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. 2024 Aug 1;30(8):1251-1257.
doi: 10.1093/ibd/izad188.

Causal Association Analysis of Periodontitis and Inflammatory Bowel Disease: A Bidirectional Mendelian Randomization Study

Xiangli Qing  1   2 , Chenhui Zhang  3 , Zhuotai Zhong  2 , Tao Zhang  2 , Lin Wang  2 , Shuangshuang Fang  2 , Tianyuan Jiang  2 , Xiaoying Luo  2 , Yang Yang  2 , Gengqing Song  4 , Wei Wei  2
Affiliations

Causal Association Analysis of Periodontitis and Inflammatory Bowel Disease: A Bidirectional Mendelian Randomization Study

Xiangli Qing et al. Inflamm Bowel Dis. .

Abstract

Background: Periodontitis has been reported to be associated with inflammatory bowel disease (IBD), including ulcerative colitis (UC), and Crohn's disease (CD). However, the causality of these 2 diseases remains unclear. We conducted bidirectional Mendelian randomization (MR) to investigate the causal relationship between periodontitis and IBD.

Methods: We obtained the genome-wide association study (GWAS) summary data of European populations from FinnGen database (for IBD) and a published article (for periodontitis), from which independent single nucleotide polymorphisms were selected as instrumental variables. Inverse variance-weighted (IVW), MR-Egger, and weighted median (WM) methods were utilized for MR analysis. Heterogeneity or pleiotropy was detected through Cochran's Q test and MR-Egger intercept, respectively. Outlier was identified with MR-PRESSO (Mendelian Randomization Pleiotropy RESidual Sum and Outlier) and leave-one-out analysis. All statistical analyses were performed with R 4.2.1 and the packages of TwoSampleMR version 0.5.6.

Results: Genetic prediction showed that periodontitis was the risk factor of UC (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.01-1.26; P = .027), rather than of CD (OR, 0.92; 95% CI, 0.74-1.15; P = .456) and IBD (OR, 0.96; 95% CI, 0.81-1.13; P = .619). To the contrary, CD, not UC or IBD, resulted in exacerbating periodontitis in terms of the results of the IVW (OR, 1.09; 95% CI, 1.01-1.17; P = .021) and WM (OR, 1.10; 95% CI, 1.01-1.20; P = .030) methods. Heterogeneity or pleiotropy was acceptable.

Conclusions: Our results indicated that CD was the risk factor for periodontitis; conversely, periodontitis was responsible for the exacerbation of UC, enhancing the existence of mouth-gut axis. Patients with UC should pay more attention to periodontal health, while patients with periodontitis should actively pay close heed to intestinal health.

Keywords: IBD; Mendelian randomization; causal relationship; periodontitis.

Plain language summary

A bidirectional Mendelian randomization study indicated that Crohn’s disease was the risk factor for periodontitis; conversely, periodontitis was responsible for the exacerbation of ulcerative colitis, enhancing the existence of the mouth-gut axis and suggesting paying attention to oral health for patients of inflammatory bowel disease.

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Conflict of interest statement

All authors declare no conflicts of interest.

Figures

Figure 1.
Figure 1.
Hypothesis of Mendelian randomization. IV, instrumental variable.
Figure 2.
Figure 2.
Flow chart of the study. IVW, inverse variance weighted; MR-PRESSO, Mendelian Randomization Pleiotropy RESidual Sum and Outlier; WM, weighted median.
See this image and copyright information in PMC

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