engleski

Long-term follow up of a girl with co-occurrence of Celiac disease and Ulcerative Colitis

Introduction: According to the literature, the co-occurrence of celiac disease (CD) and ulcerative colitis (UC) in children is extremely rare. So far there are only 5 case reports described in which both diseases are present. Methods: We report about a long-term follow up of a 18-year old girl with CD and UC. Results: Diagnosis of CD and UC was established at the age of 12. Upon admittance the patient presented with chronic diarrhea, nausea and loss of appetite. She was seriously underweight. Laboratory testing revealed anemia, elevated sedimentation rate (ESR), C- reactive protein (CRP) and low albumins. Liver and pancreatic enzymes, fecal elastase and sweat test were normal. Benzidine stool test was positive. Infective etiology was excluded. Considering high values of anti-tissue transglutaminase antibodies (tTG-163.3 RU/ml ; r.v.<20), and histopathological changes typical for CD (Marsh IIIA), gluten-free diet (GFD) was initiated. In the following period bloody loose stools were noted. Fecal calprotectin was high (FC-1296 µg/g ; r.v.<50), and colonoscopy revealed left-sided colitis, with ulcers, intraepithelial granulocytes and crypt abscesses. MR-enterography excluded Crohn's disease. After the diagnosis of UC (PUCAI-60), along with CD, the patient was prescribed prednisone and mesalazine, and continued GFD. The stools normalized in a few days, and upon discharge her clinical feature was normal (PUCAI-5). After corticosteroid discontinuation, there were no signs of relapse. The first relapse occurred after 5 years, characterized by bloody chronic diarrhea, weight loss (PUCAI-30), anemia, elevated ESR, CRP, high FC (2328, 1ug/gr). Anti- tTG was negative. Ileocolonoscopy confirmed moderate pancolitis (Mayo-2, UCEIS:2+0+1). CD was in remission. On prednisone regiment, increased mesalazine doses, and slow introduction of azathioprine remission was achieved after 3 weeks and is presently maintained. Discussion / Conclusion: Due to the high incidence of both diseases, we presume that there should be higher comorbidity prevalence than what is described in the literature. Our patient clinical course was mild, but it remains to be seen whether the shared genetic risk between both diseases predisposes to a more aggressive IBD phenotype.

celiac disease ; ulcerative colitis ; comorbidity ; long-term

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