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AB0843 Relationship between the histological classification of marsh and the affectation of the bone metabolism in patients with a recent diagnosis of celiac disease
  1. L Lόpez1,
  2. M Larrea2,
  3. A Erra1
  1. 1Rheumatology
  2. 2Gastroenterology, Hospital San Rafael, Barcelona, Spain


Background Celiac disease is a chronic autoimmune pathology that affects people with genetic predisposition, caused by a permanent intolerance to gluten. Its prevalence has been estimated at around 1% but about 30% of patients are diagnosed after age 60.Its diagnosis is made through clinical data, serological markers, study of duodenal biopsy (BD) and response to the gluten-free diet. The histological study (Marsh classification) remains the gold standard to the diagnosis and allows classification of the disease in 4 types: grade I (less histological lesion) to grade IV (total duodenal mucosal atrophy).In these patients the deficiency of 25-OH vitamin D (vit D) is very frequent and is one of the causes of osteomalacia associated with malabsorption.

Objectives To evaluate if there is a relation between the histological classification of Marsh and the bone metabolism in patients with a recent diagnosis of celiac disease.

Methods Prospective study, which included all patients with a recent diagnosis of celiac disease by the Digestive Service during the period 2014–2016. This diagnosis was made through a clinical, serological (anti-transglutaminase IgA, anti-endomysium IgA), histological BD and genetic study (HLA DQ2 and HLA DQ8).

All patients underwent a study of phospho-calcium metabolism including: calcemia, phosphataemia, vit D, PTH, alkaline phosphatases, 24-hour calciuria and a densitometric study (BMD). We present the inclusion data of these patients

Results 15 patients were included: 11 women and 4 men, with a mean age of 42.2 years (SD+/-16)

The genetic study was performed in 12 patients: 75% were positive for HLA DQ2 and 25% for HLA DQ8.

The determination of antibodies was positive in 12 patients (73%) and negative in 3 (27%). These 3 were positive for the genetic study (2 HLA DQ2 and 1 HLA DQ8).

The study of BD showed: type I in 4 patients; Type IIIa in 2 patients; Type IIIb in 6 patients; Type IIIC in 3 patients.

BMD showed normal values in 33%, osteopenia in 47% and osteoporosis (OP) in 20% of patients. Thus, 67% had an alteration in BMD at the time of diagnosis.

100% had a Vit D deficit, with a mean value of 14.3 ng/mL (range 4.15–26.8). 75% of them had values below 20 ng/mL (40% less than 10 ng/mL).

40% had secondary hyperparathyroidism (SHP), 83% of which had an alteration in BMD (67% osteopenia and 16% OP). The BD of the patients with SHP and alteration of the BMD showed a histological pattern type Marsh III.

No patient presented an alteration in the values of calcemia, phosphataemia or calciuria.

The relationship between the degree of alteration in BMD and the Marsh classification (table) was studied.

72% of patients with a Marsh III had an alteration in BMD (3 OP and 5 osteopenia vs 3 normal).

Conclusions Most patients with celiac disease have an alteration in BMD.

In our study, all patients with celiac disease had a Vit D deficiency with no alteration of calcemia or calciuria.

Only in patients with SHP, there is a correlation between alterations in BMD and a higher degree of Marsh.

Most patients with a histological Marsh III have abnormalities in BMD.

Disclosure of Interest None declared

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