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

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.

  • coeliac disease
  • autoimmune disorders
  • prevalence
  • Abbreviations used in this paper

    AI
    autoimmune
    CD
    coeliac disease
    DH
    dermatitis herpetiformis
    GFD
    gluten free diet
    IDDM
    insulin dependent diabetes mellitus
    tTG
    tissue transglutaminase
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