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Original Investigation |

Risk of Neuropathy Among 28 232 Patients With Biopsy-Verified Celiac Disease

Sujata P. Thawani, MD, MPH1; Thomas H. Brannagan III, MD1; Benjamin Lebwohl, MD, MS2,3; Peter H. R. Green, MD2; Jonas F. Ludvigsson, MD, PhD3,4
[+] Author Affiliations
1Peripheral Neuropathy Center, Neurological Institute, Columbia University College of Physicians and Surgeons, New York, New York
2Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
3Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
4Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden
JAMA Neurol. 2015;72(7):806-811. doi:10.1001/jamaneurol.2015.0475.
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Importance  Earlier research on celiac disease (CD) and neuropathy has been hampered by the use of inpatient data, low study power, and lack of neuropathic characteristics.

Objective  To examine the relative risk and absolute risk of developing neuropathy in a nationwide population-based sample of patients with biopsy-verified CD.

Design, Setting, and Participants  Between October 27, 2006, and February 12, 2008, we collected data on small-intestinal biopsies performed at Sweden’s 28 pathology departments between June 16, 1969, and February 4, 2008. We compared the risk of neuropathy in 28 232 patients with CD (villous atrophy, Marsh 3) with that of 139 473 age- and sex-matched controls. Cox proportional hazards regression estimated hazard ratios (HRs) and 95% CIs for neuropathy defined according to relevant International Classification of Diseases codes in the Swedish National Patient Register (consisting of both inpatient and outpatient data).

Main Outcomes and Measures  Neuropathy in patients with biopsy-verified CD.

Results  Celiac disease was associated with a 2.5-fold increased risk of later neuropathy (95% CI, 2.1-3.0; P < .001). We also found an increased risk (with results reported as HRs [95% CIs]) of chronic inflammatory demyelinating neuropathy (2.8; 1.6-5.1; P = .001), autonomic neuropathy (4.2; 1.4-12.3; P = .009), and mononeuritis multiplex (7.6; 1.8-32.4; P = .006), but no association between CD and acute inflammatory demyelinating polyneuropathy (0.8; 0.3-2.1; P = .68).

Conclusions and Relevance  We found an increased risk of neuropathy in patients with CD. This statistically significant association in a population-based sample suggests that CD screening should be completed in patients with neuropathy.

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