or later (when the Swedish National Patient Register became nationwide), and each test case was matched by age, calendar period of birth, and county of residence with up to five controls from the general population. Socioeconomic status and type 1 diabetes status were also taken into consideration.
For those patients for whom a diagnosis of celiac disease came first, the incidence rate of a subsequent diagnosis of anorexia nervosa was found to be 1/3 higher than in the control group. This rate was consistent across education level, socioeconomic status, and presence of type 1 diabetes. For those patients for whom the diagnosis of anorexia nervosa came first, the experimental group was found to have double the rate of celiac disease diagnosis compared to the control group. This elevated occurrence of celiac disease diagnosis persisted for patients with lesser intestinal inflammation and for those with positive blood test results.
There are several reasons why this bi-directional relationship might occur between these two conditions. First, due to significant symptom overlap, it is possible that individuals with each condition might be misdiagnosed with the other. It is also possible that genetic predisposition plays a role, as recent studies suggest that anorexia nervosa and autoimmune gastrointestinal diseases may be genetically related. Finally, it is likely that individuals already being treated with one of these conditions will be under greater scrutiny for symptoms and pathologies than those in the general population.  These two diseases can also exacerbate each other; having anorexia nervosa may make following a gluten-free diet more complicated and difficult.
This study was largely limited to women, as anorexia has a much higher prevalence in women than in men. Due to the small cohort of male participants in the study, no statistically significant conclusions about the relationship between the two diseases could be drawn for the male population in question.
In conclusion, the relationship between anorexia nervosa and celiac disease should be considered in both initial assessment and follow-up of women with either diagnosis. Due to similar presentation and the possibility for misdiagnosis, it is important to assess carefully, to avoid unnecessary complications and extended suffering by these patients.
Read the full study here.
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Read more at https://celiac.org/blog/2017/04/study-found-link-celiac-disease-anorexia-nervosa/#0j30ox46FjDECBjY.99