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Risk of Neuropathy Among 28,232 Patients With Biopsy-Verified Celiac Disease.

Abstract

IMPORTANCE

Earlier research on celiac disease (CD) and neuropathy has been hampered by the use of inpatient data, low study power, and lack of neuropathic characteristics.

OBJECTIVE

To examine the relative risk and absolute risk of developing neuropathy in a nationwide population-based sample of patients with biopsy-verified CD.

DESIGN, SETTING, AND PARTICIPANTS

Between October 27, 2006, and February 12, 2008, we collected data on small-intestinal biopsies performed at Sweden's 28 pathology departments between June 16, 1969, and February 4, 2008. We compared the risk of neuropathy in 28,232 patients with CD (villous atrophy, Marsh 3) with that of 139,473 age- and sex-matched controls. Cox proportional hazards regression estimated hazard ratios (HRs) and 95% CIs for neuropathy defined according to relevant International Classification of Diseases codes in the Swedish National Patient Register (consisting of both inpatient and outpatient data).

MAIN OUTCOMES AND MEASURES

Neuropathy in patients with biopsy-verified CD.

RESULTS

Celiac disease was associated with a 2.5-fold increased risk of later neuropathy (95% CI, 2.1-3.0; P < .001). We also found an increased risk (with results reported as HRs [95% CIs]) of chronic inflammatory demyelinating neuropathy (2.8; 1.6-5.1; P = .001), autonomic neuropathy (4.2; 1.4-12.3; P = .009), and mononeuritis multiplex (7.6; 1.8-32.4; P = .006), but no association between CD and acute inflammatory demyelinating polyneuropathy (0.8; 0.3-2.1; P = .68).

CONCLUSIONS AND RELEVANCE

We found an increased risk of neuropathy in patients with CD. This statistically significant association in a population-based sample suggests that CD screening should be completed in patients with neuropathy.

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  • Authors+Show Affiliations

    ,

    Peripheral Neuropathy Center, Neurological Institute, Columbia University College of Physicians and Surgeons, New York, New York.

    ,

    Peripheral Neuropathy Center, Neurological Institute, Columbia University College of Physicians and Surgeons, New York, New York.

    ,

    Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York3Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

    ,

    Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York.

    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden4Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden.

    Source

    JAMA neurology 72:7 2015 Jul pg 806-11

    MeSH

    Adolescent
    Adult
    Aged
    Aged, 80 and over
    Biopsy
    Celiac Disease
    Child
    Child, Preschool
    Female
    Follow-Up Studies
    Humans
    Infant
    Infant, Newborn
    Male
    Middle Aged
    Peripheral Nervous System Diseases
    Registries
    Risk Factors
    Sweden
    Young Adult

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    25962148

    Citation

    Thawani, Sujata P., et al. "Risk of Neuropathy Among 28,232 Patients With Biopsy-Verified Celiac Disease." JAMA Neurology, vol. 72, no. 7, 2015, pp. 806-11.
    Thawani SP, Brannagan TH, Lebwohl B, et al. Risk of Neuropathy Among 28,232 Patients With Biopsy-Verified Celiac Disease. JAMA Neurol. 2015;72(7):806-11.
    Thawani, S. P., Brannagan, T. H., Lebwohl, B., Green, P. H., & Ludvigsson, J. F. (2015). Risk of Neuropathy Among 28,232 Patients With Biopsy-Verified Celiac Disease. JAMA Neurology, 72(7), pp. 806-11. doi:10.1001/jamaneurol.2015.0475.
    Thawani SP, et al. Risk of Neuropathy Among 28,232 Patients With Biopsy-Verified Celiac Disease. JAMA Neurol. 2015;72(7):806-11. PubMed PMID: 25962148.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Risk of Neuropathy Among 28,232 Patients With Biopsy-Verified Celiac Disease. AU - Thawani,Sujata P, AU - Brannagan,Thomas H,3rd AU - Lebwohl,Benjamin, AU - Green,Peter H R, AU - Ludvigsson,Jonas F, PY - 2015/5/12/entrez PY - 2015/5/12/pubmed PY - 2015/9/25/medline SP - 806 EP - 11 JF - JAMA neurology JO - JAMA Neurol VL - 72 IS - 7 N2 - IMPORTANCE: Earlier research on celiac disease (CD) and neuropathy has been hampered by the use of inpatient data, low study power, and lack of neuropathic characteristics. OBJECTIVE: To examine the relative risk and absolute risk of developing neuropathy in a nationwide population-based sample of patients with biopsy-verified CD. DESIGN, SETTING, AND PARTICIPANTS: Between October 27, 2006, and February 12, 2008, we collected data on small-intestinal biopsies performed at Sweden's 28 pathology departments between June 16, 1969, and February 4, 2008. We compared the risk of neuropathy in 28,232 patients with CD (villous atrophy, Marsh 3) with that of 139,473 age- and sex-matched controls. Cox proportional hazards regression estimated hazard ratios (HRs) and 95% CIs for neuropathy defined according to relevant International Classification of Diseases codes in the Swedish National Patient Register (consisting of both inpatient and outpatient data). MAIN OUTCOMES AND MEASURES: Neuropathy in patients with biopsy-verified CD. RESULTS: Celiac disease was associated with a 2.5-fold increased risk of later neuropathy (95% CI, 2.1-3.0; P < .001). We also found an increased risk (with results reported as HRs [95% CIs]) of chronic inflammatory demyelinating neuropathy (2.8; 1.6-5.1; P = .001), autonomic neuropathy (4.2; 1.4-12.3; P = .009), and mononeuritis multiplex (7.6; 1.8-32.4; P = .006), but no association between CD and acute inflammatory demyelinating polyneuropathy (0.8; 0.3-2.1; P = .68). CONCLUSIONS AND RELEVANCE: We found an increased risk of neuropathy in patients with CD. This statistically significant association in a population-based sample suggests that CD screening should be completed in patients with neuropathy. SN - 2168-6157 UR - https://www.unboundmedicine.com/medline/citation/25962148/Risk_of_Neuropathy_Among_28232_Patients_With_Biopsy_Verified_Celiac_Disease_ L2 - https://jamanetwork.com/journals/jamaneurology/fullarticle/10.1001/jamaneurol.2015.0475 DB - PRIME DP - Unbound Medicine ER -