Screening for celiac disease in patients with eating disorders

Celiac disease (CD) affects approximately 1% of the population, and although it remains largely underdiagnosed, can have considerable long-term morbidity. Common presenting symptoms include gastrointestinal complaints and weight loss, which are also symptoms seen in patients with eating disorders (EDs). Because of this overlap, and the importance of early diagnosis of CD and identifying possible complicating factors in patients with EDs, screening in our program has become part of an initial assessment during the past 4 years.

A retrospective chart review of all patients ages 7-22 years seen in our Division of Adolescent Medicine for an ED evaluation from 2011 to 2014 were reviewed. Screening for CD was done with tissue transglutaminase IgA antibody (TTgAb) and anti-endomysial IgA antibody (aEAb). Immunoglobulin A (IgA) was also measured.

There were 1160 patients evaluated for an ED between 2011 and 2014, and 42.6% (494) were screened for CD during this time. Of those patients screened for CD the mean age was 16.0, compared to a mean age of 15.6 for those that were not screened, and 87.7% were female, compared to 84.7% of the unscreened group. Of the 494 screened, 10 (2%) screened positive with a TTgAb IgA EIA >20. Of the 10 who screened positive via blood test, four had biopsy confirmed CD via endoscopy, for an overall 0.8% prevalence in this cohort. Of the 457 patients who were also screened for IgA deficiency (92%), 5 (1.1%) had low IgA levels.

In this cohort of patients being evaluated for an ED, 0.8% had biopsy confirmed CD. This is similar to the reported prevalence in the general population, suggesting that routine screening of patients with EDs for CD is not indicated. We still need to be vigilant, however, for subtle symptoms that may indicate underlying CD in a small percentage of patients with EDs.