S1422 A Concomitant Celiac Disease Diagnosis Does Not Worsen Clinical Outcomes of Inflammatory Bowel Disease
Bibliographic record
Abstract
Introduction: Inflammatory bowel disease (IBD), Crohn’s disease (CD) and ulcerative colitis (UC), and celiac disease (CeD) are all characterized by inflammation of the gastrointestinal tract. A small subset of IBD patients is also diagnosed with CeD, though it is unclear what impact having a secondary diagnosis of CeD will have on a patient’s IBD presentation and disease course. The aim of this study is to determine the distinct and shared characteristics and clinical features of patients with UC, CD, and a dual diagnosis of CeD-UC or CeD-CD. Methods: A retrospective chart review of patients with UC, CD, and CeD-IBD from The Mount Sinai Hospital was performed. Charts were reviewed to ensure a 1:1:1 ratio of patients in each group. Inclusion criteria included any individual with UC or CD confirmed by histology and CeD patients confirmed by serology and biopsy with a concomitant diagnosis of IBD confirmed by histology. Patients were excluded if data from the initial diagnosis was missing. Results: A total of 38 CeD-IBD patients (53% female), 38 UC patients (55% female), and 38 CD patients (50% female) were evaluated. A higher proportion of CeD-IBD patients had CD (73.7%) compared to UC (26.3%). Mean age was highest in CD patients at 36.7. Mean age at diagnosis was highest in CeD-UC patients (33.9 years) compared to CeD-CD (20.3 years), UC (27.7 years) and CD (24.7 years). Family history of Celiac disease was significantly higher in patients with a dual diagnosis. Diarrhea, abdominal pain, extra intestinal symptoms, and bloody stools were the most common presenting symptoms in all cohorts. Patients with UC and CD has statistically higher rates of bloody stools compared to CeD-IBD patients. Need for biologic therapy was similar between UC (68.4%), CD (71.0%) and CeD-IBD (71.0%). The percentage of patients with stricturing or penetrating disease was significantly higher in CD (55.2%) than CeD-IBD (14.2%). Extensive UC involvement of the colon was higher in the UC cohort (65%) compared to the CeD-IBD cohort (40%). Conclusion: The concomitant diagnosis of CeD with IBD does not worsen the severity of either UC or CD. At a tertiary IBD referral center, CeD does not increase the rates of stricturing or penetrating CD and does not increase extent of colonic involvement in UC. Similar rates of biologic use among groups suggest a comparable IBD disease course between all cohorts (see Table 1). Table 1. - Characteristics of Patients with Inflammatory Bowel Disease, Ulcerative Colitis or Crohns, and Dual Disease of Inflammatory Bowel Disease and Celiac Disease UC Crohns CeD+IBD P-value Number of Patients 38 38 38 UC 10 (26.3) CD 28 (73.7) CeD 38 Number of Males (%) 19 (50.0) 17 (44.7) 18 (47.2) 0.89 Number of Females (%) 19 (50.0) 21 (55.2) 20 (52.6) Mean Age 35.9 36.7 31.3 0.23 Race (%) 0.61 White 27 (70.1) 23 (60.5) 29 (76.3) Black 1 (2.6) 2 (5.3) 0 Asian/Pacific Islander 1 (2.6) 0 1 (2.6) Hispanic 0 1 (2.6) 0 Other 9 (23.7) 12 (31.5) 9 (23.6) Mean BMI at Dx 23.19 22.57 21.88* 0.47 Mean Age (Median) at Dx 27.67 (26.0) 24.71 (21.8) UC 33.89 (28.9) 0.28 CD 20.33 (16.4) 0.19 CeD 23.04 (18.4) Family History (%) Autoimmune 3 (7.9) 2 (5.3) 3 (7.9) 0.01 Celiac 0 (0) 1 (2.6) 7 (18.4) 0.45 IBD 6 (15.7) 12 (31.5) 5 (13.1) 0.01 Symptoms at Presentation, n 0.13 Diarrhea 29 23 20 0.72 Nausea 5 8 8 0.53 Vomiting 3 8 5 0.29 Abdominal Pain 23 33 24 0.35 Bloody Stools 27 12 11 0.03 Constipation 8 1 6 0.08 Weight Loss 7 13 12 0.24 Bloating 6 3 5 0.58 Extra-Intestinal Symptoms 16 19 10 0.40 Unknown 0 0 1 0.31 No Symptoms 1 1 1 0.99 History of Prior GI infection 4 0 2 .12 Mean (Median) Time Between Infection and Dx in Days 43 (43) 16 (16.5) < 0 .001 UC 0 CD 33 Biologic Use (%) 26 (68.4) 27 (71.0) 27 (71.0) 0.96 Montreal Classification, n E1 0 2 0.01 E2 13 3 E3 25 4 S0 0 0 S1 19 5 0.91 S2 11 2 S3 8 2 A1 12 16 0 .04 A2 21 7 A3 5 2 L1 15 8 0.57 L2 4 6 L3 19 11 L4 4 2 B1 27 21 0.57 B2 5 2 B3 6 1 B4 0 1 p 10 2 0.16 Penetrating Disease (%) 55.2 14.2 0.018 Paninvolvement (%) 65.0 40.0 0.43 History of T- Cell Lymphoma 0 0 0 CeD: Celiac Disease; UC: Ulcerative Colitis; CD: Crohn's Disease; IBD: Inflammatory Bowel Disease; GI: Gastrointestinal; BMI: Body Mass Index; Dx: Diagnosis; n: number * BMI at first diagnosis of CD, CeD, or UC.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".