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Association of adult celiac disease with surgical abdominal pain: a case-control study in patients referred to secondary care.

Abstract：

BACKGROUND:Acute abdominal pain is the most common indication for surgical admission. Nonspecific abdominal pain (NSAP) may account for up to 40% of cases. There has been no published prospective study in which adult patients presenting with acute abdominal pain are investigated for celiac disease. AIMS:We aimed to assess the association of celiac disease with surgical abdominal pain. PATIENTS AND METHODS:A case-control study was undertaken involving 300 consecutive new unselected patients presenting with acute abdominal pain (in a university hospital) and healthy controls (age and sex matched) without abdominal pain (n = 300). Initial investigations for celiac disease were immunoglobulins, IgA/IgG anti-gliadin (AGA), and endomysial antibodies (EMA). Any patient with a positive IgA AGA, EMA, or only IgG AGA in the presence of IgA deficiency was offered a small bowel biopsy to confirm the diagnosis. RESULTS:: There were 33 patients with abdominal pain who had positive antibodies, of whom 9 had histologically confirmed celiac disease (6 EMA positive; 3 EMA negative). One antibody positive patient (EMA in isolation) declined duodenal biopsy and the remaining 23 had normal duodenal mucosa. Within the control group, there were 2 cases of celiac disease. Compared with matched controls the association of acute abdominal pain with celiac disease gave an odds ratio 4.6. (P = 0.068, 95% confidence interval, 1.11-19.05). When only considering NSAP the prevalence of celiac disease was highly significant at 10.5% (9 of 86, P = 0.006). Patients' symptoms improved on a gluten-free diet at 12- to 18-month follow-up. CONCLUSION:Celiac disease was diagnosed in 3% of patients who presented with unselected acute abdominal pain to secondary care. Targeting patients who have NSAP or celiac associated symptoms/diseases may improve the diagnostic yield.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Sanders DS,Hopper AD,Azmy IA,Rahman N,Hurlstone DP,Leeds JS,George RR,Bhala N

doi

10.1097/01.sla.0000171301.35513.cf

subject

Has Abstract

pub_date

2005-08-01 00:00:00

pages

201-7

issue

eissn

0003-4932

issn

1528-1140

pii

00000658-200508000-00008

journal_volume

242

pub_type

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Association of adult celiac disease with surgical abdominal pain: a case-control study in patients referred to secondary care.