Digestive Diseases and Sciences

, Volume 63, Issue 10, pp 2681–2686 | Cite as

Frequency of Celiac Disease in Children with Peptic Ulcers

  • Gokhan TumgorEmail author
  • Mehmet Agin
  • Figen Doran
  • Salih Cetiner
Original Article



The aim of the present study is to investigate the frequency of celiac disease in children with peptic ulcers and to compare it with that of non-celiac peptic ulcers in terms of clinical and laboratory values.


Upper gastrointestinal endoscopy was performed in 1769 patients at the Department of Pediatric Gastroenterology, The Faculty of Medicine, Cukurova University, Turkey, between January 2012 and January 2017. These cases consisted of subjects presenting with various GIS symptoms and indicated for endoscopy (with chronic diarrhea, delayed growth and development, abdominal pains, GIS bleeding, etc.). The levels of immunoglobulin A (IgA) serum anti-tissue transglutaminase antibodies, IgA anti-endomysial antibodies (EMA), and IgA serum were estimated in the patients with peptic ulcers.


Celiac disease was diagnosed with serology, endoscopy, and histopathology in 250 (14%) of all cases undergoing endoscopy. Peptic ulcers were diagnosed in 74 patients (4.2%) of all cases undergoing endoscopy. tTGA and EMA (+) levels were determined in 22 (29%) of the 74 patients with peptic ulcers, and then the presence of peptic ulcers was investigated in the upper gastrointestinal system using gastrointestinal endoscopy, followed by histopathological confirmation of celiac disease. HP infection was present in 14 (63%) of the patients with celiac disease and in 23 (44%) of non-celiac peptic ulcers; the difference was not statistically significant (p = 0.12). In the total ulcer group, 10.8% (8/74) of patients with celiac peptic ulcers were negative for HP infection, whereas 21% (8/37) of HP-negative patients with ulcers had celiac disease.


There exists a high risk of celiac disease in children with peptic ulcers. We thus recommend celiac disease to be investigated, particularly in HP-negative patients with peptic ulcers but with no history of NSAID use.


