Eye disorders in patients with celiac disease and inflammatory bowel disease: A study using clinical data warehouse

Abstract

Background and aim:

To analyze the prevalence of ophthalmic manifestations in patients with celiac disease, Crohn’s disease and ulcerative colitis in Munich/Germany.

Methods:

A total of 272,873 patients of Ludwig Maximilians Universitat Ophthalmological Hospital with eye disease were evaluated between 2003 and 2019. The International Classification of Diseases, 10th revision (ICD-10) of celiac disease Crohn’s disease, ulcerative colitis, and all medical records which had the diagnosis of these diseases were analyzed.

Results:

A total of 272,873 patients were analyzed, with a mean age of 53 years, with approximately 48% female patients, and 51% male patients. We selected 72 patients with celiac disease (68% women and 32% men), with a minimum age of 8 years, maximum of 103 years, and an average of 52 years. The most common diagnoses were dry eye (32%) and cataract (12%). The mean intraocular pressure of patients with celiac disease was 15 mmHg. During the same study period, 103 patients with Crohn’s disease were analyzed, with an average intraocular pressure of 14 mmHg.The minimum age of the patients was 12 years and a maximum of 93 years with an average age of 55 years, with 57% of females and 43% of males. The most common diagnoses were cataract (22%) and dry eye (19%). During the same study period, 99 patients with ulcerative colitis were analyzed, with an average intraocular pressure of 14 mmHg.The minimum age of the patients was 6 years and a maximum of 96 years, with an average age of 61 years, with 36% of females and 64% of males. The most common diagnoses were cataract (29.2%) and dry eye (12%).

Conclusions:

The main ophthalmological manifestations of patients requiring eye follow-up were dry eye and cataract for all the diseases analyzed, which can be considered as coincident complications. None of the three diseases had increased intraocular pressure. Thus, celiac disease presented a profile of ophthalmological manifestation similar to the other intestinal inflammatory diseases studied.

Keywords

Celiac disease eye inflammatory bowel disease Crohn’s disease ulcerative colitis eye manifestations ocular complications

Get full access to this article

View all access options for this article.

References

Rampertab

Pooran

Brar

, et al. Trends in the presentation of celiac disease. Am J Med 2006; 119: 355.e9–355.14.

Ludvigsson

Leffler

Bai

, et al. The Oslo definitions for coeliac disease and related terms. Gut 2013; 62(1): 43–52.

Tursi

Brandimarte

Giorgetti

, et al. Low prevalence of antigliadin and anti-endomysium antibodies in subclinical/silent celiac disease. Am J Gastroenterol 2001; 96: 1507–1510.

Bai

Brar

Holleran

, et al. Effect of gender on the manifestations of celiac disease:evidence for greater malabsorption in men. Scand J Gastroenterol 2005; 40: 183–181.

Felekis

Katsanos

Kitsanou

, et al. Spectrum and frequency of ophthalmologic manifestations in patients with inflammatory bowel disease: a prospective single-center study. Inflamm Bowel Dis 2009; 15: 29–34.

Vavricka

Schoepfer

Scharl

, et al. Extraintestinal manifestations of inflammatory bowel disease. Inflamm Bowel Dis 2015; 21: 1982–1992.

Thomas

Lin

. Ocular manifestations of inflammatory bowel disease. Curr Opin Ophthalmol 2016; 27: 552–560.

Taylor

McCluskey

Lightman

. The ocular manifestations of inflammatory bowel disease. Curr Opin Ophthalmol 2006; 17: 538–544.

Martins

TGDS

Costa

ALFA

Martins

. Big data use in medical research. Einstein (Sao Paulo) 2018; 16(3): eED4087.

10.

Kortüm

Hirneiß

Müller

, et al. The influence of a specific ophthalmological electronic health record on ICD-10 coding. BMC Med Inform Decis Mak 2016; 16: 100.

11.

Schneeweiss

Avorn

. A review of uses of health care utilization databases for epidemiologic research on therapeutics. J Clin Epidemiol 2005; 58(4): 323–337.

12.

Martins

TGDS

Francisco Kuba

Martins

TGDS

. Teaching ophthalmology for machines. Open Ophthalmol J 2018; 12: 127–129.

13.

Martins

TGDS

Costa

ALFA

. A new way to communicate science in the era of big data and citizen science. Einstein (Sao Paulo) 2017; 15(4): 523.

14.

Apushkin

Fishman

. Improvement in visual function and fundus findings for a patient with vitamin A–deficient retinopathy. Retina 2005; 25: 650–652.

15.

Martins

Costa

Oyamada

, et al. Ophthalmologic manifestations of celiac disease. Int J Ophthalmol 2016; 9(1): 159–162.

16.

Isaia

Casalis

Grosso

, et al. Hypoparathyroidism and co-existing celiac disease. J Endocrinol Invest 2004; 27(8): 778–781.13.

