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

BMC Gastroenterology

Jonas F Ludvigsson⁶  Tim Card³  Martin J Blaser⁴  Peter HR Green⁵  Benjamin Lebwohl⁵  Weimin Ye¹  Karl Mårild² 

[1] Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden;Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden;Division of Epidemiology and Public Health, University of Nottingham, Nottingham City Hospital, Nottingham, UK;Department of Medicine, New York University Langone Medical Center, New York, USA;Celiac Disease Center, Department of Medicine, Columbia University Medical Center, Columbia University, New York, USA;Department of Paediatrics, Örebro University Hospital, Örebro, Sweden

关键词: Population-based case–control study;    Microbiota;    Inflammation;    Celiac;   

Others  :  857847
DOI  :  10.1186/1471-230X-13-109

 received in 2013-01-31, accepted in 2013-06-28,  发布年份 2013

【 摘 要 】

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.

【 授权许可】

   
2013 Mårild et al.; licensee BioMed Central Ltd.

【 图 表 】

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