Background:
Celiac Disease and Crohn’s Disease are immune-mediated gastrointestinal disorders with overlapping features including abdominal pain, diarrhea, extraintestinal manifestations, and growth failure, which may obscure recognition of concomitant disease. Persistent symptoms in patients with Celiac Disease are often attributed to gluten exposure or nonresponsive disease, potentially delaying diagnosis of Inflammatory Bowel Disease. We describe three pediatric patients diagnosed with concomitant Celiac Disease and Crohn’s Disease during initial evaluation.
Case Series:
In early 2025, three females presented with findings concerning for both Celiac Disease and Crohn’s Disease. The first was a 15-year-old with abdominal pain and hematochezia, found to have elevated tTG IgA and fecal calprotectin. Duodenal biopsies demonstrated villous blunting, while colon biopsies revealed granulomatous inflammation consistent with Crohn’s disease.
The second patient, an 11-year-old with abdominal pain and poor weight gain, had elevated celiac serologies with markedly elevated calprotectin in the setting of a prior history of perianal abscess requiring Seton placement. Duodenal biopsies showed villous blunting and increased intraepithelial lymphocytes, while ileocolonic biopsies demonstrated severe active ileitis with ulceration and granulomas consistent with Crohn’s disease.
The third patient, an 11-year-old with nonbloody diarrhea, anemia, and markedly elevated celiac serologies, initially improved on a gluten-free diet but later developed nocturnal stooling with and found to have a calprotectin of 680. Colonoscopy revealed chronic inflammation and ulceration throughout the colon and terminal ileum, confirming Crohn’s disease.
All three patients were treated with Adalimumab and a gluten-free diet, resulting in clinical remission.
Conclusion:
Although adult studies demonstrate increased risk of Inflammatory Bowel Disease after diagnosis of Celiac Disease, pediatric reports remain limited, particularly for the diagnoses occurring concurrently. These cases highlight that both conditions may present simultaneously during initial evaluation and pediatric gastroenterologists should maintain suspicion for concomitant Inflammatory Bowel Disease in children with Celiac Disease, with persistent symptoms despite gluten restriction.