Malignancy in coeliac disease--effect of a gluten free diet.

Abstract

SUMMARY Two hundred and ten patients with coeliac disease previously reported from this unit were reviewed at the end of 1985 after a further 11 years of follow up. The initial review at the end of 1974 could not demonstrate that a gluten free diet (GFD) prevented these complications, probably because the time on diet was relatively short. The same series has therefore been kept under surveillance with the particular aim of assessing the effects of diet on malignancy after a further prolonged follow up period. Twelve new cancers have occurred: of which one was a carcinoma of the oesophagus and two lymphomas. Thirty nine cancers developed in 38 patients and of 69 deaths, 33 were the result of malignancy. A two-fold relative risk (RR) of cancer was found and was because of an increased risk of cancer of the mouth and pharynx (RR=9-7, p<001, 95o/o confidence interval (CI)=2-0-28 3), oesophagus (RR=12-3, p<0 01, CI=25-36'5), and of non-Hodgkin's lymphoma (RR=42-7, p<0001, CI=19-6-81 4). The results indicate that for coeliac patients who have taken a GFD for five years or more the risk of developing cancer over all sites is not increased when compared with the general population. The risk is increased, however, in those taking a reduced gluten, or a normal diet, with an excess ofcancers of the mouth, pharynx and oesophagus (RR=22 7, p<O.001), and also of lymphoma (RR=77-8, p<0 001). A significant decreasing trend in the excess morbidity rate over increasing use ofa GFD was found. The results are suggestive of a protective role for a GFD against malignancy in coeliac disease and give further support for advising all patients to adhere to a strict GFD for life.There are several reports of an association between steatorrhoea and intestinal lymphoma which have been recently summarised.' The malabsorption was attributed in the early literature to lymphatic obstruction by enlarged mesenteric glands2' but abnormalities in the small intestinal mucosa were also thought to play a part.4 In reports up to 1961, the steatorrhoea in every case was considered to occur secondary to the lymphoma.In 1962, Read and his colleagues from Bristol' suggested that lymphoma was a complication of coeliac disease in which the mucosal abnormality was a premalignant condition. They produced further

ACP Broadsheet No 149: September 1996. Serological diagnosis of gluten sensitive enteropathy.

“…The author has never seen an IgA Ri-ARA positive that does not also show IgA AEA positivity, though the converse is not true, supporting the notion that both antibodies are the same but monkey oesophagus a more sensitive substrate. The Figure 1 1 Negative result on umbilical cord. Note smooth muscle reactivity is often seen with non-coeliac serum samples.…”

Practical considerations for the identification and follow-up of children with celiac disease

“…The risk of lymphoma for symptomatic patients with celiac disease presenting in the 1960s and followed for more than 10 years was reduced from 77.8 to 16.7 through compliance with a gluten-free diet, and those with a childhood diagnosis of celiac disease who remained compliant did not develop malignancy (44). Recent calculations of lymphoma risk are lower (RR 7.0), due, in part, from exclusion of those who developed lymphoma within one year of diagnosis (46).…”

“…CELIAC DISEASE Treated patients who are diagnosed with celiac disease in childhood do not have increased mortality (3,44). Celiac disease identified in adulthood is associated with a 1.3 to 2.0 fold mortality of that of the general population (3,44,45), but this is due primarily to malignancy occurring within the first two years of diagnosis.…”

“…Celiac disease identified in adulthood is associated with a 1.3 to 2.0 fold mortality of that of the general population (3,44,45), but this is due primarily to malignancy occurring within the first two years of diagnosis.…”

Is Refractory Celiac Disease More Severe in Old Europe?

“…It remains unknown whether gluten intake is higher in Europe than in the United States. Indeed, the amount of gluten consumption may enhance the risk of developing malignancies ( 26 ) and autoimmune diseases ( 27 ) in celiac patients. A recent study reports a more severe outcome of celiac disease in South compared with North Europe in relationship to a higher gluten intake ( 28 ).…”