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Persistent mucosal damage and the risk of epilepsy in people with celiac disease
Academic Unit of Gastroenterology Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0003-1024-5602
Academic Unit of Gastroenterology Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.
Celiac Disease Center Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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2018 (English)In: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331, Vol. 25, no 3, p. 592-e38Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Celiac disease (CD) is associated with an increased risk of developing epilepsy, a risk that persists after CD diagnosis. A significant proportion of CD patients have persistent villous atrophy (VA) on follow-up biopsy. This study's objective was to determine whether persistent VA on follow-up biopsy affects long-term epilepsy risk and epilepsy-related hospital emergency admissions.

METHODS: Nationwide Cohort Study. We identified all people in Sweden with histological evidence of CD who underwent a follow-up small intestinal biopsy (1969-2008). We compared those with persistent VA to those who showed histological improvement, assessing the development of epilepsy and related emergency hospital admissions (defined according to relevant ICD codes in the Swedish Patient Register). Cox regression analysis was used to assess outcome measures.

RESULTS: Of 7590 people with CD who had a follow-up biopsy, VA was present in 43%. The presence of persistent VA was significantly associated with a reduced risk of developing newly-diagnosed epilepsy (hazard ratio [HR] 0.61; 95% confidence interval [CI] 0.38-0.98). On stratified analysis this effect was primarily amongst males (HR 0.35; 95 CI 0.15-0.80). Among the 58 CD patients with a prior diagnosis of epilepsy, those with persistent VA were less likely to visit an emergency department with epilepsy (HR 0.37; 95%CI 0.09-1.09).

CONCLUSIONS: In a population-based study of CD individuals, persisting VA on follow up biopsy was associated with reduced future risk of developing epilepsy but did not influence emergency epilepsy-related hospital admissions. Mechanisms as to why persistent VA confers this benefit requires further exploration. This article is protected by copyright. All rights reserved.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018. Vol. 25, no 3, p. 592-e38
Keywords [en]
Celiac, cohort study, epilepsy, villous atrophy
National Category
Neurology
Identifiers
URN: urn:nbn:se:oru:diva-64035DOI: 10.1111/ene.13564ISI: 000425631500028PubMedID: 29316034Scopus ID: 2-s2.0-85040866527OAI: oai:DiVA.org:oru-64035DiVA, id: diva2:1173591
Funder
Swedish Society of MedicineSwedish Research Council, 522-2A09-195
Note

Funding Agency:

Swedish Celiac Society

Available from: 2018-01-12 Created: 2018-01-12 Last updated: 2018-03-06Bibliographically approved

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Ludvigsson, Jonas F.

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