Study finds no causal link between antibiotics and celiac disease risk

The risk of celiac disease, an autoimmune reaction driven by gluten, is not a reason to avoid antibiotic treatment. This has been shown by a national study that analyzed the relationship between antibiotics and later celiac disease.

Celiac disease is a chronic autoimmune disorder with increasing awareness and diagnosis, not least among children and young people. Exposure to antibiotics – particularly at a young age – has been reported as a contributing factor for future celiac disease, but the picture is not clear-cut.

The current study, published in the journal Clinical Gastroenterology and Hepatology, analyzed data on antibiotic use up to one year before diagnosis of celiac disease among 27,789 individuals in Sweden whose disease was confirmed by gastroscopy and intestinal tissue samples.

The celiac group was compared to a control group of 133,451 individuals with matching gender, age, and regional distribution, but with the researchers adjusting for socioeconomic status, comorbidities, and healthcare contacts. The celiac group was also compared to their own siblings (33,112 individuals) without celiac disease.

No clear dividing line

The results show that individuals with celiac disease had 24% higher odds of prior antibiotics use compared to their matched controls. The association was more pronounced with more frequent antibiotic use. However, the difference in exposure was modest. The proportion of prior antibiotic use was 69% among individuals with celiac disease and 63% among population controls. The sibling analysis revealed a similar pattern.

To broaden the picture, data on 225,548 people who underwent gastroscopy and tissue sampling with findings of normal mucosa were also analyzed. These indiviuals with normal mucosa had 50% higher odds of prior antibitotic use compared to their matched controls. 73% had used antibiotics, compared to 64% of the matched controls, which in this analysis consisted of 1,089,796 individuals.

Complex connections

Maria Ulnes is a pediatrician and a doctoral student in pediatrics at Sahlgrenska Academy, University of Gothenburg.

“It’s easy to think that celiac disease is a result of antibiotic exposure,” she says. “However, the connections are much more complex. It’s possible that factors such as susceptibility to infection and dietary habits contribute to the development of celiac disease, possibly through an impact on the gut microbiota. In this case, adequate use of antibiotics does not appear to pose a risk in itself.”

According to the researchers, the fact that the strongest connection with antibiotic use was found in the group with normal mucosa suggests that increased investigation, as a result of gastric symptoms, contributes more to the observed patterns than a causal relationship between celiac disease and antibiotics.

We do not see a causal link between celiac disease and antibiotics. Responsible antibiotic use is of course important, but there is no reason to avoid antibiotics due to a fear of contracting celiac disease.”

Maria Ulnes, doctoral student in pediatrics at Sahlgrenska Academy, University of Gothenburg