A large nationwide population-based case–control study of the association between intussusception and later celiac disease

BMC Gastroenterology

Ola Olén²  Joseph A Murray¹  Agneta Nordenskjöld³  Jonas F Ludvigsson¹ 

[1] Division of Gastroenterology and Hepatology, Departments of Medicine and Immunology, Mayo Clinic College of Medicine, Rochester, NY, USA;Sachs’ Children’s Hospital, Stockholm South General Hospital, Stockholm, Sweden;Department of Women’s and Children’s Health, Karolinska Institutet and Department of Pediatric Surgery, Karolinska University Hospital, Karolinska, Sweden

关键词: Population-based;    Intussusception;    Inflammation;    Coeliac, Gluten;    Celiac;   

Others  :  857964
DOI  :  10.1186/1471-230X-13-89

 received in 2012-10-03, accepted in 2013-05-13,  发布年份 2013

【 摘 要 】

Background

Case reports and case series studies suggest a positive association between intussusception and celiac disease (CD).

Methods

We contacted Sweden’s 28 pathology departments and obtained data on 29,096 patients with biopsy-verified CD (equal to Marsh stage 3) through biopsy reports. Patients with CD were matched for age, sex, calendar period and county of residence with up to five reference individuals from the general population (n = 144,522). Cases of intussusception were identified from nationwide inpatient, hospital-based outpatient and day-surgery data from the Swedish Patient Register.

Odds ratios (ORs) for future CD in patients with intussusception were estimated using conditional logistic regression.

Results

34 (0.12%) individuals with CD had a diagnosis of intussusception vs. 143 (0.10%) reference individuals, suggesting that intussusception was not a risk factor for later CD (OR = 1.17; 95% confidence interval (CI) = 0.82–1.67). The OR for CD in patients with at least two records of intussusception was 0.40 (95% CI = 0.06–2.99).

In contrast, a post-hoc analysis showed that CD was associated with a statistically significantly increased risk of intussusception after CD diagnosis (hazard ratio = 1.95; 95% CI = 1.01–3.77); however, this analysis was based on only 12 cases with both CD and intussusception.

Conclusion

We found no association between intussusception and future CD; and a mostly modest increased risk of intussusception after a diagnosis of CD.

