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Celiac Disease Increases Lymphoma Risk

Adhering to gluten-free diet may lower the risk (August 6)

In a study conducted at Columbia University, patients with celiac disease were found to have an elevated risk of lymphoproliferative malignancies (LPM), especially if they had persistent villous atrophy.

In celiac disease, the immune system damages the intestinal lining by reacting to gluten in foods, and patients are at risk for cancer of the immune system (lymphoma). Eliminating all gluten from food is essential. If the disease is controlled, the lining usually heals. Diagnosis of celiac disease involves a biopsy of the intestine. Some patients have follow-up biopsies after treatment to see whether the disease has been controlled. The findings were reported in the Annals of Internal Medicine.

Specific subtypes linked to a higher risk of LPM when villous atrophy persisted were non-Hodgkin’s lymphoma and unspecified non-Hodgkin’s lymphoma. There was a nonsignificant risk for T-cell lymphoma (but not B-cell lymphoma).

The researchers sought to learn whether the results of follow-up biopsies were associated with a risk of LPM. In follow-up biopsies from 7,625 patients in a population-based cohort in Sweden, 43% of patients had evidence of ongoing damage to the gut lining. Compared with the rest of the population in Sweden, patients with CD who had evidence of ongoing damage to the gut lining on follow-up biopsy had an increased risk of lymphoma.

The researchers consider follow-up biopsy results important and also as a way to motivate patients to improve their dietary adherence, which should eventually diminish the increased risk of LPM.

Study imitations included a lack of information about gluten avoidance and the possibility that statistical power was inadequate. The researchers also did not consider the economic effects of repeated biopsies. A cost–benefit analysis of this approach was recommended.

Source: Annals of Internal Medicine; August 6, 2013.

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