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Recurrent Pouchitis Uncovering De Novo Celiac Disease
Chakib Khoury1, Rebal Nahas1, Emanuel Youssef Dib1
1Department of Internal Medicine, University of Balamand, Beirut, Lebanon.
Abstract:
We present the case of a 39-year-old woman with a history of severe ulcerative colitis (UC) that was refractory to 5-aminosalicylates, corticosteroids, and biologics, and who subsequently underwent total colectomy with ileal pouch-anal anastomosis (IPAA). She developed chronic antibiotic-refractory pouchitis (CARP) characterized by recurrent abdominal pain, cramping, and diarrhea unresponsive to standard treatments. A comprehensive workup, including testing for anti-tissue transglutaminase IgA antibodies, led to the diagnosis of de novo celiac disease, confirmed by endoscopic and histopathologic findings. Initiation of a gluten-free diet resulted in the resolution of symptoms, with no relapse observed during a 9-month follow-up. Our case highlights the importance of considering secondary etiologies such as celiac disease in patients with chronic refractory pouchitis and emphasizes the need for tailored management strategies.
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