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Borrelia infection and risk of celiac disease
Columbia University Medical Center, Department of Medicine, New York NY, United States; Columbia University Medical Center, Celiac Disease Center, New York NY, United States; Columbia University Medical Center, Institute of Human Nutrition, New York NY, United States.
Columbia University Medical Center, Department of Medicine, New York NY, United States; Columbia University Medical Center, Celiac Disease Center, New York NY, United States; Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden.
New York Medical College, Division of Infectious Diseases, Department of Medicine, Valhalla NY, United States.
Columbia University Medical Center, Department of Medicine, New York NY, United States; Columbia University Medical Center, Celiac Disease Center, New York NY, United States.
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2017 (English)In: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, Vol. 15, 169Article in journal (Refereed) Published
Abstract [en]

Background: Environmental factors, including infectious agents, are speculated to play a role in the rising prevalence and the geographic distribution of celiac disease, an autoimmune disorder. In the USA and Sweden where the regional variation in the frequency of celiac disease has been studied, a similarity with the geographic distribution of Lyme disease, an emerging multisystemic infection caused by Borrelia burgdorferi spirochetes, has been found, thus raising the possibility of a link. We aimed to determine if infection with Borrelia contributes to an increased risk of celiac disease.

Methods: Biopsy reports from all of Sweden's pathology departments were used to identify 15,769 individuals with celiac disease. Through linkage to the nationwide Patient Register, we compared the rate of earlier occurrence of Lyme disease in the patients with celiac disease to that in 78,331 matched controls. To further assess the temporal relationship between Borrelia infection and celiac disease, we also examined the risk of subsequent Lyme disease in patients with a diagnosis of celiac disease.

Results: Twenty-five individuals (0.16%) with celiac disease had a prior diagnosis of Lyme disease, whereas 79 (0.5%) had a subsequent diagnosis of Lyme disease. A modest association between Lyme disease and celiac disease was seen both before (odds ratio, 1.61; 95% confidence interval (CI), 1.06-2.47) and after the diagnosis of celiac disease (hazard ratio, 1.82; 95% CI, 1.40-2.35), with the risk of disease being highest in the first year of follow-up.

Conclusions: Only a minor fraction of the celiac disease patient population had a prior diagnosis of Lyme disease. The similar association between Lyme disease and celiac disease both before and after the diagnosis of celiac disease is strongly suggestive of surveillance bias as a likely contributor. Taken together, the data indicate that Borrelia infection is not a substantive risk factor in the development of celiac disease.

Place, publisher, year, edition, pages
BioMed Central, 2017. Vol. 15, 169
Keyword [en]
Celiac disease, Lyme disease, Infection, Inflammation, Borrelia burgdorferi
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-61153DOI: 10.1186/s12916-017-0926-1ISI: 000410629700001Scopus ID: 2-s2.0-85029422098OAI: oai:DiVA.org:oru-61153DiVA: diva2:1144728
Funder
Swedish Society of MedicineSwedish Research Council, 522-2A09-195
Note

Funding Agencies:

National Institute of Allergy and Infectious Diseases of the National Institutes of Health  R56AI093763 

Global Lyme Alliance 

Swedish Celiac Society  

Fulbright Commission 

Available from: 2017-09-27 Created: 2017-09-27 Last updated: 2017-09-27Bibliographically approved

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CiteExportLink to record
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