Double Threat: Interplay of Celiac Disease with Inflammatory Bowel Disease

Excerpt

A 54-year-old woman with a history of depression, obsessive–compulsive disorder, and urinary urge incontinence was initially evaluated in the gastroenterology clinic with complaints of explosive diarrhea, fecal urgency, rectal bleeding, and a 60-lbs unintentional weight loss over the previous year. She reported chronic diarrhea for over 40 years. A previous flexible sigmoidoscopy had revealed proctitis; at that point, she was managed on mesalamine suppositories but continued with intermittent symptoms. About 7 years prior to presentation, she underwent an esophagogastroduodenoscopy (EGD) that demonstrated an endoscopically normal-appearing duodenum; duodenal biopsies revealed increased intraepithelial lymphocytes with mild focal villous blunting concerning for celiac disease. Colonoscopy with random colonic biopsies revealed no evidence of colitis. She was placed on a gluten-free diet (GFD) for 6 months, but this was discontinued due to lack of efficacy. She continued to have ongoing symptoms while not consuming a gluten-free diet (GFD). Laboratory studies were notable for elevated anti-gliadin IgA (> 100), but otherwise the absence of HLA-DQ2/DQ8 alleles and a negative endomysial antibody. She was restarted on a GFD, but the patient was not compliant. …