Introduction

There is a paucity of data on mesenteric lymph node cavitating syndrome (MLNCS); a rare complication of coeliac disease, characterized by central necrosis within enlarged mesenteric lymph nodes.

Aims & Methods

A case series of all patients with MLNCS at Sheffield Teaching Hospitals, UK between 2000 and 2022.
A further systematic review using PubMed and Google Scholar for patients with MLNCS and coeliac disease until 2022.

Results

In our case series, 5/6 patients were female (mean age:58 years (SD:14.1 years)). Half of patients presented with weight loss, and all were diagnosed by CT scan. Five patients followed a gluten free diet (GFD) and 3 were still alive 1-6years later, 2 died after 5 and 9 years. One did not follow a GFD and died at 1 year.
From the literature 44 patients were identified with MLNCS (52% female, mean age 52 years (SD:14.0 years)) and 16% had refractory coeliac disease (RCD). Common features were persistent villous atrophy (90%), weight loss (82%) and hyposplenism (80%). Forty followed a strict GFD, and 28 had partial or complete improvement of their symptoms whilst 19 died. Twenty-one were treated with steroids and 12 of them died.
The overall mortality was 44% and associated with cachexia (5), lymphoma (4), and infectious complications (4).

Conclusion

MLNCS was indicative of a poor prognosis and commonly presented with weight loss, hyposplenism, persistent villous atrophy and RCD. An early diagnosis and strict GFD may lead to a better prognosis. The role of immunosuppression is unclear and needs further investigation.

Introduction

Irritable bowel syndrome (IBS) and coeliac disease are common disorders that share overlapping symptoms. In this systematic review and meta-analysis, we aimed to provide up-to-date and comprehensive estimates of the prevalence of coeliac disease in patients with IBS.

Aims & Methods

We searched several databases through January 2025 for studies reporting the prevalence of coeliac disease in patients with IBS. Eligible studies used Rome III or Rome IV criteria for IBS diagnosis and used serological screening with tissue transglutaminase, endomysial antibodies, or deamidated gliadin peptide, and/or confirmatory duodenal biopsies for coeliac disease diagnosis. We used random-effects meta-analysis to estimate the pooled prevalence of seropositive and biopsy-proven coeliac disease with 95% confidence intervals (CI). We calculated pooled odds ratios (ORs) to compare the likelihood of coeliac disease between patients with IBS and controls.

Results

A total of 29 studies comprising 7,209 patients with IBS were included. The pooled seroprevalence of coeliac disease in patients with IBS was 6% (95% CI, 5% - 8%), and the pooled prevalence of biopsy-proven coeliac disease was 2% (95% CI, 2% - 3%). A significant proportion of seropositive patients (15%; 95% CI, 6% - 24%) did not undergo endoscopy and biopsy. Patients with IBS had significantly higher odds of a positive serology than controls (OR 4.42; 95% CI, 2.82 – 6.92). The odds of coeliac disease were similar across genders and IBS subtypes.

Conclusion

Coeliac disease is highly prevalent in patients with IBS, according to the Rome III and Rome IV criteria. A positive diagnosis of IBS should not be made without excluding coeliac disease.

Disclosure

MGS received speaker fees from Thermo Fisher. IA received speaker fees from PrecisionBiotics.

Introduction

Current international guidelines recommend duodenal biopsies to confirm the diagnosis of coeliac disease in adult patients. However, growing evidence suggests that IgA anti-tissue transglutaminase (tTg) antibody levels ≥10 times the upper limit of normal (ULN) can accurately predict coeliac disease, eliminating the need for biopsy. We performed a systematic review and meta-analysis to evaluate the diagnostic accuracy of the no-biopsy approach for the diagnosis of coeliac disease in adults.

Aims & Methods

We systematically searched MEDLINE, EMBASE, Cochrane Library and Web of Science from January 1998 to April 2023 for studies reporting the sensitivity and specificity of IgA-tTG ≥10×ULN against duodenal biopsies (Marsh grade ≥2) in adults with suspected coeliac disease. We used a bivariate random-effects model to calculate the summary estimates of sensitivity, specificity, positive and negative likelihood ratios. The positive and negative likelihood ratios were used to calculate the positive predictive value (PPV) of the no-biopsy approach across different pre-test probabilities of coeliac disease. This study was registered with PROSPERO, number CRD42023398812.

Results

Thirteen studies comprising 10,078 participants from 11 countries were included. The pooled prevalence of biopsy-proven coeliac disease in the included studies was 60% (95% CI, 36% - 84%). The summary sensitivity of IgA-tTG ≥10×ULN was 52% (95% CI, 41% - 62%), and the summary specificity was 100% (95% CI, 98% - 100%). The area under the summary receiver operator characteristic curve was 0.84 (95% CI, 0.77 – 0.89). The PPV of the no-biopsy approach to identify patients with coeliac disease was 68%, 90%, 96%, and 99% if coeliac disease prevalence was 1%, 4%, 10% and 30%, respectively. Between-study heterogeneity was moderate (I²=25%), and additional sensitivity analyses did not significantly alter our findings.

Conclusion

The results of this meta-analysis support the adoption of the no-biopsy approach to diagnose adult patients with coeliac disease in secondary care settings, where the pre-test probability of coeliac disease is high. Biopsy could be avoided in almost one-in-three patients referred to gastroenterology with suspected coeliac disease. Our findings may inform future guidelines for the diagnosis of coeliac disease in adults.