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Mucosal healing and the risk of serious infections in patients with celiac disease
Department of Health Management and Health Economy, Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston MA, United States; Vårdcentralen Värmlands Nysäter & Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden.
Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States.
Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States.
Division of Gastroenterology and Hepatology, Department of Immunology, Mayo Clinic, Rochester MN, United States.
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2018 (English)In: United European Gastroenterology journal, ISSN 2050-6406, E-ISSN 2050-6414, Vol. 6, no 1, p. 55-62Article in journal (Refereed) Published
Abstract [en]

Background: Patients with celiac disease (CD) are at increased risk of certain infections, but it is unknown if mucosal healing influences this risk.

Methods: We collected data on 29,096 individuals with CD (equal to villous atrophy) through Sweden's 28 pathology departments undergoing biopsy 1969-2008. Through the Swedish Patient Register we obtained information on any infection and specifically sepsis, streptococcal infection, influenza, Clostridium difficile, herpes zoster and pneumococcal infection up until December 2009. We used Cox regression to calculate hazard ratios (HRs) for the risk of future diagnosis of infection according to mucosal healing on follow-up biopsy (persistent villous atrophy vs mucosal healing).

Results: Of 5598 CD individuals with no record of any infections before follow-up biopsy, 45% had persistent villous atrophy, 619 (24%) of them had a later infection, compared to 579 (19%) in those with mucosal healing (p<0.01); the yearly incidence was 2.1% in both groups. Adjusting for age, sex, calendar period, time between biopsies and education, persistent villous atrophy was however not associated with later infection overall (HR=0.99; 95% CI=0.88-1.11) or with any of the specific infections.

Conclusions: In CD, mucosal healing does not influence the risk of serious infection requiring hospital-based medical attention.

Place, publisher, year, edition, pages
Sage Publications, 2018. Vol. 6, no 1, p. 55-62
Keywords [en]
Celiac disease, infectious disease, epidemiology
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-64824DOI: 10.1177/2050640617707868ISI: 000423192600007Scopus ID: 2-s2.0-85041134950OAI: oai:DiVA.org:oru-64824DiVA, id: diva2:1180589
Funder
Swedish Society of MedicineSwedish Research Council, 522-2A09-195
Note

Funding Agencies:

Orebro University Hospital  

Karolinska Institutet 

Swedish Celiac Society

Available from: 2018-02-06 Created: 2018-02-06 Last updated: 2018-09-12Bibliographically approved

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Ludvigsson, Jonas F.

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