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Risk of malignancy in patients with celiac disease.

Abstract

PURPOSE

Studies from Europe have demonstrated an increased risk of malignancy, especially non-Hodgkin's lymphoma, in patients with celiac disease. However, there are no data on the risk for similar patients in the United States. Our aim was to estimate the risk of malignancy in a cohort of patients with celiac disease compared with the general U.S. population and to determine if a gluten-free diet is protective.

METHODS

Patients with celiac disease seen between July 1981 and January 2000 at a referral center were included. Standardized morbidity ratios (SMRs) (ratio of observed to expected) and corresponding 95% confidence intervals (CI) were calculated, using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program.

RESULTS

Forty-three (11%) of 381 celiac disease patients had a diagnosis of cancer; 9 were after the diagnosis of celiac disease, 7 were simultaneous (during same month or admission), and 27 were before the diagnosis. The standardized morbidity ratio for all cancers combined was 1.5 (95% CI: 0.3 to 7.5), with significantly increased values for small bowel cancer (SMR = 34; 95% CI: 24 to 42), esophageal cancer (SMR = 12; 95% CI: 6.5 to 21), non-Hodgkin's lymphoma (SMR = 9.1; 95% CI: 4.7 to 13), and melanoma (SMR = 5.0; 95% CI: 2.1 to 12). Following the diagnosis of celiac disease, patients were at increased risk of non-Hodgkin's lymphoma only (SMR = 6.2; 95% CI: 2.9 to 14), despite adherence to a gluten-free diet. The non-Hodgkin's lymphoma included both T-cell and B-cell types and occurred in both gastrointestinal (n = 5) and extraintestinal sites (n = 4).

CONCLUSION

In this cohort of patients with celiac disease, we observed increased risks of small intestinal adenocarcinoma, esophageal cancer, melanoma, and non-Hodgkin's lymphoma. The risk of non-Hodgkin's lymphoma persisted despite a gluten-free diet.

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  • Authors+Show Affiliations

    ,

    Department of Medicine, College of Physicians and Surgeons, New York, New York, USA. pg11@columbia.edu

    , , , ,

    Source

    The American journal of medicine 115:3 2003 Aug 15 pg 191-5

    MeSH

    Adult
    Age Distribution
    Celiac Disease
    Cohort Studies
    Comorbidity
    Female
    Follow-Up Studies
    Humans
    Incidence
    Lymphoma
    Male
    Middle Aged
    Neoplasms
    New York
    Risk Assessment

    Pub Type(s)

    Journal Article
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    12935825

    Citation

    Green, Peter H R., et al. "Risk of Malignancy in Patients With Celiac Disease." The American Journal of Medicine, vol. 115, no. 3, 2003, pp. 191-5.
    Green PH, Fleischauer AT, Bhagat G, et al. Risk of malignancy in patients with celiac disease. Am J Med. 2003;115(3):191-5.
    Green, P. H., Fleischauer, A. T., Bhagat, G., Goyal, R., Jabri, B., & Neugut, A. I. (2003). Risk of malignancy in patients with celiac disease. The American Journal of Medicine, 115(3), pp. 191-5.
    Green PH, et al. Risk of Malignancy in Patients With Celiac Disease. Am J Med. 2003 Aug 15;115(3):191-5. PubMed PMID: 12935825.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Risk of malignancy in patients with celiac disease. AU - Green,Peter H R, AU - Fleischauer,Aaron T, AU - Bhagat,Govind, AU - Goyal,Rishi, AU - Jabri,Bana, AU - Neugut,Alfred I, PY - 2003/8/26/pubmed PY - 2003/9/16/medline PY - 2003/8/26/entrez SP - 191 EP - 5 JF - The American journal of medicine JO - Am. J. Med. VL - 115 IS - 3 N2 - PURPOSE: Studies from Europe have demonstrated an increased risk of malignancy, especially non-Hodgkin's lymphoma, in patients with celiac disease. However, there are no data on the risk for similar patients in the United States. Our aim was to estimate the risk of malignancy in a cohort of patients with celiac disease compared with the general U.S. population and to determine if a gluten-free diet is protective. METHODS: Patients with celiac disease seen between July 1981 and January 2000 at a referral center were included. Standardized morbidity ratios (SMRs) (ratio of observed to expected) and corresponding 95% confidence intervals (CI) were calculated, using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. RESULTS: Forty-three (11%) of 381 celiac disease patients had a diagnosis of cancer; 9 were after the diagnosis of celiac disease, 7 were simultaneous (during same month or admission), and 27 were before the diagnosis. The standardized morbidity ratio for all cancers combined was 1.5 (95% CI: 0.3 to 7.5), with significantly increased values for small bowel cancer (SMR = 34; 95% CI: 24 to 42), esophageal cancer (SMR = 12; 95% CI: 6.5 to 21), non-Hodgkin's lymphoma (SMR = 9.1; 95% CI: 4.7 to 13), and melanoma (SMR = 5.0; 95% CI: 2.1 to 12). Following the diagnosis of celiac disease, patients were at increased risk of non-Hodgkin's lymphoma only (SMR = 6.2; 95% CI: 2.9 to 14), despite adherence to a gluten-free diet. The non-Hodgkin's lymphoma included both T-cell and B-cell types and occurred in both gastrointestinal (n = 5) and extraintestinal sites (n = 4). CONCLUSION: In this cohort of patients with celiac disease, we observed increased risks of small intestinal adenocarcinoma, esophageal cancer, melanoma, and non-Hodgkin's lymphoma. The risk of non-Hodgkin's lymphoma persisted despite a gluten-free diet. SN - 0002-9343 UR - https://www.unboundmedicine.com/medline/citation/12935825/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002934303003024 DB - PRIME DP - Unbound Medicine ER -