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LETTERS: David S Sanders Coeliac disease and subfertility: association is often neglected BMJ 2003; 327: 1226-e-1227-e [Full text]

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Subfertility in coeliac disease

Umberto Volta, Daniela Zauli, Alberto Grassi, Alessandro Granito, Francesco B. Bianchi   (26 November 2003)

Coeliac Disease: one or more types?

Alfonso SAURO   (4 December 2003)

Subfertility in coeliac disease 26 November 2003
Umberto Volta, Assistant Professor Department of Internal Medicine, Cardioangiology, Hepatology. Policlinico S. Orsola-Via Massarenti 9, Daniela Zauli, Alberto Grassi, Alessandro Granito, Francesco B. Bianchi Send response to journal: Re: Subfertility in coeliac disease	We do agree with Dr Sanders (1) that, unfortunately, coeliac disease is often neglected as a cause of subfertility. Our own experience is about subfertility in women with previously undiagnosed coeliac disease (CD). The diagnosis of CD was based on both humoral autoantibodies (2) and histological examination of duodenal biopsies (3). From a group of 276 CD patients, 190 women aged 18 and over years (range 18-74) were identified and interviewed about previous miscarriages and reproductive difficulties. Nineteen spontaneous abortions within the first trimester of pregnancy were reported by 11 patients (5.8%), of whom 5 had had 1 abortion, 4 had had 2 and 2 had had 3. One further patient reported one stillbirth, making the total of unsuccessful pregnancies 20. Seven additional patients reported infertility. Therefore, the overall prevalence of infertility becomes 18 out of 190 (9.5%). Furthermore, 6 of the 11 women, who had had miscarriages before the diagnosis of CD, and all the 7 previously infertile women had a total of 16 successful pregnancies after the initiation of the gluten-free diet. This links subfertility and CD even more. Unfortunately, two women in the miscarriage group were diagnosed with CD at age 49 and 48 and, of course, did not attempt any further pregnancy. These data further strengthen the results obtained by Meloni et al (4), who reported a 3.03% overall prevalence of CD in infertile women and a 8% prevalence in the subgroup of women with unexplained infertility. Clinicians, please remember that CD underlies many more unexplained medical conditions, such as failure to thrive and seizures in infancy and amenorrhea, osteoporosis, anaemia, to cite just some, in adulthood. References 1. Sanders DS. Coeliac disease and subfertility: association is often neglected. BMJ 2003;327: 1226-7. 2. Volta U, Bellentani S, Bianchi FB, Brandi G, De Franceschi L, Miglioli L et al. Hgh prevalence of celiac disease in Italian general population. Dig Dis Sci 2001;46: 1500-05. 3. Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol 1999;11: 1185-94. 4. Meloni GF, Dessole S, Vargiu N, Tomasi PA, Musumeci S. The prevalence of coeliac disease in infertility. Hum Reprod 1999;14: 2759-61. Competing interests: None declared
Coeliac Disease: one or more types? 4 December 2003
Alfonso SAURO, Resp.ble SNAMID South Italy - GP - EURACT and WONCA Member - Spec. Gastroenterology SNAMID CE - 81100 Caserta Italy Send response to journal: Re: Coeliac Disease: one or more types?	Coeliac disease has been linked to many other pathologic conditions but there is something that sounds strange to me: even if it seems to be clear that this correlation do exist why are there many different types of correlations? As GP I take in care 1300 patients and as gastroenterologist I always ask myself if that patient could be affected by coeliac disease. 12 out of 1300 pts have suffered from subfertility and none of them was found to be affected by coeliac disease. Moreover, all of the females affected by coeliac disease had perfectly normal pregnancies. Then I could think that there is no correlation between coeliac disease and subfertility but I know I could make a mistake that should influence all my future diagnoses in other similar cases. Coeliac disease correlation with other conditions surely exist but, for example, many patients are affected by different thyroid's diseases but not all of them are affected by coeliac disease. And this is true for every other disease mentioned by litterature. On the other hand not all of the patients affected by coeliac disease is suffering or will suffer for other pathologic conditions. Moreover it seems that there is a very multifor variety of correlation between coeliac disease and many other pathologic conditions. In conclusions two questions are to be made: 1- Is it right to screen for coeliac disease all the patients affected by subinfetility or thyroiditis ....and so on? Should it be correct by the point of view of cost-benefits? 2- Do exist different kinds of coeliac disease that could justify this multitude and different correlations between coelic disease and other or even no other pathologies? In my opinion there is much more to do to understand what coeliac dieases really is. Competing interests: None declared