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A large nationwide population-based case-control study of the association between intussusception and later celiac
Jonas F Ludvigsson1, Agneta Nordenskjöld, Joseph A Murray
1Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Karolinska, Sweden. jonasludvigsson@yahoo.com
Insights
This study found no link between intussusception and future celiac disease (CD). However, a diagnosis of CD was associated with a slightly increased risk of intussusception.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Epidemiology
Background:
- Previous case reports suggested a link between intussusception and celiac disease (CD).
- This study investigates the association between these two conditions using a large population-based cohort.
Purpose of the Study:
- To determine if intussusception is a risk factor for developing celiac disease (CD).
- To assess the risk of intussusception in patients previously diagnosed with celiac disease (CD).
Main Methods:
- A nationwide cohort study in Sweden included 29,096 patients with biopsy-verified celiac disease (CD).
- Patients with CD were matched with a control group from the general population (n=144,522).
- Intussusception cases were identified from national health registers, and conditional logistic regression was used to estimate odds ratios.
Main Results:
- No increased risk of future celiac disease (CD) was observed in individuals with a history of intussusception (OR=1.17).
- A statistically significant increased risk of intussusception was found after a celiac disease (CD) diagnosis (HR=1.95), though based on a small number of cases.
Conclusions:
- Intussusception is not a risk factor for developing celiac disease (CD).
- A diagnosis of celiac disease (CD) may be associated with a modest increase in the risk of intussusception.
Background:
Case reports and case series studies suggest a positive association between intussusception and celiac disease (CD).
Methods:
We contacted Sweden's 28 pathology departments and obtained data on 29,096 patients with biopsy-verified CD (equal to Marsh stage 3) through biopsy reports. Patients with CD were matched for age, sex, calendar period and county of residence with up to five reference individuals from the general population (n=144,522). Cases of intussusception were identified from nationwide inpatient, hospital-based outpatient and day-surgery data from the Swedish Patient Register.Odds ratios (ORs) for future CD in patients with intussusception were estimated using conditional logistic regression.
Results:
34 (0.12%) individuals with CD had a diagnosis of intussusception vs. 143 (0.10%) reference individuals, suggesting that intussusception was not a risk factor for later CD (OR=1.17; 95% confidence interval (CI)=0.82-1.67). The OR for CD in patients with at least two records of intussusception was 0.40 (95% CI=0.06-2.99).In contrast, a post-hoc analysis showed that CD was associated with a statistically significantly increased risk of intussusception after CD diagnosis (hazard ratio=1.95; 95% CI=1.01-3.77); however, this analysis was based on only 12 cases with both CD and intussusception.
Conclusion:
We found no association between intussusception and future CD; and a mostly modest increased risk of intussusception after a diagnosis of CD.
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