Confirming the link between celiac disease and IBD

For years, patients, clinicians, and researchers alike have wondered whether there is a link between celiac disease and inflammatory bowel disease (IBD). A new study published in Gastroenterology, one of the most important academic journals in the field, reveals a solid relationship between these two diseases.

We sat down with two of the study authors, Drs. Ines Pinto-Sanchez and Elena Verdú, who are both Crohn’s and Colitis Canada funded researchers, to learn more about their study and what it means for people living with Crohn’s or colitis.

The suspected link
IBD and celiac disease are two chronic inflammatory diseases that share many risk factors and mechanisms. Given the genetic, environmental, and immune mechanisms both diseases share, clinicians have for a long time believed there could be an association. Until now, studies on this link have been too small to draw any conclusive findings and the data has been inconsistent between studies.

Given that the data has been so inconclusive – and the need for greater understanding so great – the leads of this study chose to tackle this research question in the best possible way. They completed a systematic review and meta-analysis of all studies that have been published to date.

Increasing our confidence through research
When it comes to scientific research, numbers are important. In order to confirm any relationship between the diseases, there must be a large number of participants.

A systematic review is like a summary of all the research studies on a topic. For this one, Drs. Pinto-Sanchez and Verdú and their team found all the studies on celiac disease and IBD and summarized them. For a meta-analysis, all the participants from several different studies are pooled together. Instead of having many small studies that give you small confidence in your results, you get a study with a large number of participants, which gives you more confidence in your results.

This whole process took about a year of hard work from a team of researchers including the great effort of Caroline Seiler, a PhD student, and colleagues from the Society for the Studies of Celiac Disease board. 
But it was worth it.

Confirming the link
This study confirms – for the first time – that yes, there is an increased chance of having celiac disease in patients with IBD.

What does this mean for people with IBD? Let’s say, for instance, an IBD patient is in remission but still experiences symptoms like abdominal pain and diarrhea and doesn’t know why. There is a possibility that the symptoms are caused by celiac disease and not by IBD. Confirming that there is an increased chance of having celiac disease if you have IBD will hopefully make it easier for people with IBD to identify the root causes of the discomfort they are experiencing. It will hopefully also make it is easier for people with IBD to be tested for celiac disease.

To Victoria, who lives with both celiac and Crohn’s disease, the findings from this study do not come as a surprise. Having lived with celiac disease for almost twenty years and Crohn’s disease for two, Victoria knows firsthand the challenges of living with two lifelong diseases. Victoria is not alone in being diagnosed with both diseases; and if you are living with celiac and IBD, neither are you.

For clinicians, this meta-analysis provides a foundation for developing future guidelines. Developing a guideline for testing and treating IBD and celiac disease is an intensive process, and studies like this provide crucial evidence. As Dr. Pinto-Sanchez says, “Failing to diagnose either celiac disease or IBD compromises the health of the patient and limits their access to treatment.” 

Moving forward
As is often the case, answering this one question about the link between celiac disease and IBD leads to many more questions. Can people with IBD and celiac disease benefit from gluten-free diets? Does having celiac disease affect the absorption of IBD medications? Should we screen for celiac disease in people with IBD? How common is it to have celiac disease and IBD in Canada?

These are some of the questions Drs. Pinto-Sanchez and Verdú are excited to investigate in the coming months and years. “This study opens so many new avenues,” Dr. Pinto-Sanchez shares.

Victoria, a member of the Crohn’s and Colitis Canada community, is most looking forward to seeing the genetic studies that will be done in the future, linking celiac and Crohn’s disease.

Establishing the foundations for this research
Both Dr. Pinto-Sanchez and Dr. Verdú have been recipients of Crohn’s and Colitis Canada research grants. While Crohn’s and Colitis Canada did not directly fund this study, Drs. Pinto-Sanchez and Verdú credit Crohn’s and Colitis Canada’s support with fueling their passion and commitment to IBD research. “Crohn’s and Colitis Canada’s support of my research has been fundamental in helping me establish a long-term IBD research program,” shares Dr. Verdú.

To the researchers, patients like Victoria are grateful that this research is taking place. The more we know about IBD and celiac disease, the better we can support patients. And to you, the patients, donors, and families, Drs. Pinto-Sanchez and Verdú say “thank you”. As integral members of the IBD community, they will continue to keep answering these research questions.

If you would like to read the original publication of this study, click here.

  • Canada has among the highest incidence rates of Crohn's and colitis in the world.
  • 1 in 140 Canadians lives with Crohn’s or colitis.
  • Families new to Canada are developing these diseases for the first time.
  • Incidence of Crohn’s in Canadian kids under 10 has doubled since 1995.
  • People are most commonly diagnosed before age 30.

Other Areas of Interest