Celiac-associated peptic disease at upper endoscopy: how common is it?
OBJECTIVE
Recently, several publications in adults have shown an increased incidence of non-Helicobacter pylori (HP), non-non-steroidal anti-inflammatory drug (NSAID) peptic disease (PD). There are only a few case reports linking celiac disease (CD) to PD. We therefore aimed to review our experience of CD presenting with PD.


METHODS
We retrospectively reviewed all the endoscopies performed for children and young adults diagnosed with CD between 1 January, 2004 and 31 October, 2008. The diagnosis of CD was based on accepted guidelines. Patients with a doubtful diagnosis of CD were excluded.


RESULTS
We had 240 patients with the diagnosis of CD. We had 29 (12.0%) patients [15 males (52%), 14 females (48%)] for whom the diagnosis of PD was ascertained. The age range was 1-50 years (mean 16.9 +/- 12.1 years). Twenty-three of the 29 patients (79%) were HP-negative. Duodenal PD was noted in 22 patients (76%) and 16 (73%) were HP-negative. Gastric PD was noted in eight patients (28%) and 7 (87%) were HP-negative. The PD group was significantly older at diagnosis (p < 0.001) compared to the whole CD group.


CONCLUSIONS
PD is not uncommon in the presentation of CD. It is more likely to be found in the second decade of life. CD should be included in the differential diagnosis of patients with non-HP PD and we suggest routine CD serology and small bowel biopsy in patients with unexplained PD.
Levine
Arie
A
Pediatric Gastroenterology Unit, E Wolfson Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Domanov
Svetlana
S
Sukhotnik
Igor
I
Zangen
Tsili
T
Shaoul
Ron
R
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002446:Celiac Disease / Q000150:complications* / Q000175:diagnosis* / Q000178:diet therapy / Q000188:drug therapy / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D055050:Diet, Gluten-Free; D004359:Drug Therapy, Combination; D004381:Duodenal Ulcer / Q000175:diagnosis; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis* / Q000178:diet therapy / Q000188:drug therapy / Q000453:epidemiology; D016480:Helicobacter pylori / Q000302:isolation & purification; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007223:Infant; D007421:Intestine, Small / Q000473:pathology; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000150:complications / Q000175:diagnosis* / Q000178:diet therapy / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011899:Ranitidine / Q000627:therapeutic use; D012189:Retrospective Studies; D013276:Stomach Ulcer / Q000175:diagnosis; D016896:Treatment Outcome
D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D011899:Ranitidine