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No association between biopsy‐verified celiac disease and subsequent amyotrophic lateral sclerosis – a population‐based cohort study
Author(s) -
Ludvigsson J. F.,
Mariosa D.,
Lebwohl B.,
Fang F.
Publication year - 2014
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.12419
Subject(s) - medicine , amyotrophic lateral sclerosis , hazard ratio , cohort , proportional hazards model , population , confidence interval , cohort study , logistic regression , disease , gastroenterology , environmental health
Background and purpose Earlier data suggest an association between amyotrophic lateral sclerosis ( ALS ) and autoimmune disease, but data on its association with celiac disease ( CD ) are limited. Methods The risk of ALS in 29 093 individuals with CD , according to small intestine biopsy (villous atrophy, Marsh 3) carried out at Sweden's 28 pathology departments in 1969–2008, was compared with that in 144 515 age‐ and sex‐matched reference individuals from the general population. ALS was defined as a hospitalization or outpatient visit with ALS according to the Swedish Patient Register. We used Cox regression to estimate hazard ratios ( HR s) and 95% confidence intervals ( CI s) for ALS . Results During follow‐up 12 (3.7/100 000 person‐years) individuals with CD and 56 (3.5/100 000 person‐years) reference individuals had a diagnosis of ALS . This corresponded to an HR of 1.0 (95% CI 0.5–1.8). HR s were significantly higher in the first year of follow‐up (4.1; 1.2–13.4) than 1–5 years after first CD diagnosis (0.8; 0.2–2.7) or after more than 5 years of follow‐up (0.5; 0.2–1.5). Relative risk estimates were similar in men and women but were higher at the end of the study period [ HR for ALS in patients diagnosed with CD in year 2000 or later was 2.1 (95% CI 0.9–4.8)]. Conclusions This study found no association between CD and ALS . Earlier reports of a positive association may be due to surveillance bias just after CD diagnosis or expedited diagnostic work‐up of ALS .