Gastroenterology, Digestive Endoscopy and Nutrition Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy.
Department NEUROFARBA, University of Florence, Meyer Children's Hospital, Florence, Italy.
Inflamm Bowel Dis. 2021 Nov 15;27(12):1881-1888. doi: 10.1093/ibd/izaa360.
Adult patients with both inflammatory bowel disease (IBD) and celiac disease (CeD) have peculiar phenotypic features. This study aimed at describing the characteristics and natural history of children with both IBD and CeD.
This was a case-control study based on a national registry. Cases included children diagnosed with both IBD and CeD. Two matched IBD controls without CeD, and 2 matched CeD controls were selected for each case. Inflammatory bowel disease phenotype and natural history, comprising growth and pubertal development, were compared between groups.
Forty-nine (1.75%) patients with IBD and CeD were identified out of 2800 patients with IBD. Compared with patients with IBD alone, patients with IBD and CeD presented more frequently with autoimmune diseases (odds ratio, 2.81; 95% CI, 0.97-8.37; P = 0.04). Ileocolonic localization (46.1% vs 73.1%), treatment with azathioprine (46.2% vs 71.2%), and anti-TNF biologics (46.2% vs 69.2%) were less common in patients with Crohn's disease and CeD than in patients with Crohn's disease alone. Patients with ulcerative colitis and CeD had an increased risk of colectomy despite similar medical treatments compared with patients with ulcerative colitis alone (13.0% vs 0%). Pubertal delay was more common in patients with IBD and CeD compared with patients with IBD alone (14.9% vs 3.2%; odds artio, 5.24; 95% CI, 1.13-33.0; P = 0.02) and CeD alone (14.9% vs 1.1%; P = 0.002).
Children with IBD and CeD may have peculiar features with a higher risk for autoimmune diseases, colectomy, and pubertal delay compared with IBD alone.
患有炎症性肠病（IBD）和乳糜泻（CeD）的成年患者具有特殊的表型特征。本研究旨在描述同时患有 IBD 和 CeD 的儿童的特征和自然病史。
这是一项基于国家登记处的病例对照研究。病例包括同时诊断患有 IBD 和 CeD 的儿童。为每个病例选择了 2 个匹配的 IBD 对照组，无 CeD，以及 2 个匹配的 CeD 对照组。比较了各组之间的 IBD 表型和自然病史，包括生长和青春期发育。
在 2800 名 IBD 患者中发现了 49 名（1.75%）同时患有 IBD 和 CeD 的患者。与单独患有 IBD 的患者相比，同时患有 IBD 和 CeD 的患者更常患有自身免疫性疾病（优势比，2.81；95%置信区间，0.97-8.37；P = 0.04）。克罗恩病和 CeD 患者的回肠结肠炎定位（46.1%比 73.1%）、巯嘌呤治疗（46.2%比 71.2%）和抗 TNF 生物制剂（46.2%比 69.2%）比单独患有克罗恩病的患者更少见。与单独患有溃疡性结肠炎的患者相比，患有溃疡性结肠炎和 CeD 的患者尽管接受了相似的药物治疗，但结肠切除术的风险增加（13.0%比 0%）。与单独患有 IBD 的患者相比，同时患有 IBD 和 CeD 的患者青春期延迟更为常见（14.9%比 3.2%；优势比，5.24；95%置信区间，1.13-33.0；P = 0.02）和单独患有 CeD 的患者（14.9%比 1.1%；P = 0.002）。
与单独患有 IBD 的患者相比，同时患有 IBD 和 CeD 的儿童可能具有特殊特征，患有自身免疫性疾病、结肠切除术和青春期延迟的风险更高。
