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Antibiotic exposure and the development of coeliac disease: a nationwide case-control study
Karolinska Inst, Clin Epidemiol Unit, Stockholm, Sweden.;Astrid Lindgren Childrens Hosp, Solna, Sweden..
Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
Columbia Univ, Columbia Univ Med Ctr, Celiac Dis Ctr, Dept Med, New York, NY USA..
Columbia Univ, Columbia Univ Med Ctr, Celiac Dis Ctr, Dept Med, New York, NY USA..
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2013 (English)In: BMC Gastroenterology, ISSN 1471-230X, E-ISSN 1471-230X, Vol. 13, 109Article in journal (Refereed) Published
Abstract [en]

Background: The intestinal microbiota has been proposed to play a pathogenic role in coeliac disease (CD). Although antibiotics are common environmental factors with a profound impact on intestinal microbiota, data on antibiotic use as a risk factor for subsequent CD development are scarce. Methods: In this population-based case-control study we linked nationwide histopathology data on 2,933 individuals with CD (Marsh stage 3; villous atrophy) to the Swedish Prescribed Drug Register to examine the association between use of systemic antibiotics and subsequent CD. We also examined the association between antibiotic use in 2,118 individuals with inflammation (Marsh 1-2) and in 620 individuals with normal mucosa (Marsh 0) but positive CD serology. All individuals undergoing biopsy were matched for age and sex with 28,262 controls from the population. Results: Antibiotic use was associated with CD (Odds ratio [OR] = 1.40; 95% confidence interval [CI] = 1.27-1.53), inflammation (OR = 1.90; 95% CI = 1.72-2.10) and normal mucosa with positive CD serology (OR = 1.58; 95% CI = 1.30-1.92). ORs for prior antibiotic use in CD were similar when we excluded antibiotic use in the last year (OR = 1.30; 95% CI = 1.08-1.56) or restricted to individuals without comorbidity (OR = 1.30; 95% CI = 1.16-1.46). Conclusions: The positive association between antibiotic use and subsequent CD but also with lesions that may represent early CD suggests that intestinal dysbiosis may play a role in the pathogenesis of CD. However, non-causal explanations for this positive association cannot be excluded.

Place, publisher, year, edition, pages
2013. Vol. 13, 109
Keyword [en]
Celiac, Inflammation, Microbiota, Population-based case-control study
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-56636DOI: 10.1186/1471-230X-13-109ISI: 000322132300001PubMedID: 23834758OAI: oai:DiVA.org:oru-56636DiVA: diva2:1083392
Available from: 2017-03-21 Created: 2017-03-21 Last updated: 2017-03-21Bibliographically approved

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Card, TimLudvigsson, Jonas F.
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