Patients With Inflammatory Bowel Disease on Treatment Have Lower Rates of Celiac Disease

Inflamm Bowel Dis. 2022 Mar 2;28(3):385-392. doi: 10.1093/ibd/izab084.


Background: The association between celiac disease and inflammatory bowel disease (IBD) has been studied; however, the impact of IBD therapy on celiac disease is not known. Using a large database, we sought to describe the association of celiac disease and IBD and the impact of IBD treatment.

Methods: We queried a large multicenter database (Explorys Inc.), an electronic health record data aggregate from 26 American health care systems. We identified a cohort of patients with celiac disease and IBD between 1999 and 2020 and conducted a statistical analysis using a multivariate model.

Results: Of the 72,965,940 individuals in the database, 133,400 had celiac disease (0.18%), 191,570 (0.26%) had ulcerative colitis (UC), and 230,670 (0.32%) had Crohn disease (CD). Patients with IBD were more likely to have a diagnosis of celiac disease (odds ratio [OR], 13.680), with a greater association with CD. Treated patients with UC and with CD, respectively, had a lower risk association with celiac disease compared to those not undergoing IBD treatment, specifically corticosteroids (OR, 0.407 and 0.585), 5-aminosalicylates (OR, 0.124 and 0.127), immunomodulators (OR, 0.385 and 0.425), and anti-tumor necrosis factor drugs (OR, 0.215 and 0.242). There was no lower risk association in the vedolizumab group, but there was a higher risk association among the ustekinumab group.

Conclusions: In this large dataset, we showed a bidirectional association between celiac disease and IBD that was stronger with CD. Patients with IBD treated using corticosteroids, 5-aminosalicylates, immunomodulators, or anti-tumor necrosis factor drugs had a lower association with celiac disease. Additional studies are required to determine the underlying mechanisms for IBD therapy-related modification of celiac disease incidence.

Keywords: Crohn disease; biologics; celiac disease; immunomodulators; ulcerative colitis.

Publication types

  • Multicenter Study

MeSH terms

  • Celiac Disease* / complications
  • Celiac Disease* / epidemiology
  • Colitis, Ulcerative* / complications
  • Colitis, Ulcerative* / drug therapy
  • Colitis, Ulcerative* / epidemiology
  • Crohn Disease* / complications
  • Crohn Disease* / drug therapy
  • Crohn Disease* / epidemiology
  • Humans
  • Inflammatory Bowel Diseases* / complications
  • Ustekinumab / therapeutic use


  • Ustekinumab