title: Association of adult celiac disease with surgical abdominal pain: a case-control study in patients referred to secondary care.
abstract: BACKGROUND
  Acute abdominal pain is the most common indication for surgical admission. Nonspecific abdominal pain (NSAP) may account for up to 40% of cases. There has been no published prospective study in which adult patients presenting with acute abdominal pain are investigated for celiac disease.
  
  
  OBJECTIVE
  We aimed to assess the association of celiac disease with surgical abdominal pain.
  
  
  METHODS
  A case-control study was undertaken involving 300 consecutive new unselected patients presenting with acute abdominal pain (in a university hospital) and healthy controls (age and sex matched) without abdominal pain (n = 300). Initial investigations for celiac disease were immunoglobulins, IgA/IgG anti-gliadin (AGA), and endomysial antibodies (EMA). Any patient with a positive IgA AGA, EMA, or only IgG AGA in the presence of IgA deficiency was offered a small bowel biopsy to confirm the diagnosis.
  
  
  RESULTS
  : There were 33 patients with abdominal pain who had positive antibodies, of whom 9 had histologically confirmed celiac disease (6 EMA positive; 3 EMA negative). One antibody positive patient (EMA in isolation) declined duodenal biopsy and the remaining 23 had normal duodenal mucosa. Within the control group, there were 2 cases of celiac disease. Compared with matched controls the association of acute abdominal pain with celiac disease gave an odds ratio 4.6. (P = 0.068, 95% confidence interval, 1.11-19.05). When only considering NSAP the prevalence of celiac disease was highly significant at 10.5% (9 of 86, P = 0.006). Patients' symptoms improved on a gluten-free diet at 12- to 18-month follow-up.
  
  
  CONCLUSIONS
  Celiac disease was diagnosed in 3% of patients who presented with unselected acute abdominal pain to secondary care. Targeting patients who have NSAP or celiac associated symptoms/diseases may improve the diagnostic yield.
authors.affiliation: Department of General Surgery, Royal Hallamshire Hospital, Sheffield, UK. d.s.sanders28@btopenworld.com
authors.forename: David S
authors.initials: DS
authors.lastname: Sanders
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Hopper
authors.forename: Iman A F
authors.initials: IA
authors.lastname: Azmy
authors.forename: Nahida
authors.initials: N
authors.lastname: Rahman
authors.forename: David P
authors.initials: DP
authors.lastname: Hurlstone
authors.forename: John S
authors.initials: JS
authors.lastname: Leeds
authors.forename: Rina R
authors.initials: RR
authors.lastname: George
authors.forename: Neeraj
authors.initials: N
authors.lastname: Bhala
mesh_terms: D000006:Abdomen, Acute / Q000209:etiology* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002446:Celiac Disease / Q000150:complications* / Q000175:diagnosis / Q000276:immunology / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies