Infections in early life as risk factor for coeliac disease

• Published in: Anales de Pediatría 2021-05, Vol.94 (5), p.293-300
• Main Authors: Sandra Llorente Pelayo, Mirian Palacios Sánchez, Pablo Docio Pérez, Diana Gutiérrez Buendía, Eva Peña Sainz-Pardo, Beatriz Vega Santa-Cruz, Salvador García Calatayud
• Format: Article
• Language: Spanish
• Subjects: Enfermedad celiaca; Infecciones
• ISSN: 2341-2879; 2341-2879

Introduction: Among the environmental factors that can affect the pathological response to gluten in coeliac disease (CD), the factors that influence the immune response, such as infections and use of antibiotics, are proposed. Our objective is to determine the relationship between infections in early life and the risk of CD. Patients and methods: A retrospective case-control study, including patients aged 0–16 years with a diagnosis of CD was performed between the years 2014–2018. An analysis was made of documented infections in the first 6 months of life, types of infection (respiratory, gastrointestinal, urinary, others), microorganisms involved, and antibiotic therapy used. Results: A total of 93 coeliac patients, 93 controls, and 237 infectious episodes were registered. Documented infections affected 67.7% of coeliac patients and 50.5% of controls (P = .017), with a mean of 1.49 ± 1.53 episodes in the coeliac group and 1.05 ± 1.5 in the controls (P = .016). Documented infections in the first 6 months of life doubles the risk of developing CD (OR 2.05; 95% CI; 1.13–3.73), with this risk being higher for respiratory infections, which multiply the risk by 2.3 (OR 2.30, 95% CI; 1.28–4.14). Also, having 3 or more respiratory infections in the first 6 months of life multiplied the risk by 2.8 (OR 2.79, 95% CI; 1.03–7.54). No differences were found related to the types of involved microorganism or regarding the use of antibiotics. Conclusions: Infections in the first 6 months of life increase the risk of developing CD, especially for respiratory infections and, to a greater extent, if 3 or more episodes occur. The use of antibiotics in this period of life has not been related to an increased risk of CD. Resumen: Introducción: Dentro de los factores ambientales que favorecen la respuesta patológica al gluten en la enfermedad celiaca (EC), se proponen aquellos que modulan el tipo de respuesta inmune, como las infecciones y el uso de antibioterapia. El objetivo de este estudio es determinar la relación entre las infecciones en los primeros meses de vida y el riesgo de EC. Pacientes y métodos: Estudio de casos y controles retrospectivo que incluye pacientes menores de 16 años con diagnóstico de EC entre los años 2014-2018. Se registran las infecciones documentadas en los primeros seis meses de vida clasificadas según el tipo de infección (respiratoria, gastrointestinal, urinaria, otras), microorganismo implicado y antibioterapia utilizada. Resultados: Se analiza