An infant with both cystic fibrosis and coeliac disease

Cystic fibrosis and coeliac disease: a case report of an unusual association

Coeliac disease (CD) and cystic fibrosis (CF) are well known as the most common causes of chronic intestinal malabsorption in childhood. The coexistence of coeliac disease with cystic fibrosis is uncommon. Here, we describe the case of cystic fibrosis in a patient diagnosed with coeliac disease who failed to respond clinically to a gluten-free diet and had persistent steatorrhea and failure to thrive.

Coagulopathy as initial manifestation of concomitant celiac disease and cystic fibrosis: a case report

Introduction

Celiac disease and cystic fibrosis have many common manifestations, such as malabsorption, steatorrhea and growth failure, and were for many years recognized as one clinical entity. Since their recognition as two separate diseases, their co-existence in a patient has been described sporadically; around 20 cases have been described in the literature. Taking into consideration the incidences of the two diseases, the chance of them occurring together is one in 2,000,000 in the general population.

Case presentation

We describe the case of a five-year-old boy of Turkish ethnicity with both celiac disease and cystic fibrosis, who presented initially with a skin hemorrhage. The diagnosis of celiac disease was made with a positive serum anti-tissue transglutaminase antibody test and the presence of HLA-DQ2 heterodimer, and confirmed on histology with small intestinal villous atrophy. A positive sweat test confirmed the diagnosis of associated cystic fibrosis.

To the best of our knowledge there has been no previous report of this rare presentation of associated celiac disease and cystic fibrosis.

Conclusion

The clinical significance of this case is the consideration of malabsorption with both celiac disease and cystic fibrosis in patients who present with unexplained coagulopathy.

Concomitant cystic fibrosis and coeliac disease: reminder of an important clinical lesson

A 3½-year-old apparently healthy girl with normal development presented with steatorrhoea. Both positive serum anti-tissue transglutaminase antibody levels and an intestinal biopsy were consistent with coeliac disease. A positive sweat test and genetic analysis confirmed cystic fibrosis.

Maldigestion and malabsorption of 13C labelled tripalmitin in gastrostomy-fed patients with cystic fibrosis

BACKGROUND & AIMS

Some patients with cystic fibrosis continue to have excessive losses of stool lipid, despite the use of pancreatic enzyme replacement therapy to improve digestion. The aim of this study was to explore the residual capacity of the gastrointestinal tract to digest and absorb dietary lipid using stable isotopic methodology in ten patients with cystic fibrosis who were gastrostomy fed in comparison to eight healthy children. We sought to test the hypothesis that a reduction in the availability of dietary lipid may arise from malabsorption of the products of digestion, rather than maldigestion alone.

METHODS

All subjects consumed [1,1,1-(13)C] tripalmitin (10mg/kg body weight) with a standardised meal but the patients with cystic fibrosis did not take their habitual pancreatic enzymes. Total enrichment of (13)C was measured by isotope ratio mass spectrometry in stools collected over 3 days. Maldigestion and malabsorption was differentiated by measuring (13)C-label excretion in stool triglyceride and fatty acid fractions, respectively.

RESULTS

The patients with cystic fibrosis had elevated (13)C-label losses in total stools (56.7%, 6.8-77.9%)(median and range; % administered dose), triglyceride (6.6%, 0-31.2%) and fatty acid (16.7%, 3.4-50.3%) fractions compared to healthy children (1.9%, 0-10.9%, P<0.001; triglyceride: 0.2%, 0-0.6%, p<0.01; fatty acid 0.9%, 0-6.5%, P<0.001).

CONCLUSIONS

These results highlight differences between gastrostomy fed patients with cystic fibrosis to both digest and absorb dietary lipid. There is a need to extend these observations and apply this approach to patients both with and without pancreatic enzyme replacement therapy.

Nutritional management in cystic fibrosis--an alternative perspective in gastrointestinal function

The gastrointestinal problems in cystic fibrosis (CF) may limit energy and nutrient availability and also cause symptoms such as abdominal pain and disturbed bowel habit which may further suppress appetite or alter the diet. Taken together this may lead to an inadequate supply of energy and nutrients to meet the nutritional requirements of the individual resulting in restricted growth or weight loss. A failure to optimize the digestive and absorptive capacity of the gastrointestinal tract places greater emphasis upon nutritional management by food intake alone. Practitioners need to focus more on gastrointestinal dysfunction in CF and its impact upon food intake in order to improve the efficacy of nutritional management. Refined stable isotopic tracers allow further exploration of the pathophysiology of the gastrointestinal tract in terms of nutrient availability. In clinical practice, a closer assessment of gastrointestinal function is supported by the use of simple, noninvasive tools which, both objectively and systematically, characterize those patients who have problems.

Cystic fibrosis and coeliac disease: coexistence in two children

Two children, unrelated, in whom cystic fibrosis had been diagnosed at the ages of 14 weeks and 10 months, respectively, were found subsequently to suffer from coeliac disease as well. Both children are responding well to dietary gluten withdrawal and to conventional treatment for cystic fibrosis. It is suggested that cystic fibrosis may predispose to the development of coeliac disease. Therefore, jejunal biopsy may be a useful investigation in the occasional child with cystic fibrosis, who presents with unusual features, and who fails to thrive as well as expected.

Cystic fibrosis and coeliac disease. Report of two cases

Two cases of coeliac disease occurring in children with cystic fibrosis are presented. Both cases had low disaccharidase levels in intestinal biopsies even after 1 year on a gluten-free diet.