Celiac.com 10/15/2013 - Most case reports suggest an association between autistic spectrum disorders (ASDs) and celiac disease (CD) or positive CD serologic test results, but larger studies are contradictory.

http://archpsyc.jamanetwork.com/article.aspx?articleid=1743008A team of researchers recently set out to examine the association between ASDs and CD according to small intestinal histopathologic findings.

The research team included Jonas F. Ludvigsson; Abraham Reichenberg; Christina M. Hultman; and Joseph A. Murray. They are variously affiliated with the Department of Medicine, Clinical Epidemiology Unit, and the Department of Medical Epidemiology and Biostatistics at the Karolinska Institutet in Stockholm, Sweden, with the Department of Pediatrics at Orebro University Hospital, Orebro University in Orebro, Sweden, with the Division of Gastroenterology and Hepatology of the Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, with the Department of Psychosis Studies at the Institute of Psychiatry at King’s College in London, United Kingdom, and with the Department of Psychiatry at the Mount Sinai School of Medicine in New York, New York.

For their nationwide case-control study, the researchers used 28 Swedish biopsy registers to gather data on approximately 26,995 individuals with celiac disease, which they defined as the presence of villous atrophy, Marsh stage 3.

They found 12,304 patients with inflammation (Marsh stages 1-2), 3719 patients with normal mucosa (Marsh stage 0), but positive celiac results for IgA/IgG gliadin, endomysium, or tissue transglutaminase. They then compared these results against and results for 213,208 age- and sex-matched control subjects. The team used conditional logistic regression to estimate odds ratios (ORs) for prior ASD diagnosis according to the Swedish National Patient Register and then conducted a second analysis, using Cox proportional hazards regression to estimate hazard ratios (HRs) for future ASDs in individuals undergoing small intestinal biopsy.

They found that previous ASD was not associated with CD (OR, 0.93; 95% CI, 0.51-1.68) or inflammation (OR 1.03; 95% CI, 0.40-2.64). However, they did finds that previous ASD was associated with a sharp higher risk of having normal mucosa but positive serologic test result for celiac disease (OR, 4.57; 95% CI, 1.58-13.22).

Once the team restricted the data to individuals without no diagnosis for ASD at the time of biopsy, they found that celiac disease (HR, 1.39; 95% CI, 1.13-1.71) and inflammation (HR, 2.01; 95% CI, 1.29-3.13) were both connected with slightly higher risks of later ASDs, compared against the HR of 3.09 (95% CI, 1.99-4.80) for later ASDs in individuals with normal mucosa but positive CD serologic test results.

Even though this study showed no connection between previous ASD and celiac disease or inflammation, it did show that individuals with normal mucosa, but positive blood screens for celiac disease, have a much higher risk of ASD.

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