Incidence of autoimmune diseases in celiac disease: protective effect of the gluten-free diet.
OBJECTIVE
Celiac disease may be associated with autoimmune diseases. The aims of the present study were to determine in celiac patients which factors modulate the risk of autoimmune disease and to evaluate the effect of the gluten-free diet.


METHODS
The occurrence of autoimmune disease and compliance to gluten-free diet were specified retrospectively in 924 celiac patients recruited from 27 French pediatric and adult gastroenterology centers.


RESULTS
One or several autoimmune diseases had developed in 178 patients. The cumulative risk of autoimmune disease was 8.1% +/- 1% at age 15, and 15.7% +/- 1.5% at age 30. Factors associated with an increased risk were family history of autoimmunity (hazard ratio, 2.36; 95% confidence interval, 1.71-3.31) and diagnosis of celiac disease before 36 years of age (hazard ratio, 2.65; 95% confidence interval, 1.79-3.85). After diagnosis of celiac disease, 55 of 788 patients developed an autoimmune disease. The cumulative risk of subsequent autoimmune disease was lower in patients compliant to a gluten-free diet versus noncompliant patients (at 10 years, 6% +/- 2% vs 15.6% +/- 5.9%, respectively; P = .02). The incidence of autoimmune diseases was 5.4 per 1000 patient-years during adherence to a gluten-free diet versus 11.3 per 1000 patient-years during nonadherence to the diet (P = .002). Results were similar in both the pediatric and the adult populations.


CONCLUSIONS
Celiac patients most at risk for autoimmune disease are those diagnosed early in life and having a family history of autoimmunity. The gluten-free diet has a protective effect.
Cosnes
Jacques
J
Service de Gastroentérologie et Nutrition, Hôpital St-Antoine and Université Pierre & Marie Curie, Paris, France. jacques.cosnes@sat.aphp.fr
Cellier
Christophe
C
Viola
Sheila
S
Colombel
Jean-Frederic
JF
Michaud
Laurent
L
Sarles
Jacques
J
Hugot
Jean-Pierre
JP
Ginies
Jean-Louis
JL
Dabadie
Alain
A
Mouterde
Olivier
O
Allez
Matthieu
M
Nion-Larmurier
Isabelle
I
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001327:Autoimmune Diseases / Q000453:epidemiology*; D002446:Celiac Disease / Q000150:complications* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D004035:Diet Therapy; D005192:Family Health; D005983:Glutens; D006801:Humans; D015994:Incidence; D007223:Infant; D008875:Middle Aged; D010349:Patient Compliance; D012189:Retrospective Studies; D012307:Risk Factors
D005983:Glutens