Intussusception in Celiac Disease: is it a common feature in Children?

OBJECTIVE

There are sporadic reports of occurrence of intussusception in celiac disease (CD) but no systematic study yet. We prospectively studied the prevalence and natural history of intussusception in newly diagnosed CD.

METHODS

From January 2010 to October 2013, 150 children, diagnosed to have CD on the basis of positive serology and duodenal biopsy, were recruited in this study. Abdominal ultrasonography was carried out before starting gluten-free diet (GFD) and repeated in those who had intussusception, on day 3 and then weekly till the resolution of intussusception.

RESULTS

The median age was 72 (range, 16-204) months, and 79 (53%) were boys. Diarrhea was the presenting symptom in 119 (79%) cases. A total of 45 intussusceptions were detected in 37 (25%) children. Out of 45 intussusceptions, 95% involved small bowel. All but one had asymptomatic intussusception. On GFD, intussusception resolved spontaneously within 7 days in 65%, within 14 days in 84%, and within 28 days in 92% of cases, and none required surgical or hydrostatic reduction. On univariate analysis, younger age, low weight z score, presentation with diarrhea, abdominal distension, rickets, lower serum albumin, more severe villous atrophy, and refeeding syndrome were more common in children with intussusception. On multivariate analysis, abdominal distension and hypoalbuminemia were found to be significantly associated with intussusception.

CONCLUSIONS

Intussusception is frequently (25%) seen in children with newly diagnosed CD, generally asymptomatic and resolves spontaneously on GFD. It is often associated with more severe disease. Children with CD and intussusception should not be subjected to surgical/radiological intervention.