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Duodenal Ulceration in a Child with Coeliac Disease
Polina S Lototskaya1, Marina A Manina1, Aleksandr S Tertychnyy2
1Filatov Clinical Institute of Child Health, Sechenov First Moscow State Medical University, 119991 Moscow, Russia.
Insights
Coeliac disease (CD) can present with rare duodenal ulcers, even in non-advanced cases. This case highlights the importance of considering CD in young patients with persistent gastrointestinal issues and peptic ulcers.
Area of Science:
- Gastroenterology
- Immunology
Background:
- Coeliac disease (CD) is a prevalent gluten-induced enteropathy affecting the small intestine.
- Peptic ulcer disease, particularly duodenal ulcers, is uncommon in non-advanced CD.
Observation:
- A 17-year-old female presented with a history of erosive gastritis and duodenitis since age 9.
- She developed a duodenal ulcer with bulb deformity at 16, initially attributed to Helicobacter pylori (HP) infection.
- Diagnosis of CD was confirmed via serology and intestinal biopsy despite atypical presentation.
Findings:
- This case demonstrates a rare presentation of CD with significant ulcerative lesions in the duodenum.
- Literature suggests an increased prevalence of peptic ulcer disease in CD patients.
- Comorbid CD and HP infection are reported, but CD-associated peptic ulcers are infrequently highlighted.
Implications:
- Increased clinical awareness is crucial for diagnosing CD in patients with unexplained peptic ulcer disease.
- Further research is needed to understand the mechanisms linking CD and peptic ulcer formation.
- Early identification of CD-related ulcerative lesions can prevent diagnostic delays and improve patient outcomes.
Abstract:
Coeliac disease (CD) is a gluten-dependent inflammatory disease of the small bowel that affects up to 1% of the global population. Herein, the presence of ulcers, erosions, or strictures in the duodenum for non-advanced cases of CD is a rarity. Case report: We present a clinical case of a 17-year-old girl, who from the age of 9, had suffered from erosive Helicobacter pylori (HP)-associated gastritis and erosive duodenitis. At 16, she was diagnosed with a duodenal ulcer, complicated by cicatricial deformity of the bulb. While an atypical course in the development of the disease had led to the initial delay in diagnosis, a serum study and an intestinal biopsy confirmed CD. Discussion: A recent study found an elevated rate of peptic ulcer disease in patients with CD. From literature searches, comorbid HP infection and CD have indeed been widely reported, whereas cases highlighting the prevalence of CD-associated peptic ulcers have been observed and reported in only a few instances. Consequently, greater awareness is warranted and must be exercised for identifying the origins of ulcerative lesions that may be CD-related or -derived.
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