Gastroenteritis May Trigger Celiac Disease

NEW YORK (Reuters Health) 07/03/2012 – Food-borne infectious gastroenteritis could be triggering some cases of celiac disease, which might partly explain the rising incidence of the autoimmune condition, a new paper suggests.

The authors of the report — military researchers along with celiac disease expert Dr. Joseph Murray from the Mayo Clinic — focused on active duty personnel in the U.S. armed forces between 1999 and 2008. Altogether there were more than 13.7 million person-years of follow-up, they reported May 15th in The American Journal of Gastroenterology.

The incidence of celiac disease diagnoses increased five-fold from 1.3 per 100,000 in 1999 to 6.5 per 100,000 in 2008.

The research team identified a total of 455 cases of incident celiac disease and compared those to 1820 matched controls.

Overall, 172 subjects had infectious gastroenteritis (IGE) within 24 months before their diagnosis, with the majority (60.5%) of viral etiology. Multivariate analysis showed a significant association between celiac disease and any prior IGE (odds ratio, 2.06), which was stronger when the IGE was non-viral (odds ratio, 3.27) vs viral (odds ratio, 1.44).

Given the apparent association, the researchers suggest that infections may “act as triggers for developing gluten intolerance through molecular mimicry or other immune modulation mechanisms.”

Dr. Mark Riddle of the Naval Medical Research Center, Silver Springs, Maryland, lead author on the paper, told Reuters Health by email, “The association between acute enteric infection and celiac disease that we found needs further confirmation with additional well designed studies.”

“However,” he added, “accumulating evidence linking bacterial intestinal infections and other chronic gastrointestinal disorders, as well as animal model data, would suggest that this association may be real and that these infections may be the trigger for celiac disease in genetically susceptible individuals.”

Caucasians were also at higher risk of a new celiac disease diagnosis (odds ratio, 3.1), as were personnel older than 34, but the team cautions that the cohort of active duty soldiers and sailors was far from typical of the general population.

Summing up, Dr. Riddle concluded, “The myriad of chronic consequences of food borne infection are gaining appreciation. This study suggests that celiac disease may be another one we can add to the list. These potential long term health outcomes need further study, but clearly this burden of disease needs to be considered by public health authorities to assure continued improvements in food safety.”

SOURCE: http://www.nature.com/ajg/journal/vaop/ncurrent/full/ajg2012130a.html