Digestive Diseases and Sciences

, Volume 53, Issue 4, pp 977–981 | Cite as

Sarcoidosis in Patients with Celiac Disease

  • Elizabeth Hwang
  • Russell McBride
  • Alfred I. Neugut
  • Peter H. R. GreenEmail author
Original Paper


Purpose Several case reports and European studies have suggested an association between sarcoidosis and celiac disease; however, they have been inconsistent. We therefore analyzed a large cohort of celiac-disease patients to assess this association. Methods An anonymized database of patients with celiac disease was reviewed to determine the number of patients with sarcoidosis. Age- and gender-adjusted standardized morbidity ratios with corresponding 95% confidence intervals (CI) were calculated by comparing results to US-population-derived prevalence data. Results Ten patients were found to have a comorbid diagnosis of sarcoidosis, representing an age- and gender-adjusted standardized morbidity ratio of 36.8 (95% CI 26.7–50.9). Conclusions In this cohort of patients with celiac disease, there was a significantly increased risk of sarcoidosis when compared with the American white population. This further strengthens prior associations that have been made suggesting a shared mechanism behind the etiologies of celiac disease and sarcoidosis.


Celiac disease Sarcoidosis Prevalence Etiology Autoimmunity 


  1. 1.
    Green PHR, Jabri B (2003) Coeliac disease. Lancet 362:383–391PubMedCrossRefGoogle Scholar
  2. 2.
    Gadewar S, Fasano A (2005) Celiac disease: is the atypical really typical? Summary of the National Institutes of Health Consensus Conference and latest advances. Curr Gastroenterol Rep 7:455–461PubMedCrossRefGoogle Scholar
  3. 3.
    Green PHR, Rostami K, Marsh MN (2005) Diagnosis of coeliac disease. Best Pract Res Clin Gastroenterol 19:389–400PubMedCrossRefGoogle Scholar
  4. 4.
    Newman LS, Rose CS, Maier LA (1997) Sarcoidosis. N Engl J Med 336:1224–1334PubMedCrossRefGoogle Scholar
  5. 5.
    Bresnitz EA, Strom BL (1983) Epidemiology of sarcoidosis. Epidemiol Rev 5:124–156PubMedGoogle Scholar
  6. 6.
    Wu J, Schiff KR (2004) Sarcoidosis. Am Fam Physician 70:312–322PubMedGoogle Scholar
  7. 7.
    Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H, Bresnitz EA, Depalo L, Hunnighake G, Iannuzzi MC, Johns CJ, Mclennan G, Moller DR, Newman LS, Rabin DL, Rose C, Rybicki B, Cherniak R, A Case Control Etiologic Study of Sarcoidosis (ACCESS) research group (2001) Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med 164:1885–1889PubMedGoogle Scholar
  8. 8.
    Rutherford RM, Brutsche MH, Kearns M, Bourke M, Stevens F, Gilmartin JJ (2004) Prevalence of coeliac disease in patients with sarcoidosis. Eur J Gastroenterol Hepatol 16:911–915PubMedCrossRefGoogle Scholar
  9. 9.
    Papadopoulos K, Sjoberg K, Lindgren S, Hallengren B (1999) Evidence of gastrointestinal immune reactivity in patients with sarcoidosis. J Intern Med 245:525–531PubMedCrossRefGoogle Scholar
  10. 10.
    McCormick PA, Feighery C, Dolan C, O’Farrelly C, Kelliher P, Graeme-Cook F, Finch A, Ward K, Fitzgerald MX, O’Donoghue DP (1988) Altered gastrointestinal immune response in sarcoidosis. Gut 29:1628–1631PubMedCrossRefGoogle Scholar
  11. 11.
    Henke CE, Henke G, Elveback LR, Beard CM, Ballard DJ, Kurland LT (1985) The epidemiology of sarcoidosis in Rochester, Minnesota: a population-based study of incidence and survival. Am J Epidemiol 123:840–845Google Scholar
  12. 12.
    Breslow NE, Day NE (1987) Statistical methods in cancer research: volume II – the design and analysis of cohort studies. IARC Scientific Publication, No 82, International Agency for Research on Cancer. Oxford University Press, New YorkGoogle Scholar
  13. 13.
    Rybicki BA, Major M, Popovich J, Maliarik MJ, Iannuzzi MC (1997) Racial differences in sarcoidosis incidence: a 5-year study in a health maintenance organization. Am J Epidemiol 145:234–241PubMedGoogle Scholar
  14. 14.
    Milman N, Selroos O (1990) Pulmonary sarcoidosis in the Nordic countries 1950–1982: epidemiology and clinical picture. Sarcoidosis 7:50–57PubMedGoogle Scholar
  15. 15.
    Hoffman AL, Milman N, Byg KE (2004) Childhood sarcoidosis in Denmark 1979–1994: incidence, clinical features and laboratory results at presentation in 48 children. Acta Pediatr Scan 93:30–36CrossRefGoogle Scholar
  16. 16.
