Original article—alimentary tract
Incidence of Autoimmune Diseases in Celiac Disease: Protective Effect of the Gluten-Free Diet

https://doi.org/10.1016/j.cgh.2007.12.022Get rights and content

Background & Aims: Celiac disease may be associated with autoimmune diseases. The aims of the present study were to determine in celiac patients which factors modulate the risk of autoimmune disease and to evaluate the effect of the gluten-free diet. Methods: The occurrence of autoimmune disease and compliance to gluten-free diet were specified retrospectively in 924 celiac patients recruited from 27 French pediatric and adult gastroenterology centers. Results: One or several autoimmune diseases had developed in 178 patients. The cumulative risk of autoimmune disease was 8.1% ± 1% at age 15, and 15.7% ± 1.5% at age 30. Factors associated with an increased risk were family history of autoimmunity (hazard ratio, 2.36; 95% confidence interval, 1.71–3.31) and diagnosis of celiac disease before 36 years of age (hazard ratio, 2.65; 95% confidence interval, 1.79–3.85). After diagnosis of celiac disease, 55 of 788 patients developed an autoimmune disease. The cumulative risk of subsequent autoimmune disease was lower in patients compliant to a gluten-free diet versus noncompliant patients (at 10 years, 6% ± 2% vs 15.6% ± 5.9%, respectively; P = .02). The incidence of autoimmune diseases was 5.4 per 1000 patient-years during adherence to a gluten-free diet versus 11.3 per 1000 patient-years during nonadherence to the diet (P = .002). Results were similar in both the pediatric and the adult populations. Conclusions: Celiac patients most at risk for autoimmune disease are those diagnosed early in life and having a family history of autoimmunity. The gluten-free diet has a protective effect.

Section snippets

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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