Original article
Celiac Disease and Risk of Liver Disease: A General Population-Based Study

https://doi.org/10.1016/j.cgh.2006.09.034Get rights and content

Background & Aims: Celiac disease (CD) is an important cause of hypertransaminasemia. CD might also be associated with severe forms of liver disease. We investigated the risk of liver disease in 13,818 patients with CD (1964–2003) and 66,584 age- and sex-matched reference individuals from a general population cohort. Methods:: We used Cox regression to estimate hazard ratios (HRs) for later liver disease and conditional logistic regression to estimate the risk of CD in individuals with liver disease before study entry. Results:: CD was associated with an increased risk of acute hepatitis (HR, 5.21; 95% confidence interval [CI], 1.88–14.40; P = .001), chronic hepatitis (HR, 5.84; 95% CI, 2.89–11.79; P < .001), primary sclerosing cholangitis (HR, 4.46; 95% CI, 2.50–7.98; P < .001), fatty liver (HR, 6.06; 95% CI, 1.35–27.16; P = .018), liver failure (HR, 3.30; 95% CI, 2.22–4.88; P < .001), liver cirrhosis or liver fibrosis (HR, 2.23; 95% CI, 1.34–3.72; P < .001), and primary biliary cirrhosis (HR, 10.16; 95% CI, 2.61–39.49; P < .001). There was no increased risk of liver transplantation (HR, 1.07; 95% CI, 0.12–9.62; P = .954). Adjustment for socioeconomic index or diabetes mellitus had no notable effect on the risk estimates. Prior liver disease was associated with a statistically significant 4-fold to 6-fold increased risk of later CD. Conclusion:: This study suggests that individuals with CD are at increased risk of both prior and subsequent liver disease.

Section snippets

Patients and Methods

The Swedish National Board of Health and Welfare identified all individuals with a hospital-based discharge diagnosis of CD between 1964–2003 through the Swedish National Inpatient Register (IPR). CD was defined according to the International Classification of Disease (ICD) codes (Supplementary Table 1; see supplementary material online at www.cghjournal.org). The IPR was also used to identify individuals with liver disease, IBD (Crohn’s disease or ulcerative colitis), diabetes mellitus (DM),

Results

The majority of study participants were female (Table 2). The median age at study entry of both individuals with CD and reference individuals was 2 years (range, 0–94 years). The low median age is because most individuals with CD were diagnosed in early childhood. Some 4500 individuals with CD were 16 years or older at study entry (Table 2). In individuals with CD, the median duration (and range) from diagnosis of CD to first recorded liver disease were acute hepatitis, 6.7 years (2.0–17.2);

Discussion

This study suggests that individuals with CD are at increased risk of both prior and subsequent liver disease. Our results were based on national register data from 13,818 patients with CD and 66,584 age- and sex-matched reference individuals. The current study, therefore, has considerable power to detect associations, and the large numbers also enabled us to stratify for age and sex. The low median age at study entry is natural, considering that the majority of individuals with CD in Sweden

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    J.F.L. was supported by grants from the Swedish Research Council and the Örebro University Hospital while writing this article. This project was supported by the Swedish Research Council, the Swedish Society of Medicine, the Örebro Society of Medicine, the Majblomman Foundation, the Sven Jerring Foundation, the Clas Groschinsky Foundation, the Juhlin Foundation, the Karolinska Institute funds, and the Swedish Celiac Society.

    †

    Deceased.

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    Copyright © 2007 AGA Institute. Published by Elsevier Ltd. All rights reserved.