Gastroenterology

Gastroenterology

Volume 117, Issue 2, August 1999, Pages 297-303
Gastroenterology

Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease

https://doi.org/10.1053/gast.1999.0029900297Get rights and content

Abstract

Background & Aims: The relationship between celiac disease and many autoimmune disorders has been explained by the sharing of a common genetic factor. In a multicenter national study, we examined the relationship between the prevalence of autoimmune disorders in celiac disease and the duration of exposure to gluten. Methods: Over a 6-month period, 909 patients with celiac disease (group A; mean age, 16.1 ± 3.8 years; grouped according to age at diagnosis into three subgroups [group A1, <2 years; group A2, 2-10 years; and group A3, >10 years]), 1268 healthy controls (group B; mean age, 20.8 ± 4.5 years), and 163 patients with Crohn's disease (group C; mean age, 28.8 ± 10 years) were evaluated for the presence of autoimmune disorders. Results: Prevalence of autoimmune disorders in group A was significantly higher than in group B (14% vs. 2.8%; P < 0.000001) but not higher than in group C (12.9%). Prevalence of autoimmune disorders in celiac disease increased with increasing age at diagnosis: 5.1% in group A1, 17% in group A2, and 23.6% in group A3 (P = 0.000001). In group A3, the prevalence of autoimmune disorders was significantly higher than in group C. In a logistic regression model, age at diagnosis was the only significant predictor variable of the odds of developing an autoimmune disorder (r = 0.3; P < 0.000001). Conclusions: Our data show for the first time that the prevalence of autoimmune disorders in celiac disease is related to the duration of exposure to gluten.

Section snippets

Patients and control subjects

We enrolled three groups of subjects.

Group A consisted of 909 patients with celiac disease (521 females; mean age, 16.1 ± 3.8 years) who were consecutively recruited over a 6-month period from 10 Italian centers of pediatric gastroenterology. Actual age between 10 and 25 years was the only selection criterion. The patients represented 94% of the 967 patients within this age range who underwent follow-up in the centers participating in the study. Diagnoses were made according to the original or

Prevalence of autoimmune disorders in the study population

Figure 1 shows the overall prevalence of autoimmune disorders in the study groups.

. Fig. 1. Prevalence of autoimmune disorders in patients with Crohn's disease or celiac disease (CD) and in controls (left), and in patients with celiac disease according to age at diagnosis (years) (right).

The prevalence of autoimmune disorders in subjects with celiac disease is significantly higher than in healthy controls (127/909 [14%] vs. 36/1268 [2.8%]; χ2 = 93.1; P < 0.000001) but not significantly higher

Discussion

This study shows that the prevalence of autoimmune disorders in adolescent and young adult patients with celiac disease is significantly higher than in the general population, confirming previous reports in adults.3, 4, 13, [38], 39

The prevalence of autoimmune disorders in patients with celiac disease is comparable to that observed in patients with Crohn's disease who are known to be at risk of autoimmune disorders.40 The mean actual age of the control group and of the patients with Crohn's

References (55)

  • M. Maki

    Coeliac disease and autoimmunity due to unmasking of cryptic epitopes

    Lancet

    (1996)
  • A. Picarelli et al.

    Production of antiendomysial antibodies after in-vitro gliadin challenge of small intestine biopsy samples from patients with coeliac disease

    Lancet

    (1996)
  • B.T. Cooper et al.

    Coeliac disease and immunological disorders

    BMJ

    (1978)
  • P. Collin et al.

    Coeliac disease–associated disorders and survival

    Gut

    (1994)
  • P. Collin et al.

    High frequency of coeliac disease in adult patients with type-I diabetes

    Scand J Gastroenterol

    (1989)
  • M. Pocecco et al.

    Coeliac disease and insulin-dependent diabetes mellitus: a causal association. An Italian multicentre study

    Acta Paediatr

    (1995)
  • P. Collin et al.

    Atypical coeliac disease found with serological screening

    Scand J Gastroenterol

    (1990)
  • L. Lepore et al.

    Prevalence of coeliac disease in patients with juvenile chronic arthritis

    J Pediatr

    (1996)
  • P. Collin et al.

    Autoimmune thyroid disorders and coeliac disease

    Eur J Endocrinol

    (1994)
  • F. Shanahan et al.

    Coeliac disease and diabetes mellitus: a study of 24 patients with HLA typing

    QJM

    (1982)
  • W. Dieterich et al.

    Identification of tissue transglutaminase as the autoantigen of celiac disease

    Nat Med

    (1997)
  • U. Di Mario et al.

    Diabetes-related autoantibodies do appear in children with coeliac disease

    Acta Paediatr

    (1992)
  • C.E. Counsell et al.

    Coeliac disease and autoim-mune thyroid disease

    Gut

    (1994)
  • M.J. Rapoport et al.

    Increased prevalence of diabetes-related autoantibodies in coeliac disease

    J Pediatr Gastroenterol Nutr

    (1996)
  • S. Bodvarsson et al.

    Dermatitis herpetiformis: an autoimmune disease due to cross-reaction between dietary glutenin and dermal elastin

    Scand J Immunol

    (1993)
  • G.W. Meuwisse

    Diagnostic criteria in coeliac disease

    Acta Paediatr Scand

    (1970)
  • J.A. Walker-Smith et al.

    Revised criteria for diagnosis of coeliac disease

    Arch Dis Child

    (1990)
  • R. Troncone et al.

    Endomysial antibodies as unreliable marker for slight dietary transgressions in adolescents with celiac disease

    J Pediatr Gastroenterol Nutr

    (1995)
  • World Health Organization Study Group

    Diabetes mellitus

    (1985)
  • S.I. Katz

    Dermatitis herpetiformis

  • N. Amino et al.

    Autoimmune thyroid disease/thyroiditis

  • J.M. Mckenzie et al.

    Hyperthyroidism

  • S. Sherlock et al.

    Diseases of the liver and biliar y system

    (1997)
  • A.P. Bertolino et al.

    The alopecias

  • W.M. Weinstein

    Gastritis

  • F.C. Arnett et al.

    The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis

    Ar thritis Rheum

    (1988)
  • E.M. Tan et al.

    The 1982 revised criteria for the classification of systemic lupus erythematosus

    Arthritis Rheum

    (1982)
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