THE RISK OF INFLAMMATORY BOWEL DISEASE IS INCREASED IN CELIAC DISEASE BUT NOT IN DERMATITIS HERPETIFORMIS - 23/04/26

Doi : 10.1016/j.clinre.2026.102834

Reeta Pitkänen ¹, Camilla Pasternack ^1,², Teea Salmi ^1,², Kaisa Hervonen ^1,², Inka Koskinen ^1,³, Pia Oksanen ^4,⁵, Heini Huhtala ⁶, Timo Reunala ¹, Katri Kaukinen ^1,⁷, Rakel Nurmi ^1,^7,^⁎

¹ Celiac Disease Research Center, Tampere University, 33014, Tampere, Finland

² Department of Dermatology, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, 33520, Tampere, Finland

³ Department of Gastroenterology, Hospital Nova of Central Finland, 40620, Jyväskylä, Finland

⁴ Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, 33520, Tampere, Finland

⁵ Faculty of Medicine and Life Sciences, Tampere University, 33014, Tampere, Finland

⁶ Faculty of Social Sciences, University of Tampere, 33014, Tampere, Finland

⁷ Department of Internal Medicine, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, 33520, Tampere, Finland

^⁎ Corresponding author: Rakel Nurmi, Celiac Disease Research Center, Faculty of Medicine and Health Technology Tampere University, FI–33014 Tampere (Finland), Tel: +358 03 311 611 Celiac Disease Research Center Faculty of Medicine and Health Technology Tampere University Tampere FI–33014 Finland

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Highlights

•	Celiac disease is associated with an increased risk of IBD.
•	The risks of Crohn’s disease and colitis ulcerosa were equally increased in celiac disease.
•	No similar increase in IBD risk was seen in DH.
•	Consideration of IBD is advised when managing patients with celiac disease.

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Abstract

Background

Although an association between celiac disease and inflammatory bowel disease (IBD) has been recognized, there remains limited research on the subject. Comorbidities vary between the phenotypes of celiac disease, but the risk of IBD in the extraintestinal manifestation of celiac disease, dermatitis herpetiformis (DH), has been previously studied mainly through case reports. This study aimed to compare the risk of IBD between celiac disease and DH patients and references.

Methods

The study population consisted of 1,072 celiac disease and 368 DH patients with biopsy-proven diagnosis performed between 1969 and 2000. Three reference individuals matched for age, sex, and place of residence were taken from the population register for each patient. Cox proportional hazards model was used for assessing the risk for the diseases studied.

Results

The risk of IBD was higher in celiac patients than in the references (HR 2.77, 95% CI 1.81–4.26), with heightened risk in both ulcerative colitis (HR 2.73, 95% CI 1.71–4.83) and Crohn’s disease (HR 2.54, 95% CI 1.19–5.43). The risk of IBD did not differ statistically between DH patients and their references (HR 1.72, 95% CI 0.75–3.93).

Conclusion

Celiac disease is associated with an increased risk of IBD. The risks of Crohn’s disease and ulcerative colitis were equally increased. A smaller but not statistically significant increase was observed in DH. It is advisable to consider the possibility of IBD when managing patients with celiac disease.

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Key words : comorbidity, gut, Crohn’s disease, ulcerative colitis