Celiac disease Peptic ulcers Childhood H. pylori 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Graham DY. History of Helicobacter pylori, duodenal ulcer, gastric ulcer and gastric cancer. World J Gastroenterol. 2014;20:5191–5204.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Ecevit ÇÖ, Özgenç F, Yüksekkaya HA, Ünal F, Arikan Ç, Yağci RV. Peptic ulcer disease in children: an uncommon disorder with subtle symptomatology. Turk J Gastroenterol. 2012;23:666–669.CrossRefPubMedGoogle Scholar
  3. 3.
    Malfertheiner P, Chan FK, McColl KE. Peptic ulcer disease. Lancet. 2009;374:1449–1461.CrossRefPubMedGoogle Scholar
  4. 4.
    Troncone R, Auricchio S. Celiac Disease. In: Wyllie R, Hyams JS, Marsha K, eds. Pediatric Gastrointestinal and Liver Disease. 5th ed. Philadelphia: Elsevier; 2016:395–404.Google Scholar
  5. 5.
    Çınar A, Sadıç M, Atılgan Hİ, et al. Prevalence of Helicobacter pylori infection in school and pre-school aged children with C-14 urea breath test and the association with familial and environmental factors. Mol Imaging Radionucl Ther. 2015;24:66–70.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Xia HH, Phung N, Kalantar JS, et al. Demographic and endoscopic characteristics of patients with Helicobacter pylori positive and negative peptic ulcer disease. Med J Aust. 2000;173:515–519.PubMedGoogle Scholar
  7. 7.
    Arents NL, Thijs JC, van Zwet AA, et al. Does the declining prevalence of Helicobacter pylori unmask patients with idiopathic peptic ulcer disease? Trends over an 8 year period. Eur J Gastroenterol Hepatol. 2004;16:779–783.CrossRefPubMedGoogle Scholar
  8. 8.
    Arroyo MT, Forne M, de Argila CM, et al. The prevalence of peptic ulcer not related to Helicobacter pylori or non-steroidal anti-inflammatorydrug use is negligible in southern Europe. Helicobacter. 2004;9:249–254.CrossRefPubMedGoogle Scholar
  9. 9.
    Egbaria R, Levine A, Tamir A, et al. Peptic ulcers and erosions are common in Israeli children undergoing upper endoscopy. Helicobacter. 2008;13:62–68.CrossRefPubMedGoogle Scholar
  10. 10.
    Hill ID, Dirks MH, Liptak GS, et al. North American Society for Pediatric Gastroenterology, Hepatology and Nutrition: guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American society for pediatric gastroenterology, hepatology and nutrition. J Pediatr Gastroenterol Nutr. 2005;40:1–19.CrossRefPubMedGoogle Scholar
  11. 11.
    Bingley PJ, Williams AJ, Norcross AJ, et al. Undiagnosed coeliac disease at age seven: celiac-associated peptic disease population based prospective birth cohort study. BMJ. 2004;328:322–323.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Rewers M. Epidemiology of celiac disease: what are the prevalence, incidence, and progression of celiac disease? Gastroenterology. 2005;128:47–51.CrossRefGoogle Scholar
  13. 13.
    Dalgic B, Sari S, Basturk B, et al. Prevalence of celiac disease in healthy Turkish school children. Am J Gastroenterol. 2011;106:1512–1517.CrossRefPubMedGoogle Scholar
  14. 14.
    Aydogdu S, Cakir M, Yuksekkaya HA, et al. Helicobacter pylori infection in children with celiac disease. Scand J Gastroenterol. 2008;43:1088–1093.CrossRefPubMedGoogle Scholar
  15. 15.
    Mones RL, Mercer GO. Ulcerative duodenitis in a child with celiac disease. J Pediatr. 2011;158:857.CrossRefPubMedGoogle Scholar
  16. 16.
    Galloway D, Pasternak B, Garg S, et al. Multiple duodenal ulcers: an unexpected finding in celiac disease. J Pediatr Gastroenterol Nutr. 2013;56:e21.CrossRefPubMedGoogle Scholar
  17. 17.
    Eltumi M, Brueton MJ, Francis N. Ulceration of the small intestine in children with coeliac disease. Gut. 1996;39:613–614.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Levine A, Domanov S, Sukhotnik I, et al. Celiac-associated peptic disease at upper endoscopy: how common is it? Scand J Gastroenterol. 2009;44:1424–1428.CrossRefPubMedGoogle Scholar
  19. 19.
    Tumgor G, Agin M, Leblebisatan G. Gluten-related methemoglobinemia. Am J Gastroenterol. 2015;110:1367.CrossRefPubMedGoogle Scholar
  20. 20.
    Stringer MD, Veysi VT, Puntis JW, et al. Gastroduodenal ulcers in the Helicobacter pyloriera. Acta Paediatr. 2000;89:1181–1185.CrossRefPubMedGoogle Scholar
  21. 21.
    Dickey W, Hughes D. Erosions in the second part of the duodenum in patients with villous atrophy. Gastrointest Endosc. 2004;59:116–118.CrossRefPubMedGoogle Scholar
  22. 22.
    Cuoco L, Cammarota G, Jorizzo RA, et al. Link between Helicobacter pylori infection and iron-deficiency anaemia in patients with coeliac disease. Scand J Gastroenterol. 2001;36:1284–1288.CrossRefPubMedGoogle Scholar
  23. 23.
    Demir H, Saltik IN, Yuce A, et al. Is there any relation between Helicobacter pylori infection and iron deficiency anemia in children with celiac disease? Helicobacter. 2004;9:284.CrossRefPubMedGoogle Scholar
  24. 24.
    Biagi F, Lorenzini P, Corazza GR. Literature review on the clinical relationship between ulcerative jejunoileitis, coeliac disease, and enteropathy-associated T-cell. Scand J Gastroenterol. 2000;35:785–790.CrossRefPubMedGoogle Scholar
  25. 25.
    Yuksekkaya H, Gümüs M, Egritas O, et al. Gastrointestinal ulceration in celiac disease. J Pediatr Gastroenterol Nutr. 2013;56:e52–e53.CrossRefPubMedGoogle Scholar
  26. 26.
    Baer AN, Bayless TM, Yardley JH. Intestinal ulceration and malabsorption syndromes. Gastroenterology. 1980;79:754–765.PubMedGoogle Scholar
  27. 27.
    Myrsky E, Syrjänen M, Korponay-Szabo IR, et al. Altered small-bowel mucosal vascular network in untreated coeliac disease. Scand J Gastroenterol. 2009;44:162–167.CrossRefPubMedGoogle Scholar
  28. 28.
    Myrsky E, Kaukinen K, Syrjänen M, et al. Coeliac disease-specific autoantibodies targeted against transglutaminase 2 disturb angiogenesis. Clin Exp Immunol. 2008;152:111–119.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Veres G, Korponay-Szabó I, Maka E, et al. Duodenal ulceration in a patient with celiac disease and plasminogen I deficiency: coincidence or cofactors? Pediatrics. 2011;128:e1302–e1306.CrossRefPubMedGoogle Scholar
  30. 30.
    Scott BB, Losowsky MS. Coeliac disease: a cause of various associated diseases? Lancet. 1975;2:956–957.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Gokhan Tumgor
    • 1
    Email author
  • Mehmet Agin
    • 1
  • Figen Doran
    • 2
  • Salih Cetiner
    • 3
  1. 1.Department of Pediatric Gastroenterology, Medical FacultyÇukurova UniversityAdanaTurkey
  2. 2.Department of Pathology, Medical FacultyÇukurova UniversityAdanaTurkey
  3. 3.Department of Medical Microbiology, Medical FacultyÇukurova UniversityAdanaTurkey

Personalised recommendations