(P065) PATIENTS WITH OVERLAP OF INFLAMMATORY BOWEL AND CELIAC DISEASE HAVE A HIGHER PREVALENCE OF AUTOIMMUNE DISORDERS AND AN INCREASED USE OF IMMUNOMODULATORS AND BIOLOGICS COMPARED TO SUBJECTS WITH INFLAMMATORY BOWEL DISEASE ALONE

Background: A small fraction of Inflammatory bowel disease (IBD) subjects have celiac disease (CeD). We conducted a retrospective case-control study to compare disease characteristics of subjects with IBD vs IBD+ CeD.

Methods: A retrospective study was conducted from January 2017 to June 2022 using appropriate ICD-10 codes for IBD and CeD. Data was collected including demographics, disease phenotype, and medication use patterns. Disease groups included IBD, IBD+ CeD with subgroup analyses being further performed as follows: Crohn’s disease (CD), CD+ CeD, ulcerative colitis (UC), UC+ CeD.

Results: Females consisted of 59% of IBD (N=72) and 64% of IBD+ CeD (N=36) (p=0.62). Median age at diagnosis of IBD was 24.5 years in the IBD+CeD group compared to IBD group (43.5 years), p=0.003. Median duration of IBD since IBD diagnosis was longer (IBD:16.4 yrs vs IBD +CeD: 8.4 yrs, p< 0.001) with the age at the end of study being older in IBD subjects (64 yrs) vs. IBD+ CeD (34 yrs), p< 0.001. Subgroup analysis (Table 1) based on Montreal classification revealed a higher prevalence of A2 in CD+ CeD (56%) vs CD (24%) and A3 in CD (68%) vs CD+ CeD (22%), p=0.007. There was a higher prevalence of autoimmune conditions in the IBD+ CeD group (27%) in comparison to IBD group (6.9%), p< 0.003 with rheumatoid arthritis (RA) and thyroiditis occurring more commonly in the IBD+ CeD group (Fig 1). Immuno-modulator and biologic use (anti-TNF, anti-integrin and anti-IL12/23) use was significantly higher in the UC+ CeD group at 33%, 39%, 33%, 11% respectively when compared to 10%, 6.5%, 3.2% and 3.2% in UC subjects (p < 0.05 to < 0.001). Immuno-modulator and biologic use (anti-integrin and anti-IL12/23) use were significantly higher in the CD+ CeD group at 50%, 33%, and 33% respectively when compared to 24%, 2.4%, and 10% in CD subjects (p < 0.05 to < 0.001). 

Conclusions: The prevalence of autoimmune diseases, especially autoimmune thyroiditis and RA is higher in IBD+ CeD subjects with a greater preponderance in UC+ CeD. Further, IBD+ CeD subjects tend to be younger at disease onset than subjects with IBD alone. Use of steroids and escalation to biologics is more common in IBD+ CeD subjects than IBD subjects. These findings should encourage clinicians to assess younger IBD patients for CeD and autoimmune conditions including thyroiditis and RA. Further, early use of biologics may become necessary in this subset of IBD patients.