Clin Gastroenterol Hepatol
Antibiotics tied to celiac disease risk—bias likely drives the signal
Clinical takeaway: A modest link between prior antibiotic use and later celiac disease was observed—but an even stronger association was seen in patients with normal intestinal biopsies, suggesting surveillance bias. Do not withhold appropriate antibiotics out of concern for triggering celiac disease.
Antibiotic exposure has long been suspected as a potential trigger for celiac disease (CD) via microbiome disruption, but prior data have been inconsistent. This large study helps clarify whether the association reflects causality—or healthcare-seeking behavior.
Investigators analyzed Swedish registry data from 2007–2023, including 27,789 patients with biopsy-confirmed CD, 133,451 matched population comparators, and 33,112 unaffected siblings. Antibiotic prescriptions ≥1 year before diagnosis were analyzed to avoid capturing treatment for early, undiagnosed celiac symptoms.
Any prior antibiotic use was more common in patients with CD than population comparators (69% vs 63%), corresponding to a 24% higher adjusted odds of CD (aOR 1.24; 95% CI, 1.21–1.28). Risk estimates increased with repeated exposure (aOR 1.35 for ≥3 courses). Similar results were seen in sibling comparisons (aOR 1.29), suggesting shared familial factors did not fully explain the association.
However, a secondary analysis raised important context. Individuals undergoing endoscopy who had normal small-intestinal mucosa showed an even stronger association with prior antibiotics compared with population controls (aOR 1.50 overall; aOR 1.80 for ≥3 courses). Notably, when directly compared, patients with CD were less likely than those with normal mucosa to have received antibiotics (aOR 0.83).
These findings suggest heightened clinical surveillance—rather than a causal effect—may drive the observed link between antibiotics and CD.
Antibiotic stewardship remains essential, but concern about inducing celiac disease should not deter clinically indicated antibiotic prescribing, the authors conclude.
Source: Ulnes, M, et al. (2026, April 27). Clin Gastroenterol Hepatol. Antibiotic use and later risk of celiac disease: A nationwide case-control and sibling analysis