D0683 - Prevalence of Gastrointestinal Inflammation Beyond the Small Intestine in Celiac Disease

Robin David, MD, Kajali Mishra, MD, Alex Blachowicz, MD, Abu Fahad Abbasi, MD, Paul P. Hong, MD, Ayokunle T. Abegunde, MD, MSc, MRCGP
Loyola University Medical Center, Maywood, IL

Introduction: Celiac disease (CD) is an autoimmune-mediated sensitivity to gluten with a global prevalence of 1.4% based on serologic test results and 0.7% based on biopsy results. We hypothesize that CD is not a small bowel (SB) limited process but instead involves the pan-gastrointestinal tract. Therefore, we aim to determine the proportion of CD patients with gastrointestinal (GI) inflammation beyond the SB.

Methods: We identified 300 patients with CD seen at our institution from 2017-2021 using ICD codes. Chart review was performed and clinical information related to CD and endoscopic evaluation was entered into RedCap. Data were analyzed for descriptive statistics; categorical variables were compared with Chi-square or Fisher’s exact test as appropriate.

Results: Of 300 patients with CD, 211 (70.3%) were females and 262 (87.3%) were Caucasians. The presenting symptoms were abdominal pain (126, 42.0%), abdominal distention/bloating (100, 33.3%), diarrhea (84, 28.0%), lethargy (53, 17.7%), nausea/vomiting (53, 17.7%), unintentional weight loss (42, 14.0%), constipation (30, 10.0%) and steatorrhea (1, 0.3%). Extra intestinal involvement included hematological (27%), mucocutaneous (14.3%), metabolic bone disease (20.3%) and neuropsychiatric (10%). Of 300 patients, 259 had serological testing and 80% were positive for at least one serological marker. Histological findings suggestive or diagnostic of CD on duodenal biopsy were found in 210 (70%). Amongst these patients, 74.7% (n=157) had gastritis (90%), lymphocytic predominance (32%), metaplasia (5%) and mucosal atrophy (5%). 33% (n=69) of the patients had findings on esophageal biopsies notable for esophagitis (70%), lymphocytic esophagitis (19%) and EOE (16%). Patients with positive SB biopsy findings had higher odds of having positive findings on esophageal and/or gastric biopsies (p=0.0001)(Table 1). Only 91 (30%) patients had colonoscopy at the time or during the diagnosis of CD, out of which random biopsies were obtained in 18 patients with 33% being abnormal in form of lymphocytic colitis (33.3%), ulceration (16%), and erosions (5%).

Discussion: The results of this study suggest a broader GI process rather than enteropathy limited to the SB. Further studies are required to test the strength of association between the GI inflammatory disorders identified and CD.



Disclosures:


Robin David, MD, Kajali Mishra, MD, Alex Blachowicz, MD, Abu Fahad Abbasi, MD, Paul P. Hong, MD, Ayokunle T. Abegunde, MD, MSc, MRCGP. D0683 - Prevalence of Gastrointestinal Inflammation Beyond the Small Intestine in Celiac Disease, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.