Original article—alimentary tractIncidence of Autoimmune Diseases in Celiac Disease: Protective Effect of the Gluten-Free Diet
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Patients
Patients were recruited over a 5-year period (2003–2007) from 27 French centers of Gastroenterology and Pediatric Gastroenterology. Physicians in these centers were asked to include all patients with a diagnosis of CD that they saw consecutively as inpatients or outpatients during the period of recruitment. A diagnosis of CD required a duodenal biopsy showing increased intraepithelial lymphocyte count, crypt hypertrophy, and villous atrophy.12 Recruitment was ended when the predefined number of
Cumulative Risk of Autoimmune Disease
A total of 178 patients (19.3%) had developed an autoimmune disease from birth to the inclusion visit (209 autoimmune diseases). In 95 patients, the diagnosis of autoimmune disease was made more than 6 months before the CD diagnosis. In 38 patients, including 15 in whom serologic screening performed for type 1 diabetes was positive and led to diagnose CD, the diagnoses of autoimmune disease and CD were made within the same 6-month period. The last 45 patients developed their first autoimmune
Discussion
This study shows that the risk of development of an autoimmune disease in celiac patients is increased in patients with a family history of autoimmune disease and when a diagnosis of CD is made in childhood or young adulthood compared with later in life. More importantly, after diagnosis of CD, strict adherence to a gluten-free diet was associated with a decreased risk of subsequent autoimmune disease.
The present study had several limitations. First, although consecutive patients were included
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