Alimentary Pharmacology and Therapeutics

Letters to the Editors Letter: a hidden cause of anaemia in inflammatory bowel disease patients – coeliac disease S. Kılıncalp*, F. Karaahmet*, Y. Ustun*, S. Coban* & I. Yuksel*,† *Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital, Ankara, Turkey. † Department of Gastroenterology, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey. E-mail: [email protected] doi:10.1111/apt.12613

SIRS, We read with great interest the paper by Høivik et al. about the prevalence of anaemia in inflammatory bowel disease (IBD) patients. They found that 20.2% of ulcerative colitis (UC) patients and 48.8% of Crohn’s disease patients were anaemic at diagnosis.1 Anaemia has a significant impact on the patient’s quality of life in IBD.2 From a therapeutic perspective, distinguishing between the causes of anaemia in IBD is important. However, despite the high prevalence of anaemia in IBD, it is often managed inadequately.3 With this in mind, it is important to denote the possible relationship between coeliac disease and IBD. Both IBD and coeliac disease are inflammatory disorders of the gastrointestinal tract. In both diseases, an antigen activates several inflammatory pathways, which cause increased permeability of the intestinal epithelium. Several case reports and case series have suggested an association between coeliac disease and IBD. The prevalence of coeliac disease in IBD was comparable to that in controls, whereas the prevalence of IBD in coeliac disease is increased by 10-fold compared with that in controls.4 The variation in clinical presen-

tation and symptom similarity with IBD could delay the detection of coeliac disease in IBD patients, which may result in serious complications such as intestinal lymphoma. The first problem in clinical practice is how to investigate coeliac disease in IBD patients. This is an important point, as most of the common tests in screening coeliac disease often fail (both as false positive and as false negative) in an IBD population.5 Thus, upper gastrointestinal endoscopy and duodenal biopsy is mandatory in suspected cases to confirm or exclude coeliac disease. In conclusion, it is important to draw the attention of clinicians about the association between coeliac disease and IBD. This finding should always be kept in mind during the management of anaemia in IBD patients.

ACKNOWLEDGEMENTS Declaration of personal and funding interests: None. REFERENCES 1. Høivik ML, Reinisch W, Cvancarova M, et al.; The IBSEN study group. Anaemia in inflammatory bowel disease: a populationbased 10-year follow-up. Aliment Pharmacol Ther 2014; 39: 69– 76. 2. Pizzi LT, Weston CM, Goldfarb NI, et al. Impact of chronic conditions on quality of life in patients with inflammatory bowel disease. Inflamm Bowel Dis 2006; 12: 47–52. 3. Reinisch W, Chowers Y, Danese S, et al. The management of iron deficiency in inflammatory bowel disease–an online tool developed by the RAND/UCLA appropriateness method. Aliment Pharmacol Ther 2013; 38: 1109–18. 4. Leeds JS, H€ oroldt BS, Sidhu R, et al. Is there an association between coeliac disease and inflammatory bowel diseases? A study of relative prevalence in comparison with population controls. Scand J Gastroenterol 2007; 42: 1214–20. 5. Bizzaro N, Villalta D, Tonutti E, et al. IgA and IgG tissue transglutaminase antibody prevalence and clinical significance in connective tissue diseases, inflammatory bowel disease, and primary biliary cirrhosis. Dig Dis Sci 2003; 48: 2360–5.

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Letter: a hidden cause of anaemia in inflammatory bowel disease patients - coeliac disease.

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