Association of intussusception and celiac disease in adults.
BACKGROUND
Intussusception (IS) is rare in adults. However, the more frequent use of cross-sectional imaging has resulted in an increase in its detection. Because of the reported association with celiac disease, we determined the prevalence of IS among a cohort with celiac disease.


METHODS
An anonymized prospectively maintained celiac disease database and radiological database were reviewed.


RESULTS
Of a total of 880 patients, 14 (age 47 ± 17.5 years; 50% female) had IS that was detected by CT in 10, capsule endoscopy in three, and barium studies in two. The reason for evaluation was abdominal pain in 78% (11/14), whereas in the remainder (3/14) were incidental. IS was the initial manifestation of celiac disease in 57% (8/14). Two patients were found to have lead-point intussusceptions and both had small-bowel adenocarcinoma, and 10/14 had severe villous atrophy (subtotal or total). Among those with established celiac disease, IS was detected early, within 3 years of diagnosis. Follow-up was available for 11 patients, 9 of who adhered strictly to a gluten-free diet, and six had no recurrence. Among all the patients diagnosed with IS on radiologic studies at our institution, 45 were considered to have idiopathic IS. Only two of these patients had evaluation for celiac disease.


CONCLUSIONS
IS occurs in celiac disease. It may be the initial presentation and is associated with abdominal pain. Adenocarcinoma needs to be excluded. The majority of patients do not have recurrent symptoms after adherence to a gluten-free diet. Celiac disease should be considered more frequently when IS is encountered.
Gonda
Tamas A
TA
Division of Digestive and Liver Diseases, Department of Medicine, Celiac Disease Center, Columbia University Medical Center, New York, NY, USA. tg2214@columbia.edu
Khan
Sharif-Uz-Zaman
SU
Cheng
Jian
J
Lewis
Suzanne K
SK
Rubin
Moshe
M
Green
Peter H R
PH
D015746:Abdominal Pain / Q000453:epidemiology / Q000473:pathology; D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology; D000328:Adult; D001284:Atrophy; D001706:Biopsy; D053704:Capsule Endoscopy; D002446:Celiac Disease / Q000453:epidemiology* / Q000473:pathology*; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033162:Incidental Findings; D007414:Intestinal Neoplasms / Q000453:epidemiology / Q000473:pathology; D007443:Intussusception / Q000453:epidemiology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged