Suman, S.; Williams, E.J.; Thomas, P.W.; Surgenor, S.L.; Snook, J.A.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA9
Academic Journal
Introduction and Aim: Previous studies have shown an association between cigarette smoking and the risk oF development of adult coeliac disease (CD), but it has yet to be established whether this relationship is causal. The aim of this study was to assess causality using the Bradford-Hill criteria, specifically seeking evidence of a biological gradient. Method: Matched case control study using a questionnaire to establish a detailed smoking history for 138 incident cases of adult CD and 276 age and sex matched controls. Subjects were categorised according to various measures of the duration and intensity of active cigarette exposure prior to diagnosis of the matched case. Conditional logistic regression was used to calculate odds ratios and linear trends. Result: At the time of diagnosis, 10% of cases and 30% of controls were current smokers (odds ratio 0.21, 95% CI 0.11-0.40 for CD in current v never-smokers). The odds of developing CD fell significantly with both increasing total lifetime exposure and exposure to cigarettes over the 15 years prior to diagnosis. However, the strongest relationship was with the number of cigarettes smoked per day at the time of diagnosis (odds ratio 0.15, CI 0.06-0.37, for CD in current heavy v never-smokers). All linear trends were highly statistically significant and controlling the data for standard of living did not alter the findings. Conclusion: This study strengthens the case for a causal relationship between smoking and CD by demonstrating a strong, temporally appropriate and dose dependent effect, thus meeting the Bradford-Hill criteria. This suggests that cigarette smoking truly protects against the development of adult CD.


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