Abstract
Background
Celiac disease has been associated with hyposplenism, and multiple case reports link
celiac disease and pneumococcal infections; however, increased risk of pneumococcal
infection in celiac disease has not been confirmed. The purpose of this study was
to conduct a systematic review to determine the risk of pneumococcal infections in
celiac disease.
Methods
Relevant studies were identified using electronic bibliographic searches of PubMed,
OVID, Medline, and EMBASE (1980 to February 2017) and reviewing abstracts from major
conferences in gastroenterology. Using number of events in celiac patients and referent
patients, we calculated a summary relative risk of pneumococcal infections. All analyses
were conducted in Comprehensive Meta-Analysis software using random-effects assumptions.
Results
Of a total of 156 articles, 3, representing 3 large databases (the Swedish National
Inpatient Register; the Oxford Record Linkage Study; and the English National Hospital
Episode Statistics) were included. Each compared patients with celiac disease and
confirmed pneumococcal infection to a specific reference group: inpatients and/or
the general population. Overall, the odds of pneumococcal infection were higher among
hospitalized celiac patients compared with controls (odds ratio 1.66; 95% confidence
interval 1.43-1.92). There was no evidence of heterogeneity (Q[1] = 1.17, P = .56, I2 = 0%).
Conclusions
Celiac disease is associated with an increased risk of pneumococcal infection. Preventive
pneumococcal vaccination should be considered for those with celiac disease, with
special attention to those aged 15-64 years who have not received the scheduled pneumococcal
vaccination series as a child.
Keywords
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Article info
Publication history
Published online: August 08, 2017
Footnotes
Funding: None.
Conflict of Interest: None.
Authorship: Author contributions are as follows. MS: conception of the work, acquisition and interpretation of the data, lead author. LAJS-S: data analysis, author. YR-N: conceptualization, analysis of data, author. SM: contributing author, data analysis, critical review of the intellectual content. JFL: major contributing author, interpretation of data, critical revision of manuscript. PHRG: supervising author, critical revision of the data and intellectual content. All authors approve the final submitted draft.
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