Skip to main content
NCBI home page
Gut logoLink to Gut
. 2001 Oct;49(4):502–505. doi: 10.1136/gut.49.4.502

Duration of gluten exposure in adult coeliac disease does not correlate with the risk for autoimmune disorders

G Sategna 1, E Solerio 1, N Scaglione 1, G Aimo 1, G Mengozzi 1
PMCID: PMC1728461  PMID: 11559646

Abstract

BACKGROUND AND AIMS—Duration of gluten exposure seems to predispose adolescents with coeliac disease to autoimmune diseases. In a retrospective cohort study, we assessed the relationship between autoimmune disorders and actual gluten exposure in patients in whom coeliac disease was diagnosed in adult life (⩾16 years).
METHODS—We screened for the presence of autoimmunity in 605 controls (16-84 years) and 422 patients (16-84 years), all of whom had been on gluten withdrawal for at least one year (median follow up 9.5 years). A logistic regression analysis, setting the prevalence of autoimmunity as the dependent variable, was employed to control for independent covariates as predictors of the risk of autoimmunity.
RESULTS—The prevalence of autoimmunity was threefold higher (p<0.00001) in patients than in controls. Mean duration of gluten exposure was 31.2 and 32.6 years for patients with or without autoimmunity. Logistic regression showed that increased age at diagnosis of coeliac disease was related to the prevalence of autoimmune disease while "actual gluten exposure" which takes into account diet compliance, follow up, and age at diagnosis of autoimmune disorders were not predictive for the risk of developing autoimmune diseases (odds ratio 0.82 per year).
CONCLUSION—The prevalence of autoimmune diseases in patients with a late coeliac disease diagnosis does not correlate with duration of gluten intake. Early exposure to gluten may modify the immunological response. Gluten withdrawal does not protect patients with a late diagnosis from autoimmune diseases.


