Document Detail

A nationwide study of the association between celiac disease and the risk of autistic spectrum disorders.
MedLine Citation:
PMID:  24068245     Owner:  NLM     Status:  MEDLINE    
IMPORTANCE: Most case reports suggest an association between autistic spectrum disorders (ASDs) and celiac disease (CD) or positive CD serologic test results, but larger studies are contradictory.
OBJECTIVE: To examine the association between ASDs and CD according to small intestinal histopathologic findings.
DESIGN AND SETTING: Nationwide case-control study in Sweden.
MAIN OUTCOMES AND MEASURES: Through 28 Swedish biopsy registers, we collected data about 26,995 individuals with CD (equal to villous atrophy, Marsh stage 3), 12,304 individuals with inflammation (Marsh stages 1-2), and 3719 individuals with normal mucosa (Marsh stage 0) but positive CD serologic test results (IgA/IgG gliadin, endomysium, or tissue transglutaminase) and compared them with 213,208 age- and sex-matched controls. Conditional logistic regression estimated odds ratios (ORs) for having a prior diagnosis of an ASD according to the Swedish National Patient Register. In another analysis, we used the Cox proportional hazards regression model to estimate hazard ratios (HRs) for future ASDs in individuals undergoing small intestinal biopsy.
RESULTS: A prior ASD was not associated with CD (OR, 0.93; 95% CI, 0.51-1.68) or inflammation (OR 1.03; 95% CI, 0.40-2.64) but was associated with a markedly increased risk of having a normal mucosa but a positive CD serologic test result (OR, 4.57; 95% CI, 1.58-13.22). Restricting our data to individuals without a diagnosis of an ASD at the time of biopsy, CD (HR, 1.39; 95% CI, 1.13-1.71) and inflammation (HR, 2.01; 95% CI, 1.29-3.13) were both associated with moderate excess risks of later ASDs, whereas the HR for later ASDs in individuals with normal mucosa but positive CD serologic test results was 3.09 (95% CI, 1.99-4.80).
CONCLUSIONS AND RELEVANCE: Although this study found no association between CD or inflammation and earlier ASDs, there was a markedly increased risk of ASDs in individuals with normal mucosa but a positive CD serologic test result.
Jonas F Ludvigsson; Abraham Reichenberg; Christina M Hultman; Joseph A Murray
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JAMA psychiatry     Volume:  70     ISSN:  2168-6238     ISO Abbreviation:  JAMA Psychiatry     Publication Date:  2013 Nov 
Date Detail:
Created Date:  2013-11-07     Completed Date:  2014-01-09     Revised Date:  2014-11-04    
Medline Journal Info:
Nlm Unique ID:  101589550     Medline TA:  JAMA Psychiatry     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1224-30     Citation Subset:  AIM; IM    
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MeSH Terms
Atrophy / pathology
Autistic Disorder / complications*,  immunology,  pathology
Case-Control Studies
Celiac Disease / complications*,  immunology,  pathology
Inflammation / complications,  pathology
Intestinal Mucosa / pathology
Intestine, Small / pathology
Risk Factors
Serologic Tests
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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