ADULT CELIAC-DISEASE AND CIGARETTE-SMOKING

Background-Genetic predisposition and gliadin exposure are known to be crucial factors in the development of coeliac disease. Circumstantial evidence suggests that other unidentified environmental factors may a lso be of pathogenetic importance. Aim-To define the relation between cigarette smoking and the risk of development of symptomatic adult ons et coeliac disease. Subjects-Eighty six recently diagnosed adult coeli ac disease patients and 172 controls matched for age and sex. Method-M atched case control study, using a simple questionnaire to determine s moking history, and in particular smoking status at the time of diagno sis of coeliac disease. Results-At the time of diagnosis, the proporti on of current smokers was 7% in the coeliac group, and 32.6% in the co ntrol group, giving a matched odds ratio of 0.15 (95% confidence inter vals 0.06, 0.38). The difference could not be accounted for by social class, nor by coeliac patients giving up smoking after the onset of sy mptoms as most non-smokers in the coeliac group had never smoked. Conc lusion-Cigarette smoking, ora factor closely linked to it, seems to ex ert a major protective effect against the development of symptomatic a dult onset coeliac disease. The implication is that gliadin exposure i s not the only important environmental factor involved in the pathogen esis of this condition.