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Celiac.com 09/09/2015 - Some researchers and clinicians suspect a connection between eosinophilic esophagitis (EoE) and celiac disease, but prior studies have shown conflicting results A team of researchers recently set out to determine the relationship between EoE and celiac disease among patients with concomitant esophageal and duodenal biopsies. The research team included Elizabeth T. Jensena, Swathi Eluria, Benjamin Lebwohl, Robert M. Gentab, and Evan S. Dellon. For their cross-sectional study, they team used data covering the period from January 2009 through June 2012 from a U.S. national pathology database. They defined esophageal eosinophilia as the presence of ≥15 eosinophils per high-power field. The crude and age and sex adjusted odds of esophageal eosinophilia for patients with active celiac disease were compared with those without celiac disease. Sensitivity analyses were performed by using more stringent case definitions and by estimating the associations between celiac disease and reflux esophagitis and celiac disease and Barrett’s esophagus. Out of 292,621 patients in the source population, the team looked at data from 88,517 patients with both esophageal and duodenal biopsies. Four thousand one hundred one (4.6%) met criteria for EoE, and 1203 (1.4%) met criteria for celiac disease. Patients with celiac disease had 26% higher odds of EoE than patients without celiac disease (adjusted odds ratio, 1.26; 95% confidence interval [CI], 0.98–1.60). The strength of the connection varied according to EoE case definition, but all definitions showed a weak positive association between the two conditions. Interestingly, this study showed no connection between celiac disease and reflux esophagitis (adjusted odds ratio 0.95; 95% CI, 0.85–1.07) or between celiac disease and Barrett’s esophagus (adjusted odds ratio 0.89; 95% CI, 0.69–1.14). Overall, this study showed only a weak increase in EoE in patients with celiac disease. The connection strengthened in direct relation to the strength of definitions of EoE, and was not seen with other esophageal conditions. Doctors should consider concomitant EoE in patients with celiac disease where clinical indications support it. Disclosures: Dellon reports receiving research funds from Meritage Pharma, consulting for Aptalis, Novartis, Receptos and Regeneron, and receiving an educational grant from Diagnovus. Source: Clinical Gastroenterology and Hepatology. doi:10.1016/j.cgh.2015.02.018.
Celiac.com 04/27/2012 - Urinary stone disease is condition often caused by malabsorption. Because of its high prevalence and incidence, doctors regard it as a serious issue. However, there are few population-based studies on the risk of urinary stone disease in patients with celiac disease. A team of medical researchers recently studied the risk of urinary stone disease in people with celiac disease. The research team included J. F. Ludvigsson, F. Zingone, M. Fored, C. Ciacci and M. Cirillo. For their population-based cohort study, the team used small intestinal biopsy reports gathered from all 28 Swedish pathology departments from 1969 to 2008. In all, the team found 28,735 patients with celiac disease, all with the equivalent of Marsh 3 villous atrophy. They then isolated a control group of 142,177 people from the Swedish general population. They matched patients and control subjects for age, gender, age, county and calendar year. Using Cox regression, they estimated hazard ratios for future urinary stone disease. Using conditional logistic regression they then calculated odds ratios for urinary stone disease before celiac disease diagnosis. The team used Swedish National Patient Register data on inpatient care, outpatient care and day surgery to find cases of urinary stone disease. During follow-up, a total of 314 people with celiac disease developed urinary stone disease, compared with 1142 from the control group. These numbers indicated that people with celiac disease face a 27% increased risk of urinary stone disease [95% confidence interval (CI) = 1.12–1.44]. For celiac disease, patients the absolute risk of developing urinary stone disease was 107 cases per 100,000 person-years; which corresponds to an excess risk of 23 cases per 100,000 person years. Men and women faced similar risk levels, and showed no difference with respect to age at celiac disease diagnosis. Using conditional logistic regression the team found that celiac disease patients also faced a moderately higher risk of prior urinary stone disease (OR = 1.19; 95% CI = 1.06–1.33). The study indicates that people with celiac disease face a slightly higher risk of urinary stone disease both before and after celiac disease diagnosis. Source: Alimentary Pharmacology & Therapeutics. 2012;35(4):477-484.
Celiac.com 10/17/2011 - Some research has shown celiac disease to be associated with higher rates of tuberculosis (TB), but study results have been inconclusive due to small sample sizes. A team of researchers studied a larger population to get a better look at the relationship between celiac disease and TB. The study team included J. F. Ludvigsson, D. S. Sanders, M. Maeurer, J. Jonsson, J. Grunewald, and J. Wahlström. They are affiliated with the Department of Paediatrics at Örebro University Hospital in Örebro, Sweden. The team gathered biopsy data from all 28 pathology departments in Sweden. They then used the data to identify individuals who were diagnosed with celiac disease between 1969 and 2007. The included only individuals who showed Marsh 3 villous atrophy. Their group included a total of 29,026 individuals. They then selected a group of sex- and age-matched control subjects were selected from the Total Population Register. They used Cox regression Cox to calculate hazard ratios (HRs) for TB from data in the Swedish national health registers. They found that people with celiac disease faced a slightly increased TB risk (HR=2.0; 95% CI=1.3-3.0). For people with celiac disease, the absolute risk of contracting TB was 10/100,000 person-years, with an excess risk of 5/100,000. Risk estimates were the highest in the first year. When the team restricted its focus to TB confirmed by (I) a record of TB medication (HR=2.9; 95% CI=1.0-8.3), (II) data in the National Surveillance System for Infectious Diseases in Sweden (HR=2.6; 95% CI=1.3-5.2) or (III) positive TB cultivation (HR=3.3; 95% CI=1.6-6.8) they saw increased risk levels. The team also noted the positive association between celiac disease and TB prior to celiac disease diagnosis (odds ratio=1.6; 95% CI=1.2-2.1). In the end, the team was able to confirm a slightly higher TB risk for people with celiac disease. Source: Aliment Pharmacol Ther. 2011 Mar;33(6):689-96. doi: 10.1111/j.1365-2036.2010.04572.x.