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 In a nationwide study, a diagnosis of anorexia nervosa was more
likely both before a celiac disease diagnosis, and afterward.
“Before this study, there have been published a few small `case
reports’ of patients with celiac disease developing eating
disturbances after their celiac disease diagnosis,” said lead study
author Dr. Karl Marild, a researcher at the University of Colorado
in Aurora.
“This, however, is the first large study to show an association
between celiac disease and anorexia nervosa,” Marild said by email.
Anorexia nervosa is an emotional disorder that involves an obsessive
desire to lose weight by refusing to eat. Celiac disease is an
autoimmune disorder in which consumption of the gluten protein in
wheat, barley or rye leads to damage of the small intestine and
problems with absorption of nutrients from food.
The two disorders sometimes share similar symptoms, like fatigue,
abdominal problems, discomfort after eating, excessive weight loss
and an inability to absorb certain nutrients.
For the study, researchers examined data collected from 1987 through
2009 on almost 18,000 Swedish women diagnosed with celiac disease
and roughly 89,000 women around the same age who didn’t have the
autoimmune disorder.
After a celiac disease diagnosis, women were 46 percent more likely
to be diagnosed with anorexia nervosa, researchers report in
Pediatrics. After an anorexia diagnosis, women had twice the odds of
a later diagnosis of celiac disease.
More specifically, each year during the study period, a new
diagnosis of anorexia nervosa was made in about 0.03 percent in
women with a diagnosis of celiac disease, compared to about 0.02
percent in women without celiac disease.
Also, the researchers report, nearly 0.2 percent of women with
celiac disease had been previously diagnosed with anorexia nervosa,
compared to only about 0.1 percent of women in the study who didn’t
have celiac disease.
The study wasn’t a controlled experiment designed to prove that
celiac disease causes anorexia, or that the reverse is true, the
authors note.
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It’s possible that at least some patients were initially
misdiagnosed with one disease when they had the other disorder, the
researchers point out. At least some of the overlap in diagnoses of
both conditions might be explained by what’s known as “surveillance
bias,” or the fact that women being closely monitored due to one
issue with eating might be more likely to be evaluated for another
food-related health problem.
In addition, dietary restrictions prescribed for celiac disease
might trigger an obsessive eating pattern that leads to anorexia,
Marild said.
The potential for misdiagnosis may be particularly important in
treating teens, Dr. Neville Golden, an adolescent medicine
researcher at Stanford Children’s Health in California writes in an
accompanying editorial.
“Both celiac disease and anorexia nervosa may have similar symptoms:
abdominal discomfort after eating, a feeling of fullness, changes in
bowel habits and weight loss,” Golden said by email. “So the correct
diagnosis may not always be clear.”
With either diagnosis, it’s important that patients see a
specialist, said Alice Bast, chief executive officer of Beyond
Celiac, a patient advocacy organization.
“The higher level of scrutiny by informed healthcare providers may
unearth problems that might fly under the radar otherwise,” Bast,
who wasn’t involved in the study, said by email.
SOURCE: http://bit.ly/2nU0w64 Pediatrics, online April 3, 2017.
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