    Douglas JG, Fillon J, Logan RF, Grant IW, Crompton GK (1984) Sarcoidosis and coeliac disease: an association? Lancet 2:13–15PubMedCrossRefGoogle Scholar
  17. 17.
    Lowe G, Johnston RN (1984) Sarcoidosis and coeliac disease. Lancet 2:637PubMedCrossRefGoogle Scholar
  18. 18.
    Bianconcini G, Mazzali F, Candini R, Silingardi M, Iori I (1994) Celiac disease (familial) associated with sarcoidosis: a clinical case and review of the literature. Minerva Med 85:541–553PubMedGoogle Scholar
  19. 19.
    Hagerstrand I (1964) The prevalence of sarcoidosis in the autopsy material from a Swedish town: proceedings of the third international conference on sarcoidosis. Acta Med Scand 176:171–174CrossRefGoogle Scholar
  20. 20.
    Reid JD (1998) Sarcoidosis in coroner’s autopsies: a critical evaluation in diagnosis and prevalence from Cuyahoga County, Ohio. Sarcoid Vascul Diffuse Lung Dis 15:44–51Google Scholar
  21. 21.
    Price P, Witt C, Allcock R, Sayer D, Garlepp M, Kok CC, French M, Mallal S, Christiansen F (1999) The genetic basis for the association of the 8.1 ancestral haplotype (A1, B8, DR3) with multiple immunopathological diseases. Immunol Rev 167:257–274PubMedCrossRefGoogle Scholar
  22. 22.
    Sollid LM, Thorsby E (1993) HLA susceptibility genes in celiac disease: genetic mapping and role in pathogenesis. Gastroenterology 105:910–922PubMedGoogle Scholar
  23. 23.
    Bai D, Brar P, Holleran S, Ramakrishnan R, Green PH (2005) Effect of gender on the manifestations of celiac disease: evidence of greater malabsorption in men. Scand J Gastroenterol 40:183–187PubMedCrossRefGoogle Scholar
  24. 24.
    Cronin CC, Feighery A, Ferriss JB, Liddy C, Shanahan F, Feighery C (1997) High prevalence of celiac disease among patients with insulin-dependent (type 1) diabetes mellitus. Am J Gastroenterol 92:2210–2212PubMedGoogle Scholar
  25. 25.
    Luft LM, Barr SG, Martin LO, Chan EK, Fritzler MJ (2003) Autoantibodies to tissue transglutaminase in Sjögren’s syndrome and related rheumatic disease. J Rheumatol 30:2613–2619PubMedGoogle Scholar
  26. 26.
    Counsell CE, Taha A, Ruddell WS (1994) Coeliac disease and autoimmune thyroid disease. Gut 35:844–846PubMedCrossRefGoogle Scholar
  27. 27.
    Dickey W, McMillan SA, Callender ME (1997) High prevalence of celiac sprue among patients with primary biliary cirrhosis. J Clin Gastroenterol 25:328–329PubMedCrossRefGoogle Scholar
  28. 28.
    O’Leary C, Walsh CH, Weineke P, O’Regan P, Buckley B, O’Halloran DJ, Ferriss JB, Quigley EM, Annis P, Shanahan F, Cronin CC (2002) Coeliac disease and autoimmune Addison’s disease: a clinical pitfall. QJM 95:79–82PubMedCrossRefGoogle Scholar
  29. 29.
    Poulter LW (1988) Immune aspects of sarcoidosis. Postgrad Med J 64:536–543PubMedGoogle Scholar
  30. 30.
    Hanock BW, Millard LG (1976) Sarcoidosis and thyrotoxicosis. A study of 5 patients. Br J Dis Chest 70:129–133CrossRefGoogle Scholar
  31. 31.
    Baughman RP, Lower EE, du Bois RM (2003) Sarcoidosis. Lancet 361:1111–1118PubMedCrossRefGoogle Scholar
  32. 32.
    Papadopoulos KI, Hornblad Y, Hallengren B (1994) The occurrence of polyglandular autoimmune syndrome type III associated with coeliac disease in patients with sarcoidosis. J Intern Med 236:661–663PubMedCrossRefGoogle Scholar
  33. 33.
    Papadopoulos KI, Hallengren B (1992) Polyglandular autoimmune syndrome type III associated with coeliac disease and sarcoidosis. Postgrad Med J 69:72–74CrossRefGoogle Scholar
  34. 34.
    Green PHR, Fleischauer AT, Bhagat G, Goyal R, Jabri B, Neugut AI (2003) Risk of malignancy in patients with celiac disease. Am J Med 115:191–195PubMedCrossRefGoogle Scholar
  35. 35.
    Ventura A, Magazzu G, Greco L (1999) Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease. SIGEP Study Group for autoimmune disorders in celiac disease. Gastroenterology 117:297–303PubMedCrossRefGoogle Scholar
  36. 36.
    Ventura A, Neri E, Ughi C, Leopaldi A, Citta A, Not T (2000) Gluten-dependent diabetes-related and thyroid-related autoantibodies in patients with celiac disease. J Pediatr 137:263–265PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Elizabeth Hwang
    • 1
  • Russell McBride
    • 2
  • Alfred I. Neugut
    • 2
  • Peter H. R. Green
    • 1
    Email author
  1. 1.Department of MedicineColumbia University Medical CenterNew YorkUSA
  2. 2.Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkUSA

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