Keywords: coeliac disease; autoimmune disorders; prevalence

Full Text

The Full Text of this article is available as a PDF (139.4 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Collin P., Mäki M. Associated disorders in coeliac disease: clinical aspects. Scand J Gastroenterol. 1994 Sep;29(9):769–775. doi: 10.3109/00365529409092508. [DOI] [PubMed] [Google Scholar]
  2. Collin P., Mäki M. Associated disorders in coeliac disease: clinical aspects. Scand J Gastroenterol. 1994 Sep;29(9):769–775. doi: 10.3109/00365529409092508. [DOI] [PubMed] [Google Scholar]
  3. Collin P., Reunala T., Pukkala E., Laippala P., Keyriläinen O., Pasternack A. Coeliac disease--associated disorders and survival. Gut. 1994 Sep;35(9):1215–1218. doi: 10.1136/gut.35.9.1215. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Dieterich W., Ehnis T., Bauer M., Donner P., Volta U., Riecken E. O., Schuppan D. Identification of tissue transglutaminase as the autoantigen of celiac disease. Nat Med. 1997 Jul;3(7):797–801. doi: 10.1038/nm0797-797. [DOI] [PubMed] [Google Scholar]
  5. Feighery C. Coeliac disease, auto-immunity and thyroid disease. Ital J Gastroenterol Hepatol. 1999 May;31(4):288–289. [PubMed] [Google Scholar]
  6. Feighery C. Fortnightly review: coeliac disease. BMJ. 1999 Jul 24;319(7204):236–239. doi: 10.1136/bmj.319.7204.236. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Ferreira M., Davies S. L., Butler M., Scott D., Clark M., Kumar P. Endomysial antibody: is it the best screening test for coeliac disease? Gut. 1992 Dec;33(12):1633–1637. doi: 10.1136/gut.33.12.1633. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Fornasieri A., Sinico R. A., Maldifassi P., Bernasconi P., Vegni M., D'Amico G. IgA-antigliadin antibodies in IgA mesangial nephropathy (Berger's disease). Br Med J (Clin Res Ed) 1987 Jul 11;295(6590):78–80. doi: 10.1136/bmj.295.6590.78. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Garioch J. J., Lewis H. M., Sargent S. A., Leonard J. N., Fry L. 25 years' experience of a gluten-free diet in the treatment of dermatitis herpetiformis. Br J Dermatol. 1994 Oct;131(4):541–545. doi: 10.1111/j.1365-2133.1994.tb08557.x. [DOI] [PubMed] [Google Scholar]
  10. Gilhar A., Shalaginov R., Assy B., Serafimovich S., Kalish R. S. Alopecia areata is a T-lymphocyte mediated autoimmune disease: lesional human T-lymphocytes transfer alopecia areata to human skin grafts on SCID mice. J Investig Dermatol Symp Proc. 1999 Dec;4(3):207–210. doi: 10.1038/sj.jidsp.5640212. [DOI] [PubMed] [Google Scholar]
  11. Hadjivassiliou M., Gibson A., Davies-Jones G. A., Lobo A. J., Stephenson T. J., Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369–371. doi: 10.1016/s0140-6736(96)90540-1. [DOI] [PubMed] [Google Scholar]
  12. Iltanen S., Collin P., Korpela M., Holm K., Partanen J., Polvi A., Mäki M. Celiac disease and markers of celiac disease latency in patients with primary Sjögren's syndrome. Am J Gastroenterol. 1999 Apr;94(4):1042–1046. doi: 10.1111/j.1572-0241.1999.01011.x. [DOI] [PubMed] [Google Scholar]
  13. Jacobson D. L., Gange S. J., Rose N. R., Graham N. M. Epidemiology and estimated population burden of selected autoimmune diseases in the United States. Clin Immunol Immunopathol. 1997 Sep;84(3):223–243. doi: 10.1006/clin.1997.4412. [DOI] [PubMed] [Google Scholar]
  14. Kingham J. G., Parker D. R. The association between primary biliary cirrhosis and coeliac disease: a study of relative prevalences. Gut. 1998 Jan;42(1):120–122. doi: 10.1136/gut.42.1.120. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Michaëlsson G., Gerdén B., Hagforsen E., Nilsson B., Pihl-Lundin I., Kraaz W., Hjelmquist G., Löf L. Psoriasis patients with antibodies to gliadin can be improved by a gluten-free diet. Br J Dermatol. 2000 Jan;142(1):44–51. doi: 10.1046/j.1365-2133.2000.03240.x. [DOI] [PubMed] [Google Scholar]
  16. Mäki M., Collin P. Coeliac disease. Lancet. 1997 Jun 14;349(9067):1755–1759. doi: 10.1016/S0140-6736(96)70237-4. [DOI] [PubMed] [Google Scholar]
  17. Ortonne J. P. Recent developments in the understanding of the pathogenesis of psoriasis. Br J Dermatol. 1999 Apr;140 (Suppl 54):1–7. doi: 10.1046/j.1365-2133.1999.140s54001.x. [DOI] [PubMed] [Google Scholar]
  18. Reunala T. Dermatitis herpetiformis: coeliac disease of the skin. Ann Med. 1998 Oct;30(5):416–418. doi: 10.3109/07853899809002482. [DOI] [PubMed] [Google Scholar]
  19. Sategna-Guidetti C., Bruno M., Mazza E., Carlino A., Predebon S., Tagliabue M., Brossa C. Autoimmune thyroid diseases and coeliac disease. Eur J Gastroenterol Hepatol. 1998 Nov;10(11):927–931. doi: 10.1097/00042737-199811000-00005. [DOI] [PubMed] [Google Scholar]
  20. Sategna-Guidetti C., Grosso S., Pulitanó R., Benaduce E., Dani F., Carta Q. Celiac disease and insulin-dependent diabetes mellitus. Screening in an adult population. Dig Dis Sci. 1994 Aug;39(8):1633–1637. doi: 10.1007/BF02087768. [DOI] [PubMed] [Google Scholar]
  21. Sategna-Guidetti C., Volta U., Ciacci C., Usai P., Carlino A., De Franceschi L., Camera A., Pelli A., Brossa C. Prevalence of thyroid disorders in untreated adult celiac disease patients and effect of gluten withdrawal: an Italian multicenter study. Am J Gastroenterol. 2001 Mar;96(3):751–757. doi: 10.1111/j.1572-0241.2001.03617.x. [DOI] [PubMed] [Google Scholar]
  22. Strobel S. Mechanisms in adverse reactions to food. Mechanisms of tolerance and sensitization in the intestine and other organs of the body. Allergy. 1995;50(20 Suppl):18–25. doi: 10.1111/j.1398-9995.1995.tb04342.x. [DOI] [PubMed] [Google Scholar]
  23. Ventura A., Magazzù G., Greco L. Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease. SIGEP Study Group for Autoimmune Disorders in Celiac Disease. Gastroenterology. 1999 Aug;117(2):297–303. doi: 10.1053/gast.1999.0029900297. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES