323 - COVID-19 Infection is Not Associated with Incident Diagnosis of Celiac Disease

Publication Number: 323.4242

Cade M. Nylund, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Sarah Prabhakar, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Rian C. Calo, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Kensinton, MD, United States; Apryl Susi, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States

Background: The COVID-19 pandemic and COVID-19 infection have been linked to immune-mediated diseases. It is not known whether COVID-19 infection is associated with the development of celiac disease (CD).

Objective: This study evaluates the causal relationship between COVID-19 infection and incident diagnosis of CD.

Design/Methods: A propensity score-matched retrospective cohort study using the Military Health System (MHS) Database data for children 0-17 years of age was performed. ICD-10 codes and laboratory test results identified patients with COVID-19 infections from July 2020 to June 2021. Counts of inpatient and outpatient diagnoses, procedures, and outpatient medication prescription data one year preceding COVID-19 infection were categorized by a clinical classification software. Using 1770 clinical variables, a propensity score for COVID-19 infection was matched 1:2 to non-exposed, additionally matched on age, sex, and month of the year.. The cohort was followed for a diagnosis of CD and separately for any esophagogastroduodenoscopy (EGD). Any subject and their controls with an ICD-10 code indicating the outcome in the year prior to their cohort entry date was excluded. Participants were followed for a year with censoring at loss to follow-up or COVID-19 infection or a diagnosis of CD. Cox Proportional Hazards Model was used to generate hazard ratios (HR).

Results: There were 72,027 total participants in the study, 24,009 with COVID-19 exposure and 48,018 controls. 53.3% were female and the median age was 11 (interquartile range [IQR], 5-15). Children with COVID-19 were more likely to have an EGD (HR, 1.74; 95% confidence interval[CI], 1.43-2.13; N=384). There were 54 total subjects with CD for the first time; 21 (0.09%) among those with COVID-19 and 33 (0.07%) among controls. Of those with CD the median age was 13 years (IQR, 8-15) and 64.8 % were females (n= 35). Children who had a recorded diagnosis of COVID-19 were not more likely to have a new diagnosis of CD (HR, 1.22; 95% CI, 0.70-2.16).

Conclusion(s): Children 0-17 years of age diagnosed with COVID-19 were more likely to have an EGD but were not more likely to be diagnosed with CD. However, our study suggests that children with COVID-19 may have more post-COVID-19 gastrointestinal symptoms leading to evaluation with an EGD. The study was limited by a low number of CD patients and future larger studies, possibly including a longer follow-up period and young adults would be warranted.

Figure 1 Cumulative Percent of Subjects with a Newly Diagnosed Celiac Disease by COVID-19 Exposure Status


Figure 2 Cumulative Percent of Subjects with an Esophagogastroduodenoscopy by COVID-19 Exposure Status