Sonnenberg Amnon, Genta Robert M
Section of Gastroenterology, Portland VA Medical Center, Portland, Oregon, USA.
Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon, USA.
Aliment Pharmacol Ther. 2023 May;57(9):988-992. doi: 10.1111/apt.17408. Epub 2023 Feb 2.
Previous studies suggested that inflammatory bowel disease (IBD) is associated with an increased prevalence of comorbid coeliac disease. Our case-control study aimed to test this association using a large histopathology database.
The Inform Diagnostics database is a repository of histopathologic records from patients distributed throughout the United States. In a case-control study among patients with bidirectional endoscopy, we compared the occurrence of coeliac disease in case subjects with IBD or microscopic colitis (MC) and control subjects without inflammatory colitis, calculating odds ratios (OR) and their 95% confidence intervals (CI) adjusted to the varying age, gender and ethnic distributions of case and control subjects.
The study population was split into 12,816 IBD cases and 6486 MC cases, who were compared to 345,733 control subjects without colitis. A total of 2892 patients were diagnosed with coeliac disease. Of 12,816 IBD patients, 57 patients (0.4%) harboured coeliac disease compared to 0.7% (2548/345,733) in the control population. The prevalence of coeliac disease among MC patients was 4.4% (288/6486). The corresponding ORs were significantly decreased in IBD (OR: 0.50, CI: 0.38-0.64) and significantly increased in MC patients (6.78, 5.96-7.69). Further stratification of the case populations into subtypes of IBD (Crohn's disease or ulcerative colitis) and MC (collagenous or lymphocytic colitis) similarly revealed significantly decreased and increased ORs for each subtype.
The previously reported positive association between coeliac disease and IBD may have been possibly biased by the inclusion of MC cases in the IBD patient population.
既往研究表明，炎症性肠病（IBD）与共患乳糜泻的患病率增加有关。我们的病例对照研究旨在使用一个大型组织病理学数据库来验证这种关联。
Inform Diagnostics数据库是一个来自分布于美国各地患者的组织病理学记录库。在一项针对双向内镜检查患者的病例对照研究中，我们比较了患有IBD或显微镜下结肠炎（MC）的病例组与无炎症性结肠炎的对照组中乳糜泻的发生率，计算优势比（OR）及其95%置信区间（CI），并根据病例组和对照组不同的年龄、性别和种族分布进行调整。
研究人群分为12816例IBD病例和6486例MC病例，并与345733例无结肠炎的对照者进行比较。共有2892例患者被诊断为乳糜泻。在12816例IBD患者中，57例（0.4%）患有乳糜泻，而对照组人群中这一比例为0.7%（2548/345733）。MC患者中乳糜泻的患病率为4.4%（288/6486）。IBD患者的相应OR显著降低（OR：0.50，CI：0.38 - 0.64），而MC患者的OR显著升高（6.78，5.96 - 7.69）。将病例人群进一步分层为IBD亚型（克罗恩病或溃疡性结肠炎）和MC亚型（胶原性或淋巴细胞性结肠炎）后，同样显示各亚型的OR显著降低和升高。
先前报道的乳糜泻与IBD之间的正相关可能因IBD患者人群中纳入了MC病例而存在偏差。
