A large nationwide population-based case-control study of the association between intussusception and later celiac disease

Background: Case reports and case series studies suggest a positive association between intussusception and celiac disease (CD).Methods: We contacted Sweden's 28 pathology departments and obtained data on 29,096 patients with biopsy-verified CD (equal to Marsh stage 3) through biopsy reports. Patients with CD were matched for age, sex, calendar period and county of residence with up to five reference individuals from the general population (n = 144,522). Cases of intussusception were identified from nationwide inpatient, hospital-based outpatient and day-surgery data from the Swedish Patient Register. Odds ratios (ORs) for future CD in patients with intussusception were estimated using conditional logistic regression. Results: 34 (0.12%) individuals with CD had a diagnosis of intussusception vs. 143 (0.10%) reference individuals, suggesting that intussusception was not a risk factor for later CD (OR = 1.17; 95% confidence interval (CI) = 0.82-1.67). The OR for CD in patients with at least two records of intussusception was 0.40 (95% CI = 0.06-2.99).In contrast, a post-hoc analysis showed that CD was associated with a statistically significantly increased risk of intussusception after CD diagnosis (hazard ratio = 1.95; 95% CI = 1.01-3.77); however, this analysis was based on only 12 cases with both CD and intussusception. Conclusion: We found no association between intussusception and future CD; and a mostly modest increased risk of intussusception after a diagnosis of CD.