The following is a summary of “Characteristics of Children With Inflammatory Bowel Disease and Coexisting Celiac Disease Seropositivity” published in the December 2022 issue of Pediatric Gastroenterology and Nutrition by Cheung et al.

Celiac disease (CeD) 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 CeD antibodies and to find out how confident providers were that they could diagnose CeD in this group. Researchers did a single-center retrospective cohort study of people with IBD and CeD seropositivity younger than 18 years old between 2006 and 2020. Subjects were thought to have IBD-CeD if they were diagnosed with CeD by serology and histology, as recommended by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition, and if providers thought they might have CeD based on a survey. In the IBD-only cohort, some seropositive people did not meet the criteria for CeD. The Fisher exact test was used to compare demographic, histologic, gross endoscopic, and laboratory characteristics.

Out of 475 children with IBD, 8 also had CeD, 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-CeD children had eosinophilia in the esophagus, duodenal cryptitis, duodenal ulceration, or fecal 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 CeD in IBD.

It is still hard to figure out if a child with IBD has CeD. Even though high levels of tTG IgA and VA gave providers more confidence in diagnosing CeD 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 CeD but add to uncertainty are.