Coeliac Disease and Autoimmune Disorders
The prevalence of autoimmune diseases in coeliac disease has been found to be two to three times higher than in the general population. The coexistence of various autoimmune endocrinological disorders with coeliac disease appears to be partly due to a common genetic predisposition and similar immune mediated mechanisms in the autoimmune disease processes1,2.
The role of gluten in the development of auotimmune disorders in general has been explored, with the pertinient question of whether early treatment of coeliac disease could prevent the development of autoimmune endocrinological disorders, being raised. There is some evidence to suggest that individuals who commence a gluten-free diet in early childhood have a similar prevalence of autoimmune disorders as that of the general population. In addition, other data suggests the duration of gluten exposure affects the prevalence of other autoimmune disorders in coeliac disease3. The subsequent suggestion that early diagnosis and treatment of coeliac disease may have a role in the protection against development of autoimmune disorders has been put forward.
Conversely, there is some evidence that is not supportive of this link4. The difficulty with exploring this association is in defining the time and duration of gluten exposure as well as defining when the development of the autoimmune disease occurred as these may have been present subclinically for years, prior to diagnosis4. Due to the unresolved nature of this issue early detection and treatment of coeliac disease could be justified1.
References
1. Collin P, Kaukinen K, Valimaki M & Salmi J. Endocrinological disorders and celiac disease. Endocrine Reviews 2002;23(4):464-483
2. Feighery C. Fortnightly review: Coeliac Disease. BMJ 1999;319:236-239
3. Ventura A, Magazzu G, Greco L. Duration of exposure to gluten and risk for autoimmune disorders in patients with coeliac disease. Gastroenterology 1999;117:297-303
4. Sategna Guidetti C, Solerio E, Scaglione N et al. Duration of gluten exposure in adult coeliac disease does not correlate with the risk for autoimmune disorders. Gut 2001;49:502-505
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