S1656 Celiac Disease and Inflammatory Bowel Disease – Overlap, Presentation, and Management of Co-Existing Disease: A Systematic Review

Introduction: Celiac disease (CeD) and inflammatory bowel disease (IBD) are chronic immune-mediated gastrointestinal disorders with distinct pathophysiology but increasingly recognized clinical overlap. The co-occurrence of CeD and IBD presents unique diagnostic and therapeutic challenges. In this systematic review, we explore the epidemiologic association, diagnostic considerations, and management strategies for patients affected by both CeD and IBD. Methods: An advanced PubMed search was conducted to identify studies with both CeD and IBD published between the years 2004 and 2024. Results: The literature search generated 450 titles for manual review. A total of 44 studies were ultimately included. Eleven studies reported an increased prevalence of CeD in IBD patients, and vice versa, and one study reported against an association. Three studies attributed this overlap to shared genetic susceptibility and common immune pathways. Two studies recommended CeD screening in IBD patients with persistent symptoms, but no studies supported routine screening for either disease in the presence of the other. Eight studies found that patients with both diseases had higher rates of complications and hospitalizations in the setting of increased inflammatory burden. Four studies discussed management strategies, recommending closer follow-up and routine monitoring for micronutrient deficiencies, though none advised preemptive escalation of IBD therapy. Conclusion: Current evidence suggests a 2-fold increased prevalence of CeD among IBD patients and a 5- to ten-fold increased prevalence of IBD among those with CeD. Despite this, universal screening is not recommended. Instead, selective screening may be appropriate in patients with persistent symptoms. Patients with coexisting disease often experience more complex disease courses, requiring close clinical monitoring, strict adherence to a gluten-free diet, and routine screening for micronutrient deficiencies.