【 授权许可】

   
2013 Ludvigsson et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Samad L, Marven S, El Bashir H, Sutcliffe AG, Cameron JC, Lynn R, Taylor B: Prospective surveillance study of the management of intussusception in UK and Irish infants. Br J Surg 2012, 99:411-415.
• [2]Loukas M, Pellerin M, Kimball Z, de la Garza-Jordan J, Tubbs RS, Jordan R: Intussusception: an anatomical perspective with review of the literature. Clin Anat 2011, 24:552-561.
• [3]Dube C, Rostom A, Sy R, Cranney A, Saloojee N, Garritty C, Sampson M, Zhang L, Yazdi F, Mamaladze V, et al.: The prevalence of celiac disease in average-risk and at-risk Western European populations: a systematic review. Gastroenterology 2005, 128:S57-S67.
• [4]Walker MM, Murray JA, Ronkainen J, Aro P, Storskrubb T, D'Amato M, Lahr B, Talley NJ, Agreus L: Detection of Celiac Disease and Lymphocytic Enteropathy by Parallel Serology and Histopathology in a Population-Based Study. Gastroenterology 2010, 139:112-119.
• [5]Walker MM: Murray. An update in the diagnosis of coeliac disease. Histopathology: JA; 2010.
• [6]Tomei E, Semelka RC, Braga L, Laghi A, Paolantonio P, Marini M, Passariello R, Di Tola M, Sabbatella L, Picarelli A: Adult celiac disease: what is the role of MRI? J Magn Reson Imaging 2006, 24:625-629.
• [7]Bartusek D, Valek V, Husty J, Uteseny J: Small bowel ultrasound in patients with celiac disease. Retrospective study. Eur J Radiol 2007, 63:302-306.
• [8]Schweiger GD, Murray JA: Postbulbar duodenal ulceration and stenosis associated with celiac disease. Abdom Imaging 1998, 23:347-349.
• [9]Fishman DS, Chumpitazi BP, Ngo PD, Kim HB, Lightdale JR: Small bowel intussusception in celiac disease: revisiting a classic association. J Pediatr Gastroenterol Nutr 2010, 50:237.
• [10]Mushtaq N, Marven S, Walker J, Puntis JW, Rudolf M, Stringer MD: Small bowel intussusception in celiac disease. J Pediatr Surg 1999, 34:1833-1835.
• [11]Onkendi EO, Grotz TE, Murray JA, Donohue JH: Adult intussusception in the last 25 years of modern imaging: is surgery still indicated? J Gastrointest Surg 2011, 15:1699-1705.
• [12]Cohen MD, Lintott DJ: Transient small bowel intussusception in adult coeliac disease. Clin Radiol 1978, 29:529-534.
• [13]Gonda TA, Khan SU, Cheng J, Lewis SK, Rubin M, Green PH: Association of intussusception and celiac disease in adults. Dig Dis Sci 2010, 55:2899-2903.
• [14]Reilly NR, Aguilar KM, Green PH: Should intussusception in children prompt screening for celiac disease? J Pediatr Gastroenterol Nutr 2013, 56:56-59.
• [15]Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, Heurgren M, Otterblad Olausson P: External review and validation of the Swedish national inpatient register. BMC Public Health 2011, 11:450. BioMed Central Full Text
• [16]Ludvigsson JF, Brandt L, Montgomery SM, Granath F, Ekbom A: Validation study of villous atrophy and small intestinal inflammation in Swedish biopsy registers. BMC Gastroenterol 2009, 9:19. BioMed Central Full Text
• [17]Ludvigsson JF, Otterblad-Olausson P, Pettersson BU, Ekbom A: The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research. Eur J Epidemiol 2009, 24:659-667.
• [18]Marsh MN: Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity (‘celiac sprue’). Gastroenterology 1992, 102:330-354.
• [19]Ludvigsson JF, Montgomery SM, Ekbom A, Brandt L, Granath F: Small-intestinal histopathology and mortality risk in celiac disease. JAMA 2009, 302:1171-1178.
• [20]Ivarsson A, Persson LA, Nystrom L, Ascher H, Cavell B, Danielsson L, Dannaeus A, Lindberg T, Lindquist B, Stenhammar L, Hernell O: Epidemic of coeliac disease in Swedish children [see comments]. Acta Paediatr 2000, 89:165-171.
• [21]Elfstrom P, Granath F, Ekstrom Smedby K, Montgomery SM, Askling J, Ekbom A, Ludvigsson JF: Risk of Lymphoproliferative Malignancy in Relation to Small Intestinal Histopathology Among Patients With Celiac Disease. J Natl Cancer Inst 2011, 103:436-444.
• [22]Green PH, Fleischauer AT, Bhagat G, Goyal R, Jabri B, Neugut AI: Risk of malignancy in patients with celiac disease. Am J Med 2003, 115:191-195.
• [23]Elfstrom P, Granath F, Ye W: Ludvigsson. Low Risk of Gastrointestinal Cancer Among Patients With Celiac Disease, Inflammation, or Latent Celiac Disease. Clin Gastroenterol Hepatol: JF; 2011.
• [24]Socialstyrelsen: Cancer incidence in Sweden 2005. In Book Cancer incidence in Sweden 2005. City: ; 2007.
• [25]Germann R, Kuch M, Prinz K, Ebbing A, Schindera F: Celiac disease: an uncommon cause of recurrent intussusception. J Pediatr Gastroenterol Nutr 1997, 25:415-416.
• [26]Ludvigsson JF, Wahlstrom J, Grunewald J, Ekbom A, Montgomery SM: Coeliac disease and risk of tuberculosis: a population based cohort study. Thorax 2007, 62:23-28.
• [27]Ludvigsson JF, Sanders DS, Maeurer M, Jonsson J, Grunewald J, Wahlstrom J: Risk of tuberculosis in a large sample of patients with coeliac disease–a nationwide cohort study. Aliment Pharmacol Ther 2011, 33:689-696.
• [28]Peters U, Askling J, Gridley G, Ekbom A, Linet M: Causes of death in patients with celiac disease in a population-based Swedish cohort. Arch Intern Med 2003, 163:1566-1572.
• [29]Ludvigsson JF, Brandt L, Montgomery SM: Symptoms and signs in individuals with serology positive for celiac disease but normal mucosa. BMC Gastroenterol 2009, 9:57. BioMed Central Full Text
• [30]Jenke AC, Klaassen-Mielke R, Zilbauer M, Heininger U, Trampisch H, Wirth S: Intussusception: incidence and treatment-insights from the nationwide German surveillance. J Pediatr Gastroenterol Nutr 2011, 52:446-451.
• [31]Intussusception among recipients of rotavirus vaccine--United States, 1998–1999 MMWR Morb Mortal Wkly Rep 1999, 48:577-581.
• [32]Myleus A, Stenlund H, Hernell O, Gothefors L, Hammarstrom ML, Persson LA, Ivarsson A: Early vaccinations are not risk factors for celiac disease. Pediatrics 2012, 130:e63-e70.