Celiac Disease and IBD: What's the connection?

As I type this, Celiac Awareness Week is in full swing here in the UK; while American folks get the whole of May dedicated to raising awareness of the illness. But what's that got to do with Crohn's or UC? Of course, both diseases are digestive in their nature, but actually, the connection runs much deeper. Let's take a moment to discuss celiac disease and why it might be more closely related to IBD than you'd think.

What is celiac disease?

Like Crohn's disease, celiac disease is an autoimmune disease (and not an allergy). However, with celiac disease; the trigger is known: the small intestines overreact to gluten particles; causing the villi (which we absorb nutrients through) to flatten, and a whole host of symptoms such as malnutrition, diarrhea, stomach pain, and anemia. Celiac disease has a 'cure': patients who eliminate gluten from their diet usually return to normal and their small intestine repairs itself.

What's the connection between celiac disease and IBD?

Unfortunately, those of us with IBD are automatically more likely to be at risk of a second autoimmune disease (fun!) and since celiac disease is one of the more common ones, it makes sense there would be an increased chance. A 2015 study managed to put a statistical finding to the connection, by estimating that the 'prevalence of IBD in celiac patients is reported up to ten times higher than the general population;' concluding that it was reasonable for those with IBD to be tested for the disease if certain symptoms remained prevalent-e.g. iron deficiency anemia. Another study noted that as well being both autoimmune disease, IBD and celiac disease shared a 'partially common genetic background.'

The most important thing is that IBD patients are made aware of the symptoms of celiac disease. Unfortunately, these are very similar to IBD but it might explain the ongoing nature of symptoms when patients are in clinical remission; especially when patients aren't responding to treatments for iron deficiency anemia. (source)

Does celiac disease show up on colonoscopy?

Most people think celiac disease would show up on a colonoscopy, but it doesn't! The damages happen higher up and are therefore found via an endoscopy (which is not a very common procedure for those of us with IBD) or a specific blood test. So if you haven't had it ruled out, definitely chat to your doctor!

Should patients with Crohn's and UC stop eating gluten?

The answer to this is a resounding no! If you suspect you might have celiac disease, it's incredibly important to keep eating gluten so it stays in your system for testing. If you've already had celiac disease ruled out, keeping a food diary might be beneficial when considering if gluten could be an issue for you. It's important you don't make any drastic diet changes without consulting a doctor or dietician.

Some people with IBD do find removing gluten from their diet helpful (a patient study found the majority of those with IBD had some form of improvement in gastrointestinal symptoms) and may suffer from non-celiac gluten sensitivity if celiac disease is ruled out. However, given that may patients have complex nutritional needs, it's always best to make diet changes with the support of a qualified professional.

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