The list of frustrating aspects of celiac disease can be endless. However, one of the top contenders for me is how little information is out there about what actually causes the disease. Instead, all we have are a lot of unanswered questions. The biggest being, why when 30% of children are identified as possessing the celiac gene, are only 1% actually developing it? What sets them apart? Stumping questions like these are at least good for one thing – they push scientists and researchers to strive for answers.
With that in mind, there is a recent Norwegian study published in the American Journal of Gastroenterology that?s generating some buzz. It appears they found a possible link between early childhood illness and celiac disease. Specifically, the study cites that children with 10 or more respiratory or gastrointestinal infections during the first 18 months of life were 30% more likely to develop celiac disease. Surprisingly, the researchers found that children with repeated respiratory infections were at greater risk than repeated gastrointestinal infections.
Now of course, this does open the door to more questions again. Are the children developing celiac disease after these infections because of damage the infection imposed, or was it just that the immune system was left compromised and more vulnerable? Overall, they still don?t have definitive answers, but we might finally be heading in the right direction.
To find out just how much stock to put into this study, we spoke with Dr. Hilary Jericho from the University of Chicago to get a celiac expert?s opinion. She had some enlightening thoughts.
DGF: What are your overall feelings about the study?
Dr. Jericho: I think it sheds light on the million-dollar question: what is the actual trigger? We all know autoimmune conditions have a likely genetic component. But, we?ve always guessed there was probably some disruption or environmental factor that got the ball rolling. Otherwise what would cause that onset in some, but not all, and why do some people get it earlier than others? This study at least offers a possible answer.
DGF: Why would infections be the possible answer and why respiratory infections in particular?
Dr. Jericho: Well, in children the typical onset for celiac disease is 6-7 years. At that young of an age, the question has always been what else could they be exposed to? An infection in the gastrointestinal tract could definitely lead to leaky gut or at least leave someone more susceptible to it. And respiratory infections are more connected to the gastrointestinal tract than people realize. A virus is distributed everywhere. It might be predominantly upper respiratory, but it does also upset the stomach and gut. I see many patients with post-infection gastroparesis complaining of lingering stomach distress symptoms and we trace the symptoms back to a recent respiratory infection as the trigger.
DGF: Were you surprised by any of the findings?
Dr. Jericho: I was definitely surprised to see that antibiotics did not appear to affect the results. We?ve always believed that being on antibiotics would cause damage to our gut health. And yet in this study the findings were identical for both patients who had taken antibiotics and those who had not.
DGF: Are there any limitations or issues you see with the study?
Dr. Jericho: I think the only issue I would see is it?s retrospective. Whenever a study is retrospective you?re dealing with possible recall bias or family looking back and filling in gaps to fit a mold rather than as they actually occurred.
DGF: How would you perform the study differently then?
Dr. Jericho: It?d be difficult to do, but I?d love to see a study performed that identifies high risk patients through genetics and follows them through life beginning in utero to see possible connections in who actually develops celiac disease. Perhaps then we can find links in the 1% that does.
In closing, I have to say I like that the study gives us food for thought and possible triggers to track. I don?t want us to now worry every time our children get sick. But, perhaps if there is already a family history of celiac disease, then taking note when they do wouldn?t hurt. The only way we?ll ever get answers is if we have evidence to build upon.