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Prevalence of Celiac Disease in Inflammatory Bowel Disease: A Prospective Cohort Study from Northern India
Munesh Kumar1, Bharat Sapra2, Prabhat Narain Sharma3
1Associate professor, Department of Gastroenterology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India.
Background:
Celiac disease (CeD) and inflammatory bowel disease (IBD) share immune and genetic pathophysiological pathways, suggesting a possible increased coexistence. Indian data on biopsy-confirmed CeD in IBD are limited, and false-positive anti-tissue transglutaminase (tTG) antibody results complicate interpretation.
Aim:
To determine the prevalence of biopsy-confirmed CeD in an Indian IBD cohort and compare clinical features between CeD-positive and CeD-negative IBD patients.
Materials And Methods:
In this prospective observational study, 477 IBD patients were assessed. All patients underwent IgA anti-tTG screening. Seropositive patients underwent upper gastrointestinal endoscopy with duodenal biopsies. The standardized prevalence ratio (SPR) for CeD was calculated, and clinical and laboratory parameters were compared between patients with and without CeD.
Results:
Among 477 IBD patients (UC 421; CD 56), 14 (2.94%) were anti-tTG positive, and 11 had biopsy-confirmed CeD, giving a prevalence of 2.31% (95% confidence interval: 1.29-4.08%). Prevalence was 2.14% in UC and 3.57% in CD (p = 0.59). The SPR, compared with the Indian population prevalence of 1.04%, was 2.22. The anti-tTG false-positive rate was 21.4%. No significant differences were observed between CeD-positive and CeD-negative patients, although UC patients with CeD showed a non-significant trend toward pancolitis.
Conclusion:
In conclusion, CeD prevalence in Indian IBD patients was numerically higher than the Northern Indian general population but did not reach statistical significance. Larger multicenter studies are needed to definitively establish the CeD-IBD association in Indian populations. Selective screening is preferable, and histological confirmation remains essential due to high false-positive serology.
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