Lebwohl Benjamin, Spechler Stuart J, Wang Timothy C, Green Peter H R, Ludvigsson Jonas F
Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA; Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden.
Division of Gastroenterology, Department of Internal Medicine, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, USA.
Dig Liver Dis. 2014 Jan;46(1):36-40. doi: 10.1016/j.dld.2013.08.128. Epub 2013 Sep 12.
The prevalence of celiac disease and the use of medications that inhibit acid secretion have both increased in recent decades.
To explore the association between antisecretory medication exposure and subsequent development of celiac disease.
In this population-based case control study, we identified patients with celiac disease diagnosed at all pathology departments in Sweden from July 2005 through February 2008. Patients were matched by age and gender with up to 5 controls. We identified prior prescriptions for proton pump inhibitors and histamine-2 receptor antagonists in all subjects. We used conditional logistic regression to measure the association between these prescriptions and the subsequent diagnosis of celiac disease.
Prior proton pump inhibitor prescription was strongly associated with celiac disease (OR 4.79; 95% CI 4.17-5.51). Patients prescribed both proton pump inhibitors and histamine-2 receptor antagonists had a higher risk of celiac disease (OR 5.96; 95% CI 3.58-9.91) than those prescribed proton pump inhibitors alone (OR 4.91; 95% CI 4.26-5.66) or histamine-2 receptor antagonists alone (OR 4.16; 95% CI 2.89-5.99).
Exposure to antisecretory medications is associated with a subsequent diagnosis of celiac disease. The persistence of this association after excluding prescriptions in the year preceding the celiac disease diagnosis suggests a causal relationship.
近几十年来，乳糜泻的患病率和抑制胃酸分泌药物的使用均有所增加。
探讨抗分泌药物暴露与随后发生乳糜泻之间的关联。
在这项基于人群的病例对照研究中，我们确定了2005年7月至2008年2月期间在瑞典所有病理科诊断为乳糜泻的患者。患者按年龄和性别与多达5名对照进行匹配。我们确定了所有受试者先前使用质子泵抑制剂和组胺-2受体拮抗剂的处方情况。我们使用条件逻辑回归来衡量这些处方与随后乳糜泻诊断之间的关联。
先前使用质子泵抑制剂与乳糜泻密切相关（比值比4.79；95%置信区间4.17 - 5.51）。同时开具质子泵抑制剂和组胺-2受体拮抗剂的患者患乳糜泻的风险（比值比5.96；95%置信区间3.58 - 9.91）高于仅开具质子泵抑制剂的患者（比值比4.91；95%置信区间4.26 - 5.66）或仅开具组胺-2受体拮抗剂的患者（比值比4.16；95%置信区间2.89 - 5.99）。
暴露于抗分泌药物与随后乳糜泻的诊断相关。在排除乳糜泻诊断前一年的处方后这种关联仍然存在，提示存在因果关系。
