P3061 - Pandora’s Box of Gastrointestinal Conditions

Simone A. Jarrett, MD¹, Lisa F. Barrett, DO¹, Yogesh K. Govil, MD, FACG^2
1Einstein Healthcare Network, Philadelphia, PA; ²Einstein GI Associates, East Norriton, PA

Introduction: Chronic diarrhea is a common presentation. While there is a multitude of differentials to consider, we present a case of a middle-aged female with a pandora’s box of gastrointestinal conditions who was eventually diagnosed with Celiac Disease.

Case Description/Methods: A 62-year-old female with a history of asthma, allergic rhinitis, dyslipidemia, and hypertension presented with a 1-month history of non-bloody, straw-colored loose stools associated with abdominal bloating and pain. She denied recent travel, ill contacts, antibiotics, new medication or diet. Physical examination and initial laboratory studies were unremarkable. She underwent a colonoscopy which revealed nonbleeding internal hemorrhoids but was otherwise normal. No biopsies were taken. She continued to have symptoms. Further investigations including stool Clostridium Difficile (C. Diff), calprotectin, fat, elastase, and serum C-reactive protein and tissue transglutaminase IgG were ordered. Results showed markedly elevated fecal calprotectin and positive stool for C diff toxin. She was diagnosed with C. diff colitis and treated with a 10- day course of oral vancomycin. Her diarrhea resolved. However, she continued to experience abdominal pain and bloating. Her serum tissue transglutaminase returned high. She underwent upper endoscopy and biopsies were taken. Gastric biopsies revealed active chronic gastritis and H. Pylori infection as well as lymphocytic gastritis. The duodenal biopsies were consistent with celiac disease. She was treated with quadruple therapy for H pylori and started on a gluten-free diet with resolution of her symptoms. Follow-up endoscopic biopsies showed resolution of H pylori and lymphocytic gastritis while duodenal biopsies showed histological improvement.

Discussion: Our patient had multiple diseases raising suspicion of a common denominator of altered immunity. Celiac disease, a well-known autoimmune disease, remains an uncommon disease with a worldwide prevalence of 1.4% based on serology and 0.7% on biopsy. It is unclear if there is an association of celiac disease with H. Pylori and C. diff infection. H. Pylori is known to trigger autoimmunity thus triggering the celiac disease. Further studies looking at the relationship between H. Pylori and celiac disease should be explored. There have been multiple studies confirming that celiac disease patients have a higher incidence of C. diff infection than other patient populations due to the possibility of altered gut immunity and/or microbiome.


Disclosures:


Simone A. Jarrett, MD¹, Lisa F. Barrett, DO¹, Yogesh K. Govil, MD, FACG². P3061 - Pandora’s Box of Gastrointestinal Conditions, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.