CELIAC DISEASE

Abstract

Purpose: Celiac disease (CD) is an inflammatory disease of the small intestine. Because the erythrocyte sedimentation rate (ESR) is a marker of inflammation, we evaluated whether there was a difference in ESR before diagnosis of CD and after treatment with a gluten-free diet (GFD). Methods: A database at a CD referral center was analyzed. Biopsy-proven patients with CD who had ESR values measured priorto and after a GFD were assessed. Patients were divided into two groups based on ESR value priorto the initiation of a GFD: ESR >50 and ESR <50. The mean change in ESR pre- and post-GFD was calculated for each group. In addition, hemoglobin (Hg) levels, small bowel biopsy and celiac antibody titers were also analyzed. Results: Of 590 patients, 74 had both pre- and post-GFD ESR values. In this group as a whole, the mean ESR pre-diagnosis was 29.1 ± 35.6 and post-diagnosis was 14.9 ± 17.4 (p = 0.001) with corresponding Hg values of 12.9 ± 1.2 g/dL and 13.2 ± 1.3 g/dL (p = 0.012). In the subgroup of 14 patients with ESR >50, pre-diagnosis ESR was 91.7 ± 35.8 (range 50–154) while ESR after GFD was 20.5 ± 18.9 (p = 0.0001). Corresponding Hg values were 11.7 ± 1.0 g/dL and 12.9 ± 1.6 g/dL (p = 0.02). In the remaining 60 patients with ESR <50, mean pre-diagnosis ESR was 14.5 ± 12.0 and post-diagnosis ESR was 13.6 ± 17.0 (p = 0.725); corresponding Hg values were 13.1 ± 1.2 g/dL and 13.3 ± 1.3 g/dL (p = 0.093). The fall in ESR was accompanied by an improvement in histology and decrease in antibody titer. Conclusions: This study indicates that CD is an inflammatory bowel disease with systemic inflammatory manifestations as evidenced by elevation of the ESR, including values >100. The ESR decreases on a GFD concomitant with improvement in Hg level, histology and antibody titer. Therefore, CD should be considered in the differential diagnosis of an elevated ESR.Table: Pre and Post Diagnosis ESR Values and Hg Levels in Patients with CD