Disclosures: The study received funding from Janssen. Ludvigsson coordinated the study on behalf of the Swedish IBD quality register.
August 12, 2020
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Childhood celiac linked with increased risk for psychiatric disorders

Disclosures: The study received funding from Janssen. Ludvigsson coordinated the study on behalf of the Swedish IBD quality register.
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Patients diagnosed with celiac disease in childhood have a higher risk for psychiatric disorders with the increased risk persisting until adulthood, according to study results.

“Several studies describe the wide range of extraintestinal manifestations in celiac disease such as fatigue, neurological conditions including headache and neuropathy, but also psychiatric disorders,” Jonas F. Ludvigsson, MD, PhD, of the department of medical epidemiology and biostatistics at Karolinska Institutet in Sweden, and colleagues wrote. “While a few studies have reported an increased prevalence of neuropsychiatric disorders before a celiac disease diagnosis, these have generally lacked in power to give precise risk estimates.”

Researchers analyzed data from the Swedish nationwide ESPRESSO cohort to explore associations between childhood celiac disease and psychiatric disorders. They matched 19,186 children with biopsy verified celiac with as many as five reference children (n = 94,249) and obtained data on psychiatric disorders from the patient register.

During a media follow-up of 12.3 years, 3,174 children with celiac disease (16.5%; incidence rate 12.2 per 1,000 person years) received a diagnosis of a psychiatric disorder compared with 13,286 controls (14.1%; 10.3 per 1,000 person years). Childhood celiac was associated with a 19% increase in risk for any psychiatric disorder (95% CI, 1.14–1.23), and researchers observed that increase in every childhood age group.

The risk was highest in the first year after celiac diagnosis (HR = 1.7; 95% CI, 1.41–2.05). However, the increase persisted into adulthood (older than age 18 years, HR = 1.11; 95% CI, 1.04–1.17).

Specifically, investigators identified increased risks for mood disorders (HR = 1.2; 95% CI, 1.12–1.28), anxiety disorders (HR = 1.12; 95% CI, 1.06–1.19), eating disorders (HR = 1.34; 95% CI, 1.18–1.51), attention deficit hyperactivity disorder (HR = 1.29; 95% CI, 1.2–1.39) and autism spectrum disorder (HR = 1.47; 95% CI, 1.32–1.64) among patients with celiac disease. Celiac disease was also linked to increased use of psychiatric drugs (HR = 1.34; 95% CI, 1.24–1.43).

Ludvigsson and colleagues wrote that their findings highlight the importance of mental health surveillance in patients with celiac disease.

“Though small in absolute magnitude, there is an elevated risk of psychiatric disorder in individuals diagnosed with celiac disease in childhood with an increased risk in the long term, emphasizing the importance of not just somatic surveillance but also mental health surveillance for timely support and intervention,” they wrote.