Celiac-associated peptic disease at upper endoscopy: how common is it?

Area of Science:

• Gastroenterology
• Pediatric Gastroenterology
• Celiac Disease Research

Background:

• Growing evidence suggests an increased incidence of non-Helicobacter pylori (HP), non-non-steroidal anti-inflammatory drug (NSAID) peptic disease (PD) in adults.
• Limited case reports associate celiac disease (CD) with peptic disease (PD), necessitating further investigation.

Purpose of the Study:

• To review the clinical experience of celiac disease (CD) presenting with peptic disease (PD) in pediatric and young adult populations.
• To determine the prevalence and characteristics of PD in patients diagnosed with CD.

Main Methods:

• Retrospective review of endoscopic findings in children and young adults diagnosed with CD between January 2004 and October 2008.
• Inclusion criteria required accepted diagnostic guidelines for CD; patients with doubtful diagnoses were excluded.

Main Results:

• Of 240 CD patients, 29 (12.0%) were diagnosed with PD, with a mean age of 16.9 years.
• A significant majority (79%) of PD cases in CD patients were HP-negative.
• Duodenal PD (76%) was more common than gastric PD (28%), with most cases being HP-negative.

Conclusions:

• Peptic disease (PD) is a notable, often HP-negative, presentation in pediatric and young adult celiac disease (CD) patients.
• Celiac disease (CD) should be considered in the differential diagnosis for unexplained non-HP PD, especially in the second decade of life.
• Routine CD serology and small bowel biopsy are recommended for patients with unexplained PD.