New research studying the association of celiac disease and inflammatory bowel disease (IBD) shows a strong relationship between the two conditions. Celiac disease has long been associated with IBD, but estimates of the risk vary, and few studies have assessed the risk compared to the general population. 

Researchers set out to determine the risk of IBD in patients with celiac disease (and vice versa) compared to the general population. They found that after the first year postdiagnosis, patients with celiac disease had an almost 4-fold increased risk of IBD, and patients with IBD had a more than 5-fold increased risk of celiac disease. 

“The risk of IBD in celiac disease (and vice versa) showed a distinct increase even 10 years after the first diagnosis,” the authors explain. “During 20 years of follow-up, 2.5% of celiac disease patients developed incident IBD [meaning they developed IBD during this time], and 1.3% of IBD patients developed celiac disease.” 

Using Swedish healthcare registry data, the research team, led by Karl Mårild, MD, PhD, and including Benjamin Lebwohl, MD, Director of Clinical Research, Celiac Disease Center at Columbia University and a Celiac Disease Foundation Young Investigator Awardee, identified more than 48,000 patients with celiac disease and more than 83,000 patients with IBD diagnosed between 1969 and 2016. The patients were compared with a general population control group matched by sex and age. The authors excluded the first year postdiagnosis in follow-up analysis due to potential misdiagnosis of celiac disease and IBD. 

During follow-up, 1.6% of celiac patients were diagnosed with IBD compared to 0.4% in the general population control group, and 0.8% of IBD patients were diagnosed with celiac disease compared to 0.1% of the general population control group.  

“The significantly increased risk of celiac disease and IBD even 10 years after diagnosis of the other condition suggests an etiological link between celiac disease and IBD,” the authors write. “Common immunological, genetic, and environmental factors may play a role here.” This study indicates that the presence of one condition may increase the likelihood of developing the other. 

The strong relationship between the two conditions should prompt healthcare providers to consider an alternative diagnosis for patients with celiac disease or IBD who continue to have persistent symptoms. For instance, when patients with celiac disease are following a strict gluten-free diet and their symptoms persist, this study suggests that a second diagnosis of IBD should be explored by the healthcare provider. 

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