Does hemochromatosis predispose to celiac disease? A study of 29,096 celiac disease patients

Abstract

Background and aim. Case reports suggest an association between hereditary hemochromatosis (HH) and celiac disease (CD), but estimates of association are lacking. We estimated the association between HH and CD in a population-based study. Material and methods. Case–control study. We identified 29,096 individuals with biopsy-verified CD (equal to villous atrophy, Marsh stage III) through biopsy reports from all 28 pathology departments in Sweden. We then investigated the risk of a clinical diagnosis of HH in CD and in 144,522 controls matched for age, sex, county and calendar year. Conditional logistic regression was used to calculate odds ratios (ORs) for CD in patients with HH. Results. HH was seen in 30 patients with CD and in 60 matched controls. HH was hence associated with an increased risk of CD (OR = 2.30; 95% CI = 1.53–3.45). Restricting HH to individuals with at least two records of HH, the OR for CD was 2.54 (95% CI = 1.57–4.11), with a similar risk estimate when we only looked at HH diagnosed before CD (and matched date in controls) (OR = 2.64; 95% CI = 1.24–5.60). Conclusion. HH seems to be associated with an increased risk of CD.

Key Words::

• autoimmunity
• celiac
• hemochromatosis
• inflammation

Acknowledgement

Guarantor: JFL had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analyses. Grant Support (Funding): JFL was supported by grants from The Swedish Society of Medicine, the Swedish Research Council – Medicine (522-2A09-195), the Swedish Coeliac Society, and the Fulbright Commission. JAM was supported by NIH DK 57892.

Declaration of interest: JAM: Grant support: Alba Therapeutics (>$50,000); Advisory board: Alvine Pharmaceuticals, Inc. (<$10,000), Nexpep (<$10,000), Consultant (none above 10,000 USD): Ironwood, Inc., Flamentera, Actogenix, Ferring Research Institute Inc., Bayer Healthcare Pharmaceuticals, Vysera Biomedical, 2G Pharma, Inc., ImmunosanT, Inc. and Shire US Inc. The other authors have no conflict of interest to declare.