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Gastrointestinal Ulceration in Celiac Disease

Yuksekkaya, Hasan*; Gümüs, Meltem*; Egritas, Odul; Esen, Hasan*

Journal of Pediatric Gastroenterology and Nutrition: June 2013 - Volume 56 - Issue 6 - p e52–e53
doi: 10.1097/MPG.0b013e31827a7c60
Letters to the Editor

*Necmettin Erbakan University, Konya

Gazi University School of Medicine, Ankara, Turkey

To the Editor:

We read the letter by Galloway et al (1) with interest. The authors evaluated associated ulcerative duodenitis in a patient with celiac disease. They demonstrated multiple ulcers of the duodenal bulb and the second part of the duodenum and attributed these ulcers to celiac disease; however, they do not mention the use of nonsteroidal anti-inflammatory drugs (NSAIDs). We would like to add our experience of 7 children with celiac disease and gastric, duodenal, and jejunoileal ulcers alongside Galloway et al's study (1).

Between February 2009 and April 2012, we evaluated 96 children with celiac disease. We performed upper gastrointestinal endoscopy, colonoscopy, and/or capsule endoscopy at time of diagnosis. Endoscopy demonstrated multiple ulcers of the duodenal bulb and second part of the duodenum in 4 children, the prepyloric region in 1, the gastric corpus in 1, and the jejunoileal region in another (Fig. 1 A–D). Histopathological examination revealed Helicobacter pylori in 2 of these 7 cases. Histories revealed that all of the patients used NSAIDs, except for 1 with duodenal bulb ulcers. The characteristics of patients with gastrointestinal ulcers in celiac disease are shown in Table 1.





Ulceration of the duodenal bulb was described in association with celiac disease in children (2,3), although these ulcerations are a result of the use of NSAIDs rather than being related to celiac disease. Stomach and jejunoileal ulcers can be seen in celiac disease as well as duodenal ulcers. Because abdominal pain usually occurs in celiac disease, it needs to be established whether these patients use NSAIDs.

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1. Galloway D, Pasternak B, Garg S, et al. Multiple duodenal ulcers: an unexpected finding in celiac disease. J Pediatr Gastroenterol Nutr 2013; 56:e21.
2. Mones RL, Mercer GO. Ulcerative duodenitis in a child with celiac disease. J Pediatr 2011; 158:857.
3. Eltumi M, Brueton MJ, Francis N. Ulceration of the small intestine in children with coeliac disease. Gut 1996; 39:613–614.
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