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- Ludvigsson, Jonas F., 1969-, et al.
(author)
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No association between biopsy-verified celiac disease and subsequent amyotrophic lateral sclerosis : a population-based cohort study
- 2014
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In: European Journal of Neurology. - : Wiley-Blackwell. - 1351-5101 .- 1468-1331. ; 21:7, s. 976-982
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Journal article (peer-reviewed)abstract
- 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 29093 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 144515 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 (HRs) and 95% confidence intervals (CIs) for ALS.Results: During follow-up 12 (3.7/100000 person-years) individuals with CD and 56 (3.5/100000 person-years) reference individuals had a diagnosis of ALS. This corresponded to an HR of 1.0 (95% CI0.5-1.8). HRs were significantly higher in the first year of follow-up (4.1; 1.2-13.4) than 1-5years after first CD diagnosis (0.8; 0.2-2.7) or after more than 5years 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% CI0.9-4.8)].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.
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