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Inflammatory Bowel Diseases in Children and Young Adults with Celiac Disease. A Multigroup Matched Comparison
Cristina Canova1, Gisella Pitter, Loris Zanier
1*Department of Molecular Medicine, University of Padua, Padua, Italy; †School of Specialization in Hygiene and Preventive Medicine, University of Padua, Padua, Italy; ‡Epidemiological Service, Udine, Italy; §Department of Cardiological, Thoracic and Vascular Sciences, University of Padua, Padua, Italy; ‖Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; ¶Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden; **Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom; and ††Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York.
Insights
Celiac disease (CD) is linked to a higher risk of inflammatory bowel disease (IBD). However, this association may be due to surveillance bias, as the risk diminishes when compared to individuals without villous atrophy.
Area of Science:
- Gastroenterology
- Epidemiology
- Immunology
Background:
- Celiac disease (CD) has been inconsistently linked to inflammatory bowel disease (IBD).
- Previous reports may have been influenced by surveillance bias, complicating the interpretation of the CD-IBD association.
Purpose of the Study:
- To investigate the association between celiac disease (CD) and inflammatory bowel disease (IBD).
- To assess the impact of surveillance bias on the reported risk of IBD in individuals with CD.
Main Methods:
- A matched birth cohort study was conducted in Italy, including 1294 individuals with CD and 5681 general population controls.
- Individuals with IBD were identified via medical records; secondary comparisons used individuals with negative small intestinal biopsies (Marsh 0-1-2 or Marsh 0).
- Conditional logistic regression estimated odds ratios (ORs) for IBD in CD patients compared to reference groups.
Main Results:
- An initial analysis showed a significantly increased risk of IBD in individuals with CD compared to the general population (OR = 24.17).
- When compared to individuals with Marsh 0-1-2, the OR for IBD in CD decreased to 1.41.
- Comparing CD patients to individuals with Marsh 0, the OR for IBD was 1.28, suggesting a reduced association.
Conclusions:
- A high risk of IBD in CD patients is observed when compared to the general population.
- Surveillance bias is the likely explanation for the inflated risk, as the association weakens with appropriate control groups.
- The study highlights the importance of careful selection of control groups in epidemiological research to avoid bias.
Background:
Celiac disease (CD) has been linked to inflammatory bowel disease (IBD) but previous reports have been inconsistent and may have been affected by surveillance bias.
Methods:
Matched birth cohort study in Friuli-Venezia Giulia Region, Italy. We identified 1294 individuals with CD aged 0 to 23 years at diagnosis using pathology reports, hospital discharge records, or copayment exemptions. Each CD individual was matched with up to 5 general population reference individuals from the regional Medical Birth Register in Friuli-Venezia Giulia (n = 5681). As secondary comparison groups, we used individuals undergoing small intestinal biopsy but not having villous atrophy (either Marsh 0-1-2 or exclusively Marsh 0). Individuals with IBD were identified through hospital discharge records or copayment exemptions. Conditional logistic regression was used to estimate odds ratios (ORs) for having IBD among CD individuals (before or after CD diagnosis) compared with their matched references.
Results:
Overall 35 individuals with IBD were identified (29 with CD and 6 general population controls). This corresponded to an increased risk of IBD in CD (OR = 24.17; 95% CI, 10.03-58.21). However, compared with individuals with Marsh 0-1-2 the OR decreased to 1.41 (95% CI, 0.91-2.18) and restricting our comparison group to individuals with Marsh 0, the OR was 1.28 (95% CI, 0.61-2.70).
Conclusions:
In conclusion, this article found a highly increased risk of IBD in individuals with CD when comparing with the general population. Bias is the likely explanation for the very high risk increase for IBD in CD because the excess risk was substantially lower when we used individuals with a small intestinal biopsy without villous atrophy as our reference.
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