Antibiotic exposure and the development of coeliac disease: a nationwide case–control study
Open accessAbstract
BACKGROUND: The intestinal microbiota has been proposed to play a pathogenic role in coeliac disease (CD). Although antibiotics are common environmental factors with a profound impact on intestinal microbiota, data on antibiotic use as a risk factor for subsequent CD development are scarce. METHODS: In this population-based case-control study we linked nationwide histopathology data on 2,933 individuals with CD (Marsh stage 3; villous atrophy) to the Swedish Prescribed Drug Register to examine the association between use of systemic antibiotics and subsequent CD. We also examined the association between antibiotic use in 2,118 individuals with inflammation (Marsh 1-2) and in 620 individuals with normal mucosa (Marsh 0) but positive CD serology. All individuals undergoing biopsy were matched for age and sex with 28,262 controls from the population. RESULTS: Antibiotic use was associated with CD (Odds ratio [OR] = 1.40; 95% confidence interval [CI] = 1.27-1.53), inflammation (OR = 1.90; 95% CI = 1.72-2.10) and normal mucosa with positive CD serology (OR = 1.58; 95% CI = 1.30-1.92). ORs for prior antibiotic use in CD were similar when we excluded antibiotic use in the last year (OR = 1.30; 95% CI = 1.08-1.56) or restricted to individuals without comorbidity (OR = 1.30; 95% CI = 1.16 - 1.46). CONCLUSIONS: The positive association between antibiotic use and subsequent CD but also with lesions that may represent early CD suggests that intestinal dysbiosis may play a role in the pathogenesis of CD. However, non-causal explanations for this positive association cannot be excluded.
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Destruction of protective Bifidobacteria can explain the association between incident celiac disease and previous antibiotic exposure.
“Destruction of protective Bifidobacteria can explain the association between incident CD and previous antibiotic exposure.57”
From The Gut Microbiome and the Brain (2014) · cites this paper as [57]
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- Authors
- Mårild, K., Ye, W., Lebwohl, B., Green, P. H., Blaser, M. J., Card, T., & Ludvigsson, J. F.
- Affiliations
- Karolinska Institutet (SE)
- Columbia University Irving Medical Center (US)
- NYU Langone Health (US)
- University of Nottingham (GB)
- Corresponding author
- Mårild, Karl
- ORCID
- Venue
- BMC Gastroenterology
- Published
- 2013-07-08
- Volume
- 13
- Issue
- 1
- Pages
- 109-109
- ISSN
- 1471-230X (ISSN-L)
- PMC
- PMC3720284
- OpenAlex
- W2071445798
- Cited by
- 175
- References
- 44
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 14 · 2023: 8 · 2022: 8 · 2021: 16 · 2020: 16 · 2019: 13 · 2018: 7 · 2017: 16 · 2016: 21 · 2015: 27 · 2014: 18 · 2013: 1
- FWCI
- 21.41
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Gastroenterology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Rutgers University Community Repository (Rutgers University) (submittedVersion)
- Funders
- American-Scandinavian Foundation
- Regionala Forskningsrådet Uppsala/Örebro
- Karolinska Institutet
- Vetenskapsrådet
- Svenska Läkaresällskapet
- National Institutes of Health
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK090989)
- National Center for Research Resources (KL2RR024157)
- Topics
- Health Sciences › Medicine › Gastroenterology › Celiac Disease Research and Management
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Keywords
- celiac disease, antibiotic exposure, gut microbiota, dysbiosis, villous atrophy, intestinal inflammation, Marsh classification, pathogenesis, environmental risk factors
- MeSH terms
- Protein Glutamine gamma Glutamyltransferase 2, Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents, Celiac Disease, Child, Child, Preschool, Enteritis, Female, Gliadin, Humans, Immunoglobulin A, Immunoglobulin G, Infant, Intestinal Mucosa, Intestines, Male, Middle Aged, Transglutaminases, Registries, Risk Factors, Sweden, Case-Control Studies, GTP-Binding Proteins, Metagenome, Young Adult
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