title: Celiac disease and risk of liver disease: a general population-based study.
abstract: OBJECTIVE
  Celiac disease (CD) is an important cause of hypertransaminasemia. CD might also be associated with severe forms of liver disease. We investigated the risk of liver disease in 13,818 patients with CD (1964-2003) and 66,584 age- and sex-matched reference individuals from a general population cohort.
  
  
  METHODS
  We used Cox regression to estimate hazard ratios (HRs) for later liver disease and conditional logistic regression to estimate the risk of CD in individuals with liver disease before study entry.
  
  
  RESULTS
  CD was associated with an increased risk of acute hepatitis (HR, 5.21; 95% confidence interval [CI], 1.88-14.40; P = .001), chronic hepatitis (HR, 5.84; 95% CI, 2.89-11.79; P < .001), primary sclerosing cholangitis (HR, 4.46; 95% CI, 2.50-7.98; P < .001), fatty liver (HR, 6.06; 95% CI, 1.35-27.16; P = .018), liver failure (HR, 3.30; 95% CI, 2.22-4.88; P < .001), liver cirrhosis or liver fibrosis (HR, 2.23; 95% CI, 1.34-3.72; P < .001), and primary biliary cirrhosis (HR, 10.16; 95% CI, 2.61-39.49; P < .001). There was no increased risk of liver transplantation (HR, 1.07; 95% CI, 0.12-9.62; P = .954). Adjustment for socioeconomic index or diabetes mellitus had no notable effect on the risk estimates. Prior liver disease was associated with a statistically significant 4-fold to 6-fold increased risk of later CD.
  
  
  CONCLUSIONS
  This study suggests that individuals with CD are at increased risk of both prior and subsequent liver disease.
authors.affiliation: Department of Pediatrics, Orebro University Hospital, Orebro, Sweden. jonasludvigsson@yahoo.com
authors.forename: Jonas F
authors.initials: JF
authors.lastname: Ludvigsson
authors.forename: Peter
authors.initials: P
authors.lastname: Elfström
authors.forename: Ulrika
authors.initials: U
authors.lastname: Broomé
authors.forename: Anders
authors.initials: A
authors.lastname: Ekbom
authors.forename: Scott M
authors.initials: SM
authors.lastname: Montgomery
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002446:Celiac Disease / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015209:Cholangitis, Sclerosing / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008107:Liver Diseases / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D013548:Sweden / Q000453:epidemiology