Celiac disease & IBD

Celiac disease & IBD

November 22, 2022

Issue 22

Clinical Question

What is the risk of IBD among celiac disease patients, and vice versa?

Editor’s Bottom Line

Patients with IBD have an increased risk of being diagnosed with celiac disease, just as patients with celiac disease have an increased risk of being diagnosed with IBD. Whether this association reflects increased case finding or common pathophysiology remains to be determined.


Mårild K, Söderling J, Lebwohl B, et al. Association of Celiac Disease and Inflammatory Bowel Disease: A Nationwide Register-Based Cohort Study. Am J Gastroenterol. 2022;117(9):1471–81; https://journals.lww.com/ajg/Abstract/2022/09000.23.aspx


An international group of researchers examined records and histopathology reports from 48,551 people with celiac disease and 83,529 individuals with IBD diagnosed between 1969 and 2016 at one of 28 centers in Sweden. The data were extracted from a national registry. Patients with celiac disease met Marsh 3 histopathological criteria, while IBD was defined by histopathology findings and an International Classification of Diseases (ICD) diagnosis. Individuals with an initial celiac disease diagnosis were a mean 32 years of age at the time of that diagnosis, while those with IBD were a mean 43.8 years of age at diagnosis of IBD.

After an average of 11.7 years of follow-up, 1.6% of patients with celiac disease were diagnosed with IBD. When compared to the 0.4% incidence of IBD among age and sex-matched controls in the general population, the increased incidence among celiac disease patients translated to a nearly four-fold higher risk of a subsequent diagnosis of IBD (Hazard Ratio [HR], 3.91; 95% Confidence Interval [CI], 3.56–4.31). The risk was similarly elevated for developing either Crohn’s disease (CD) (HR: 4.36; 3.72–5.11) or ulcerative colitis (UC) (HR: 3.40; 3–3.85). The risk of IBD was lower among individuals diagnosed with celiac disease during childhood, and a diagnosis of IBD was most likely to occur closer to the initial celiac disease diagnosis.

Among those with an initial diagnosis of IBD, after a mean 11.1 years of follow-up, 0.8% were diagnosed with celiac disease, compared to 0.1% of controls in the general population. That translated to a 5.5-fold increased risk (95% CI, 4.9–6.16), with the risk higher among UC patients (HR: 6.99; 6.07–8.05), but was still elevated among those with CD (HR: 3.31; 2.69–4.06). The highest risk of celiac disease was seen among males and those with pediatric-onset IBD. A celiac disease diagnosis was most likely to occur within one year of IBD diagnosis but still remained elevated after 10 years of follow-up.


Study Design: Retrospective national registry analysis

Funding: Government of Sweden, Karolinska Institutet  

Allocation: Not applicable

Setting: Multicenter

Level of Evidence: 2b