Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
Aliment Pharmacol Ther. 2018 Nov;48(10):1091-1098. doi: 10.1111/apt.14991. Epub 2018 Oct 4.
Coeliac disease has been linked to anxiety and depression. However, their association with mucosal healing is unknown.
To examine the relationship between anxiety, depression and mucosal healing in coeliac disease.
Between 1969 and 2008, we collected data on all small intestinal biopsies with villous atrophy from Sweden's 28 pathology departments. We restricted our cohort to individuals with data on follow-up biopsy (either persistent villous atrophy [n = 3317] or mucosal healing [n = 4331]). Through Cox regression, we estimated hazard ratios (HRs) for anxiety or depression.
During follow-up, 123 (2.8/1000 person-years) individuals with mucosal healing had developed anxiety, compared to 94 (2.1/1000 person-years) with persistent villous atrophy. Mucosal healing was hence associated with a higher risk of future anxiety (HR = 1.49; 95% CI = 1.12-1.96). Similarly, 167 (3.8/1000 person-years) individuals with mucosal healing developed depression, compared to 148 (3.3/1000 person-years) with persistent villous atrophy, corresponding to a HR of 1.25 (95% CI = 0.99-1.59). Mucosal healing was more common in individuals with prior diagnoses of anxiety or depression before follow-up biopsy. Anxiety diagnosed between diagnostic and follow-up biopsy for coeliac disease was associated with an almost nine-fold increased chance of mucosal healing (odds ratio = 8.94; 95%CI = 2.03-39.27).
Anxiety and depression are more common in coeliac disease patients with mucosal healing, both before and after follow-up biopsy, an association potentially mediated through more vigilant compliance with a gluten-free diet. This finding raises concern that achieving the goal of mucosal healing may come at a cost of an increased risk of mood disorders.
乳糜泻与焦虑和抑郁有关。然而，它们与黏膜愈合的关系尚不清楚。
检查乳糜泻患者中焦虑、抑郁与黏膜愈合之间的关系。
在 1969 年至 2008 年间，我们从瑞典的 28 个病理部门收集了所有具有绒毛萎缩的小肠活检数据。我们将队列限制为具有随访活检数据的个体（持续绒毛萎缩[n=3317]或黏膜愈合[n=4331]）。通过 Cox 回归，我们估计了焦虑或抑郁的风险比（HR）。
在随访期间，4331 例黏膜愈合患者中有 123 例（2.8/1000 人年）出现了焦虑，而 3317 例持续绒毛萎缩患者中有 94 例（2.1/1000 人年）出现了焦虑。因此，黏膜愈合与未来发生焦虑的风险增加相关（HR=1.49；95%CI=1.12-1.96）。同样，在 4331 例黏膜愈合患者中有 167 例（3.8/1000 人年）出现了抑郁，而在 3317 例持续绒毛萎缩患者中有 148 例（3.3/1000 人年）出现了抑郁，相应的 HR 为 1.25（95%CI=0.99-1.59）。在进行随访活检之前，有焦虑或抑郁既往诊断的患者黏膜愈合更为常见。在乳糜泻的诊断和随访活检之间诊断出的焦虑与黏膜愈合的几率几乎增加了九倍（比值比=8.94；95%CI=2.03-39.27）。
在接受随访活检的乳糜泻患者中，焦虑和抑郁更为常见，无论是在随访活检之前还是之后，这种关联可能通过更严格地遵守无麸质饮食而得到介导。这一发现令人担忧的是，实现黏膜愈合的目标可能会带来情绪障碍风险增加的代价。