17.

dos Santos Martins

de Azevedo Costa

Sipahi

, et al. Eye disorders in children with celiac disease. Eur J Ophthalmol 2016; 26(4): e83.

18.

Digre

Corbett

. Idiopathic intra cranial hypertension (pseudotumo rcerebri): a reappraisal. Neurologist 2001; 7: 2–67.

19.

Friedman

Jacobson

. Diagnostic criteria for idiopathic intracranial hypertension. Neurology 2002; 59(10): 1492–1505.

20.

Biousse

Bruce

Newman

. Update on the pathophysiology and management of idiopathic intracranial hypertension. J Neurol Neurosurg Psychiatry 2012; 83(5): 488–494.

21.

Soiberman

Stolovitch

Balcer

, et al. Idiopathic intracranial hypertension in children: visual outcome and risk of recurrence. Childs Nerv Syst 2011; 27(11): 1913–1918.

22.

Digre

Warner

. Is vitamin A implicated in the pathophysiology of increased intracranial pressure? Neurology 2005; 64(11): 1827.

23.

Warner

Bernstein

Yemelyanov

, et al. Vitamin A in the cerebrospinal fluid of patients with and without idiopathic intracranial hypertension. Ann Neurol 2002; 52(5): 647–650.

24.

Lewis

Traboulsi

Rothner

, et al. Xerophthalmia and intracranial hypertension in an autistic child with vitamin A deficiency. J Pediatr Ophthalmol Strabismus 2010; 26: 1–3.

25.

Mollazadegan

Kugelberg

Tallstedt

, et al. Increased risk of uveitis in celiac disease: a nationwide cohort study. Br J Ophthalmol 2012; 96(6): 857–861.

26.

Orbach

Amitai

Barzilai

, et al Autoantibodyscreen in inflammatory myopathies high prevalence of antibodies to gliadin. Ann N Y Acad Sci 2009; 1173: 174–179.

27.

Alawneh

Ashley

Carlson

. Neutrophilic myositis as a manifestation of celiac disease: a case report. Clin Rheumatol 2008; 27(Suppl 1): 11–13.

28.

Song

Farber

Bitton

, et al Dermatomyositis associated with celiac disease: response to a gluten-free diet. Can J Gastroenterol 2006; 20(6): 433–435.

29.

Verma

Kroeker

Fedorak

. Adalimumab for orbital myositis in a patient with Crohn’s disease who discontinued infliximab: a case report and review of the literature. BMC Gastroenterol 2013; 13: 59.

30.

Martins

Costa

. Decreased visual acuity secondary to celiac disease. Einstein (Sao Paulo) 2012; 10(3): 389–390.

31.

Pfaender

D’Souza

Trost

, et al. Visual disturbances representing occipital lobe epilepsy in patients with cerebral calcifications and coeliac disease: a case series. J Neurol Neurosurg Psychiatry 2004; 75: 1623–1625.

32.

Ong

Kohane

Cai

, et al. Population-level evidence for an autoimmune etiology of epilepsy. JAMA Neurol 2014; 71(5): 569–574.

33.

Díaz

González-Rabelino

Delfino

. Epilepsy, cerebral calcifications and coeliac disease. The importance of an early diagnosis. Rev Neurol 2005; 40(7): 417–420.

34.

Gumus

Koc

Doganay

, et al. Susceptibility-based differentiation of intracranial calcification and hemorrhage in pediatric patients. J Child Neurol 2015; 30(8): 1029–1036.

35.

Calvani

Parisi

Guaitolini

, et al. Latent coeliac disease in a child with epilepsy, cerebral calcifications, drug-induced systemic lupus erythematosus and intestinal folic acid malabsorption associated with impairment of folic acid transport across the blood–brain barrier. Eur J Pediatr 2001; 160: 288–292.

36.

Labate

Gambardella

Messina

, et al. Silent celiac disease in patients with childhood localization-related epilepsies. Epilepsia 2001; 42: 1153–1155.

37.

Johnson

Dale

Wienholt

, et al. Coeliac disease, epilepsy, and cerebral calcifications: association with TG6 autoantibodies. Dev Med Child Neurol 2013; 55(1): 90–93.

38.

Fasano

Berti

Gerarduzzi

, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med 2003; 163: 286–292.

39.

Cury

Moss

. Ocular manifestations in a community-based cohort of patients with inflammatory bowel disease. Inflamm Bowel Dis 2010; 16: 1393–1396.

40.

Lee

Han

Park

, et al. Ophthalmologic manifestation of inflammatory bowel disease: a review. Korean J Gastroenterol 2019; 73(5): 269–275.

41.

Rutgeerts

. Review article: the limitations of corticosteroid therapy in Crohn’s disease. Aliment Pharmacol Ther 2001; 15(10): 1515–1525.

42.

Curkovic

Egbring

Kullak-Ublick

. Risks of inflammatory bowel disease treatment with glucocorticosteroids and aminosalicylates. Dig Dis 2013; 31(3–4): 368–373.