TY - JOUR
T1 - Decreased risk of celiac disease in patients with helicobacter pylori colonization
AU - Lebwohl, Benjamin
AU - Blaser, Martin J.
AU - Ludvigsson, Jonas F.
AU - Green, Peter H R
AU - Rundle, Andrew
AU - Sonnenberg, Amnon
AU - Genta, Robert M.
PY - 2013/12
Y1 - 2013/12
N2 - The prevalence of celiac disease (CD) has increased in recent decades without a clear explanation. The "hygiene hypothesis" theorizes that decreased exposure to bacterial antigens may trigger autoimmunity. We aimed to determine whether Helicobacter pylori infection and CD were associated among patients undergoing upper gastrointestinal endoscopy. We performed a cross-sectional study of patients who underwent esophagogastroduodenoscopy with submission of gastric and duodenal biopsies to Miraca Life Sciences, Inc. (Irving, Texas), a US commercial pathology laboratory, during a 4.5-year period (January 2008-June 2012). We compared the prevalence of H. pylori in CD patients with that in persons without CD. We performed multiple logistic regression analysis, adjusting odds ratios for patient age, gender, and racial, ethnic, and socioeconomic factors. Among 136,179 patients, a total of 2,689 (2.0%) had CD. H. pylori prevalence was significantly lower in patients with CD (4.4%) than in those without CD (8.8%; P < 0.0001). After adjustment for the above covariates, this inverse relationship remained strong (adjusted odds ratio (OR) = 0.48, 95% confidence interval (CI): 0.40, 0.58). The relationships were similar in men (unadjusted OR = 0.51, 95% CI: 0.38, 0.69) and women (unadjusted OR = 0.46, 95% CI: 0.36, 0.58) and in all age groups. We conclude that H. pylori presence and CD are inversely associated, a relationship that persists after adjustment for socioeconomic factors. Future studies should address whether H. pylori modulates immune responses to ingested gluten.
AB - The prevalence of celiac disease (CD) has increased in recent decades without a clear explanation. The "hygiene hypothesis" theorizes that decreased exposure to bacterial antigens may trigger autoimmunity. We aimed to determine whether Helicobacter pylori infection and CD were associated among patients undergoing upper gastrointestinal endoscopy. We performed a cross-sectional study of patients who underwent esophagogastroduodenoscopy with submission of gastric and duodenal biopsies to Miraca Life Sciences, Inc. (Irving, Texas), a US commercial pathology laboratory, during a 4.5-year period (January 2008-June 2012). We compared the prevalence of H. pylori in CD patients with that in persons without CD. We performed multiple logistic regression analysis, adjusting odds ratios for patient age, gender, and racial, ethnic, and socioeconomic factors. Among 136,179 patients, a total of 2,689 (2.0%) had CD. H. pylori prevalence was significantly lower in patients with CD (4.4%) than in those without CD (8.8%; P < 0.0001). After adjustment for the above covariates, this inverse relationship remained strong (adjusted odds ratio (OR) = 0.48, 95% confidence interval (CI): 0.40, 0.58). The relationships were similar in men (unadjusted OR = 0.51, 95% CI: 0.38, 0.69) and women (unadjusted OR = 0.46, 95% CI: 0.36, 0.58) and in all age groups. We conclude that H. pylori presence and CD are inversely associated, a relationship that persists after adjustment for socioeconomic factors. Future studies should address whether H. pylori modulates immune responses to ingested gluten.
KW - Celiac disease
KW - Gluten
KW - Helicobacter pylori
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U2 - 10.1093/aje/kwt234
DO - 10.1093/aje/kwt234
M3 - Article
C2 - 24124196
AN - SCOPUS:84890614587
SN - 0002-9262
VL - 178
SP - 1721
EP - 1730
JO - American Journal of Epidemiology
JF - American Journal of Epidemiology
IS - 12
ER -