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No association between biopsy-verified celiac disease and subsequent amyotrophic lateral sclerosis: a population-based cohort study
Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden.ORCID iD: 0000-0003-1024-5602
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, United States.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
2014 (English)In: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331, Vol. 21, no 7, 976-982 p.Article in journal (Refereed) Published
Abstract [en]

Background and purpose: Earlier data suggest an association between amyotrophic lateral sclerosis (ALS) and autoimmune disease, but data on its association with celiac disease (CD) are limited.

Methods: The risk of ALS in 29093 individuals with CD, according to small intestine biopsy (villous atrophy, Marsh 3) carried out at Sweden's 28 pathology departments in 1969-2008, was compared with that in 144515 age- and sex-matched reference individuals from the general population. ALS was defined as a hospitalization or outpatient visit with ALS according to the Swedish Patient Register. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for ALS.

Results: During follow-up 12 (3.7/100000 person-years) individuals with CD and 56 (3.5/100000 person-years) reference individuals had a diagnosis of ALS. This corresponded to an HR of 1.0 (95% CI0.5-1.8). HRs were significantly higher in the first year of follow-up (4.1; 1.2-13.4) than 1-5years after first CD diagnosis (0.8; 0.2-2.7) or after more than 5years of follow-up (0.5; 0.2-1.5). Relative risk estimates were similar in men and women but were higher at the end of the study period [HR for ALS in patients diagnosed with CD in year 2000 or later was 2.1 (95% CI0.9-4.8)].

Conclusions: This study found no association between CD and ALS. Earlier reports of a positive association may be due to surveillance bias just after CD diagnosis or expedited diagnostic work-up of ALS.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2014. Vol. 21, no 7, 976-982 p.
Keyword [en]
amyotrophic lateral sclerosis, autoimmune, coeliac, gluten
National Category
Neurology
Identifiers
URN: urn:nbn:se:oru:diva-35820DOI: 10.1111/ene.12419ISI: 000337616900008PubMedID: 24708265Scopus ID: 2-s2.0-84902278502OAI: oai:DiVA.org:oru-35820DiVA: diva2:741246
Note

Funding Agency:

NCATS NIH HHS  UL1 TR000040

Available from: 2014-08-27 Created: 2014-07-30 Last updated: 2017-10-18Bibliographically approved

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