Meta‐analysis: coeliac disease and the risk of all‐cause mortality, any malignancy and lymphoid malignancy

Abstract

SUMMARY BackgroundCoeliac disease has been associated with an increased risk of mortality and malignancy. However, the strength of this association is conflicting among different studies.

Commentary: coeliac disease, mortality and malignancy

“…1 As shown by most earlier original studies, the overall excess mortality was low in coeliac disease; and patients with coeliac disease do not seem to be at increased risk of 'any malignancy'. Although a positive association between coeliac disease and lymphoid malignancy is confirmed, it should be remembered that this malignancy is still rare in absolute terms.…”

“…These objections are, however, minor remarks, and there are many reasons to read the paper by Tio et al 1 Among them are the well-crafted discussion on ascertainment bias and the speculation as to why coeliac disease patients are not at increased risk of 'any malignancy' (coeliac disease may be negatively associated with some non-lymphoid cancers such as breast, endometrial and ovarian cancer). 9,10 The authors should also be lauded for using an existing meta-analysis guideline (MOOSE) and clearly outlining where heterogeneity may have affected their results.…”

A review of the role of lymphoma markers and occupational and environmental exposures

“…Moreover, individuals with auto-immune conditions, such as rheumatoid arthritis, systemic lupus erythematosis, Sjogren's syndrome, Coeliac disease, and psoriasis, are at a higher risk of developing NHL (Hoover 1992;Mariette 2001;Engels et al 2005;Grulich et al 2007;Tio et al 2012). Additional evidence of the integral role of the immune system in lymphomagenesis can be seen from epidemiologic studies that examined polymorphisms in genes coding for cytokines that modulate the inflammatory process or are linked to B cell activation (Wang et al 2007;Ambinder et al 2010;Skibola et al 2010).…”

Diagnosis of Celiac Disease

“…15 But in four other studies in England, 16 Finland, 17 Ireland, 18 and individuals older than 50 in Olmsted county, 19 no increase in mortality was noted in undiagnosed seropositive individuals as compared to their seronegative counterparts. A recent metaanalysis found a modestly increased mortality risk in patients with CD based on serology alone (OR 1.16; 95% CI 1.02-1.31), 20 but this pooled analysis included seropositive patients who underwent small intestinal biopsy that was normal, 10 raising the possibility of confounding by indication.…”