Potential confounders in observed association between coeliac disease and tuberculosis.

摘要

Sirs, I read with interest the article by Ludvigsson et al. The authors have convincingly established the incidence of tuberculosis to be higher in patients with coeliac disease and evidence of villous atrophy. In their case control study of 29 026 patients, they noted a doubling [HR 2.0 (CI = 1.3-3.0)] in risk of tuberculosis. The risk was the highest in the first year after diagnosis of tuberculosis and, interestingly, the risk was similar in those with milder histological lesions {Marsh I and II [HR 1.9 (1.2-3.1)]}. Although absolute risk was small (10/100 000) the findings provide a further insight into the risks coeliac disease may pose. The authors are to be congratulated on their thorough evaluation of the proposed mechanisms, although the dietary intake of vitamin D in a gluten-free diet may not be as low as the author's claim.2 In addition, absorption of vitamin D from the gut is believed to be a minor contributor to total body vitamin D.