Auteur Topic: Antibiotic exposure and the development of coeliac disease: a nationwide case--c  (gelezen 1010 keer)

ine

  • Gold Member
  • *****
  • Berichten: 1157
Een Zweeds/Amerikaans/Engels onderzoek (volledig artikel)


Antibiotic exposure and the development of coeliac disease:
a nationwide case--control study


1  Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
2  Astrid Lindgren Children’s Hospital, Solna, Sweden *)
3  Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm,
    Sweden
4  Celiac Disease Center, Department of Medicine, Columbia University Medical Center,
    Columbia University, New York, USA
5  Department of Medicine, New York University Langone Medical Center, New York, USA
6  Division of Epidemiology and Public Health, University of Nottingham, Nottingham City
    Hospital, Nottingham, UK
7  Department of Paediatrics, Örebro University Hospital, Örebro, Sweden
*) Corresponding author. Astrid Lindgren Children’s Hospital, Solna, Sweden



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

Conclusions
In conclusion, we found a positive association between antibiotic use and subsequent CD, as well as with inflammation, and with having a normal mucosa but positive CD serology. One explanation could be that antibiotic exposure, possibly through changes in the gut microbiota, plays a role in early CD development, but non-causal explanations cannot be ruled out.

Within the limited time window studied, the lack of a time-response effect raises the
possibility of reverse causation, in particular, prescription of antibiotics to individuals with
manifestations of undiagnosed CD.


Table 1
Descriptive characteristics of individuals with coeliac disease, small-intestinal
inflammation, and normal small-intestinal mucosaa

Table 2
Odds ratios for prior antibiotic use in individuals with coeliac disease, small-intestinal inflammation and normal mucosa

Table 3
Odds ratios for prior antibiotic a use in individuals with coeliac disease


Volledig artikel:
http://www.biomedcentral.com/content/pdf/1471-230X-13-109.pdf