P0744 - Are We Meeting Celiac Disease Benchmarks in Inflammatory Bowel Disease Patients With Celiac Disease? Evaluation of Clinical, Serological, and Histological Characteristics: Case-Control Study From a Tertiary Referral Center

Jonathan Montrose, DO¹, Eleazar E.. Montalvan-Sanchez, MD¹, Renato Beas, MD², Wade Billings, MD¹, Mahmoud Rahal, MD¹, Sanjna Vinze, MD, MPH¹, Yunpeng Yu, BS², Sashidhar Sagi, MD¹, Matthew Bohm, DO³, Megan Walker, MD², Monika Fischer, MD, MSc, FACG², Satya Kurada, MD^1
1Indiana University School of Medicine, Indianapolis, IN; ²Indiana University, Indianapolis, IN; ³Indiana University Hospital, Indianapolis, IN

Introduction: A small portion of Inflammatory bowel disease (IBD) subjects have celiac disease (CeD). We conducted a retrospective case-control study to compare disease characteristics of subjects with IBD+ CeD versus CeD.

Methods: Patients were screened from January 2017 until June 2022 using appropriate ICD-10 codes for IBD and CeD. Data was collected including demographics, gluten-free diet (GFD) adherence patterns, celiac disease symptom index (CSI), serologic and histologic remission of CeD, from earliest available until time of administrative censoring.

Results: 80 subjects with CeD and 36 subjects with IBD+ CeD were included. 70% of CeD and 64% of IBD+ CeD subjects were female (p=0.54). The median age at diagnosis of CeD in the CeD and IBD+ CeD subjects was similar. There was a higher rate of self-taught (83%), internet-taught (14%), or book-taught (14%) initiation of GFD in the IBD+ CeD group as compared to 50%, 0%, and 1% respectively in the CeD group (all p£0.01). Dietician referral was low in both groups (< 22%). The prevalence of the following components of the CSI were more frequently reported in IBD+ CeD: abdominal pain (89%), nausea and vomiting (58%), bloating (58%), diarrhea (89%), and weight loss (78%) when compared to 53%, 29%, 29%, 48%, and 13% in CeD, respectively (all p£0.01). Other significant co-morbidities that were notably more common in IBD+ CeD include unexplained anemia (47%), malnutrition (19%), arthritis (8%), and rheumatoid arthritis (RA) (8%) when compared to CeD group at 21%, 1%, 4%, 0%, respectively (p< 0.05). The median and IQR serum tTG IgA titers dropped consistently over a 5-year timeline in both groups (Fig 1a). Kaplan-Meir (KM) curves indicated a similar estimated survival probability by log rank test of Marsh Score remaining 1 or below at 2 years in the IBD+ CeD group when compared to CeD group (Fig 1b) (p=0.37) over the observed period of years since first GFD start date. No subjects with IBD+ CeD had follow-up duodenal biopsies beyond 2 years.

Discussion: Only 20% of IBD+ CeD were referred to a dietician for initiation of a GFD. Further, CSI burden and associated co-morbid conditions were higher in IBD+ CeD group. Very few IBD+ CeD underwent duodenal biopsy beyond two years and celiac serologies beyond 5 years. This study highlights the need for clinicians to objectively assess celiac disease activity and GFD adherence, especially in IBD+ CeD with high CSI symptom burden.




Disclosures:


Jonathan Montrose, DO¹, Eleazar E.. Montalvan-Sanchez, MD¹, Renato Beas, MD², Wade Billings, MD¹, Mahmoud Rahal, MD¹, Sanjna Vinze, MD, MPH¹, Yunpeng Yu, BS², Sashidhar Sagi, MD¹, Matthew Bohm, DO³, Megan Walker, MD², Monika Fischer, MD, MSc, FACG², Satya Kurada, MD¹. P0744 - Are We Meeting Celiac Disease Benchmarks in Inflammatory Bowel Disease Patients With Celiac Disease? Evaluation of Clinical, Serological, and Histological Characteristics: Case-Control Study From a Tertiary Referral Center, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.