The Link Between Celiac Disease and Anorexia

By: Rebecca Reidel

Celiac disease is an immune disease in which gluten damages the small intestines causing pain and irritability. 1 Considering gluten is found in many foods, such as wheat, rye, and barley, people with celiac disease (CD) must pay close attention to their diets. On another note, anorexia nervosa (AN) is an eating disorder that causes weight loss from a decreased consumption of food, therefore a reduced caloric intake. The causes of AN are not known, however, many factors are thought to be involved, such as genes, hormones, and social attitudes.2 Interestingly enough, recent studies have shown that CD and AN have been linked.

In the past, data showing that CD and AN are linked has mostly been case reports, researchers sought to find answers that aimed to determine their association through a cohort, case-control study. The researchers accessed records from Sweden’s 28 pathology departments for 17,959 cases of small intestinal biopsy-verified CD in women from 1969 through 2008 and 89,379 sex- and age-matched population-based controls.3 They also identified AN cases through inpatients and outpatient records.

Researchers found that 42 patients with CD were diagnosed with AN and the hazard ratio for later AN was 1.46 (95% confidence interval [CI], 1.08-1.98) and 1.31 beyond the first year after CD diagnosis.4 The study concludes that the association between CD and AN should be considered when evaluating the first assessment because there is potential for misdiagnosis or underdiagnoses when dealing with these two conditions. This is partly due to an overwhelmingly high number of similar symptoms, such as abdominal pain, bloating, diarrhea, and weight loss.

The researchers hypothesize three possible explanations for the bidirectional findings of this study which include:

  • CD may have been misdiagnosed earlier as AN, or vice versa;
  • Closer scrutiny of patients diagnosed with one condition may have led to a surveillance bias in detecting the second condition; and
  • A shared genetic susceptibility may have increased the risk of developing both conditions.3

Understanding how CD effects the body allows us to evaluate how patients with CD plan their meals, and therefore this can have a potential cause-and-effect relationship in the long-term with AN patients’ eating patterns. Although there is more research to be done, there is no denying that these very separate conditions can indeed be linked.


References

  1. Celiac disease.https://medlineplus.gov/celiacdisease.html. Accessed Jun 10, 2017.
  2. Anorexia nervosa.https://www.mentalhealth.gov/what-to-look-for/eating-disorders/anorexia/index.html. Accessed Jun 10, 2017.
  3. Celiac disease and anorexia nervosa linked, study shows. Medscape Web site.http://www.medscape.com/viewarticle/878092. Accessed Jun 13, 2017.
  4. Karl Mårild, Ketil Størdal, Cynthia M Bulik, et al. Celiac disease and anorexia nervosa: A nationwide study.Pediatrics. 2017;139(5):E20164367.

 

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