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- Mitselou, Niki, 1982-, et al.
(författare)
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Association of celiac disease with eosinophilic esophagitis : Nationwide register-based cohort study with sibling analyses
- 2024
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Ingår i: The journal of allergy and clinical immunology. Global. - : Elsevier. - 2772-8293. ; 3:3
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Celiac disease (CeD) is associated with several immune-mediated disorders, but it is unclear whether it is associated with eosinophilic esophagitis (EoE).OBJECTIVE: We sought to examine the risk of EoE in patients with biopsy-verified CeD compared with matched controls and siblings.METHODS: Using nationwide population-based histopathology data, we identified 27,338 patients with CeD diagnosed in the period 2002 to 2017 in Sweden. Patients with CeD were age- and sex-matched with up to 5 reference individuals (n = 134,987) from the general population. Cox Regression was used to estimate hazard ratios (HRs) for developing biopsy-verified EoE. In a secondary analysis, we used unaffected siblings of patients with CeD as comparators to adjust for intrafamilial confounding.RESULTS: The median age at CeD diagnosis was 27 years, and 63.3% were female patients. During a median follow-up of 8.1 years, 17 patients with CeD and 13 matched reference individuals were diagnosed with EoE. This corresponded to incidence rates of 0.08 versus 0.01 per 1000 person-years, respectively, and an adjusted HR for EoE of 6.65 (95% CI, 3.26-13.81). Compared with their siblings without CeD, patients with CeD were however at a no increased risk of EoE (HR, 1.39; 95% CI, 0.55-3.51).CONCLUSIONS: In this study, individuals with CeD were at a 6.6-fold increased risk of later EoE compared with the general population. This association might be explained by an altered health-seeking behavior or through shared genetic or early environmental factors because the excess risk disappeared in sibling analyses.
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- Röjler, Lovisa, 1983-
(författare)
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Eosinophilic esophagitis and disease complications : register-based studies
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis presents four studies on Eosinophilic Esophagitis (EoE). The overall aim is to grasp the basics of epidemiologic research and use this understanding on EoE disease complications. EoE is a fairly new inflammatory disease with clinicopathological diagnosis that increases in prevalence. It is considered a relatively mild disease, but the evidence concerning mortality and morbidity is scarce. Although EoE has a prevalence peak in childbearing age, pregnancy outcomes are poorly examined. In Study I, a random portion of 131 patient charts from the cohort werecollected for a diagnosis validation through a patient chart review. EoE was found in 99 patients, which corresponds to a positive predictive value of 89%. The cohort was predominately male, and the most common symptom was dysphagia. Study II examines mortality in EoE individuals compared to matched reference individuals using survival analysis. We performed sibling analysis to adjust for intrafamilial (genetic and environmental) confounding. We found no elevated risk for death. Study III uses a similar method to find higher risk of psychiatric comorbidity among EoE patients compared to matched reference individuals. Mean follow-up time was 4.03 years, and there were 106 events of psychiatric disease in the EoE-group, which corresponds to an elevated risk of 50% compared to reference individuals. Study IV investigates outcomes of pregnancy in EoE females versus comparators. The main outcome is premature birth; in secondary analyses, we examined both maternal and fetal outcomes. The only elevated risk was low birth weight; although a significant finding, it was still based on a small sample size and should be interpreted with caution.
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