Study Points to Shared Origins for Celiac Disease and Inflammatory Bowel Disease

Celiac.com 07/25/2022 - Celiac disease and inflammatory bowel disease share a number of factors, including some co-occurrence, independent of temporal sequence, which suggests a shared etiology. To better understand the picture, a team of researchers recently set out to determine the risk of inflammatory bowel disease (IBD) in patients with celiac disease (and vice versa) compared to matched subjects from the general-population.

The research team included Karl Mårild MD PhD; Jonas Söderling PhD; Lebwohl, Benjamin MD; Green, Peter HR MD; Pinto-Sanchez, Maria Ines MD MSc; Halfvarson, Jonas MD PhD; Bjorn Roelstraete PhD; Ola Olén MD PhD; and Jonas F. Ludvigsson MD PhD.

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The researchers used the Swedish histopathology and healthcare register data to identify nearly 50,000 patients with celiac disease, along with nearly 85,000 with IBD diagnosed in 1969-2016. The team compared each patient to age- and 336 sex-matched general-population subjects with celiac disease, and 503 with IBD. They used Cox regression to estimated hazard ratios (HRs) for IBD in celiac patients and vice versa. 

To reduce potential surveillance bias, the team limited their main analyses to events beyond the first year of follow-up. Nearly eight-hundred patients were diagnosed with IBD during follow-up, compared to 1015 in the matched group. Te HR for IBD was 3.91 in celiac patients, which is similar to HRs for Crohn’s disease and ulcerative colitis. 

During follow-up, 644 IBD patients and nearly six-hundred in the matched group were diagnosed with celiac disease. The HR for celiac disease in IBD patients was 5.49, with the highest risk estimates seen in ulcerative colitis, the HR for Crohn’s disease was 3.31.

Even though most patients with celiac disease and IBD are diagnosed in under a year, many experienced HRs of 3-4 even ten years later. 

Over a twenty year follow-up period, 2.5% of celiac patients developed IBD, while 1.3% of IBD patients developed celiac disease.

The team is advising physicians to keep in mind the two-way connection between celiac diagnosis and IBD in the initial assessment and follow-up of both conditions. 

Because of their common co-occurrence, which is independent of the order in which the diseases are contracted, the researchers suggest the potential for a shared etiology between the two conditions.

Read more in the American Journal of Gastroenterology

The researchers are variously affiliated with the Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden; the Department of Pediatric Gastroenterology, Queen Silvia Children's Hospital, Gothenburg, Sweden; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; the Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; the Celiac Disease Center Department of Medicine Columbia University College of Physicians and Surgeons New York NY USA; the Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada; the Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; the Sachs' Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden; the Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; and the Department of Pediatrics, Orebro University Hospital, Orebro, Sweden.