P221 Celiac disease and autoimmune associations in adults

Abstract

<h3>Introduction</h3> Celiac disease (CD) is a chronic inflammatory enteropathy of autoimmune origin, triggered by the ingestion of gluten in genetically predisposed individuals. The association with other autoimmune diseases (AIDs) is frequent, which makes it necessary to systematically search for them. The aim of our work was to assess the prevalence of these autoimmune diseases in adults with CD, emphasising the importance of screening for them as they are sometimes asymptomatic. <h3>Materials and Methods</h3> This was a retrospective descriptive and analytical study, spread over a period of 26 years from January 1995 to September 2021, and including all adult patients followed for CD in the hepato-gastroenterology department. It should be noted that in all coeliac patients, we systematically looked for the existence of an autoimmune disease or an associated autoimmune marker. Chronic inflammatory bowel disease (IBD) and vasculitis were excluded from our study. The statistical study was carried out using JAMOVI software. A linear regression test was used for univariate analyses, and a significant p was p&lt;0.05. <h3>Results</h3> Of a total of 340 celiac patients, 71 patients had an autoimmune disease associated with celiac disease, a prevalence of 20,9% of cases. The average age was 44. 75 years with extremes ranging from 18 to 79 years. The sex ratio F/M was 2.73 with a clear female predominance in 73.2% (n=52). The diagnosis of celiac disease was based on clinical, serological (positive IgA anti-transglutaminase antibodies) and histological criteria (intraepithelial lymphocytosis &gt; 30% and villous atrophy). The diagnosis of associated autoimmune diseases preceded that of CD in 28.1% of cases (n=20), followed it in 32.9% of cases (n=24), and was concomitant in 39% of cases (n=27). 64 patients had a single associated AD, six patients had two associated AD, and one patient had three associated autoimmune diseases. These autoimmune diseases were mainly autoimmune thyroiditis in 40.8% of the cases (n=29) of which 18 patients were euthyroid, 9 patients hypothyroid and 2 patients hyperthyroid, Gougerot-sjögren syndrome in 15,4% of the cases (n=11), insulin-dependent diabetes type I in 14% of the cases (n=10), autoimmune hepatitis in 9.85% of the cases (n=7) all were type I, immune deficiency in 7% of the cases (n=5), dermatitis herpetiformis in 5.6% (n=4), palmoplantar psoriasis in 5.6% (n=4), hepatic sarcoidosis in 4.2% (n=3), Biermer’s disease in 4.2% (n=3), primary biliary cholangitis in 2.8% (n=2), and in 1.4% (n=1) each of the following ADRs, rheumatoid arthritis, ankylosing spondylitis, autoimmune hypophysitis and vitiligo. All patients followed a well-monitored gluten-free diet (GFD) in addition to the specific treatment of the associated IDA. Young age at diagnosis and female gender were significantly associated with the occurrence of autoimmune thyroiditis in univariate analysis (p&lt;0.01 with 95% confidence interval (0.16-1.19). <h3>Conclusion</h3> Adult celiac disease is often associated with other autoimmune diseases, in our study this prevalence represented 20,9% of cases, dominated by autoimmune thyroiditis. These diseases should be systematically investigated in order to avoid diagnostic and therapeutic delays and to improve prognosis.