Risk of primary sclerosing cholangitis among patients with gastritis: a nationwide cohort study.

IF 5.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Lina Lindström Älgå, Isabella Ekheden, Marcus Thuresson, Jonas F Ludvigsson
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Abstract

The pathogenesis of primary sclerosing cholangitis (PSC), a severe autoimmune liver disease, remains largely unknown. Infection with Helicobacter pylori (H. pylori) and subsequent gastritis could act as a triggering event of PSC, as H. pylori seems to be more prevalent in chronic liver disease. However, the risk of PSC among patients with gastritis and its precursor, H. pylori infection, is undetermined. In this nationwide cohort study, we included Swedish individuals undergoing a gastroscopy with biopsy during 1990-2017 showing gastritis (n = 306 588) or H. pylori (n = 11 890). Three control groups were used (1) matched controls from the Swedish general population (n = 1 544 667), (2) individuals with a gastric biopsy indicating normal mucosa (n = 318 754) and (3) sibling controls (n = 231 879). We calculated the hazard ratios (HRs) for PSC development, adjusting for age, sex, calendar year, county, comorbidities, alcohol-related disorders, education, and country of birth. Patients with a histological diagnosis of gastritis or H. pylori were more likely to be diagnosed with PSC during follow up. Compared to the general Swedish population, the fully adjusted HR for PSC among patients with gastritis was 3.35 (95% CI 2.67-4.20). However, compared to secondary controls with a normal gastric mucosa, the PSC risk was not increased among patients with gastritis. Patients with a gastroscopy biopsy showing gastritis have a moderately increased risk for PSC later in life but not compared to other individuals undergoing gastrointestinal work up ("normal mucosa)". The association with PSC may be non-specific and apply to several gastrointestinal disorders.

胃炎患者发生原发性硬化性胆管炎的风险:一项全国性队列研究
原发性硬化性胆管炎(PSC)是一种严重的自身免疫性肝病,其发病机制在很大程度上仍然未知。幽门螺杆菌(h.p ylori)感染和随后的胃炎可能是PSC的触发事件,因为幽门螺杆菌似乎在慢性肝病中更为普遍。然而,胃炎及其前体幽门螺杆菌感染患者发生PSC的风险尚不确定。在这项全国性队列研究中,我们纳入了在1990-2017年期间接受胃镜检查并活检的瑞典人,显示胃炎(n = 3060588)或幽门螺旋杆菌(n = 11890)。使用三个对照组(1)来自瑞典普通人群的匹配对照组(n = 1 544 667),(2)胃活检显示粘膜正常的个体(n = 318 754)和(3)兄弟姐妹对照组(n = 231 879)。我们计算了PSC发展的风险比(hr),调整了年龄、性别、日历年、县、合并症、酒精相关疾病、教育程度和出生国家。组织学诊断为胃炎或幽门螺杆菌的患者在随访期间更有可能被诊断为PSC。与瑞典一般人群相比,胃炎患者PSC的完全调整HR为3.35 (95% CI 2.67-4.20)。然而,与胃粘膜正常的次要对照组相比,胃炎患者的PSC风险并未增加。胃镜活检显示胃炎的患者在以后的生活中患PSC的风险适度增加,但与其他接受胃肠检查(“正常粘膜”)的患者相比,这一风险没有增加。与PSC的关联可能是非特异性的,适用于几种胃肠道疾病。
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来源期刊
European Journal of Epidemiology
European Journal of Epidemiology 医学-公共卫生、环境卫生与职业卫生
CiteScore
21.40
自引率
1.50%
发文量
109
审稿时长
6-12 weeks
期刊介绍: The European Journal of Epidemiology, established in 1985, is a peer-reviewed publication that provides a platform for discussions on epidemiology in its broadest sense. It covers various aspects of epidemiologic research and statistical methods. The journal facilitates communication between researchers, educators, and practitioners in epidemiology, including those in clinical and community medicine. Contributions from diverse fields such as public health, preventive medicine, clinical medicine, health economics, and computational biology and data science, in relation to health and disease, are encouraged. While accepting submissions from all over the world, the journal particularly emphasizes European topics relevant to epidemiology. The published articles consist of empirical research findings, developments in methodology, and opinion pieces.
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