Inflammatory bowel disease and celiac disease: Overlaps and differences

Table 1 Main clinical features associated with inflammatory bowel disease and celiac disease

IBD	CeD
Intestinal mucosal involvement	Intestinal mucosal involvement
Clinical heterogeneity Depending on location and severity	Clinical heterogeneity Depending on degree of gluten sensitivity and amount of gluten ingested
Symptomatic (relapses/remission)	Commonly symptomatic (early onset) Mono or oligosymptomatic (late onset)
Digestive signs or symptoms	Digestive signs or symptoms
Diarrhea (± rectorrhagia) Abdominal pain (less predominant in UC)	Diarrhea Abdominal distension Abdominal pain Constipation Dyspepsia Recurrent vomiting Pyrosis and regurgitation Irritable bowel syndrome with diarrhea predominance
Extraintestinal manifestations	Extraintestinal manifestations
Refractory iron-deficiency anemia Short stature Poor appetite Weight loss (less prevalent and extreme in UC) Sexual maturation delay Pneumopathies Psychological syndromes Joints: arthritis and arthralgias (the most common in both CD and UC) Ocular: acute episcleritis, uveitis, orbital myositis Skin: erythema nodosum, pyoderma gangrenosum Hepatobiliary system: primary sclerosing cholangitis (less predominant in CD), autoimmune hepatitis (unusual) Renal system: ureteral obstruction, hydronephrosis, urinary stones Vascular system: thrombocytosis, hyperfibrinogenemia, elevated factor V–VII, depression antithrombin III Bone: osteoporosis (less predominant in UC)	Refractory iron-deficiency anemia Short stature Failure to thrive Dermatitis herpetiformis Vitamin B12 deficiency Neurological symptoms Menstrual disturbances Bleeding diathesis (malabsorption of vitamin K) Paresthesia, cramps and tetany (hypocalcemia) Hepatobiliary system: hypertransaminasemia Osteopenia, osteomalacia and osteoporosis Edema, ascites and anasarca (hypoproteinemia) Hypopituitarism and adrenal insufficiency Recurrent mouth ulcers
Severe complications	Severe complications
Malnutrition with weight loss and emaciation Fistulae Abscesses Obstruction Perforation Dysplasia and colorectal cancer	(In refractory CeD or in patients who do not follow a GFD) Collagenous CeD Ulcerative jejunitis T cell lymphomas

IBD: Inflammatory bowel disease; CeD: Celiac disease; UC: Ulcerative colitis; CD: Crohn's disease; GFD: Gluten-free diet.