Risks for lymphoma and gastrointestinal carcinoma in patients with newly diagnosed adult-onset celiac disease: Consequences for follow-up: Celiac disease, lymphoma and GI carcinoma. Issue 10 (December 2018)

• Record Type: Journal Article
• Authors: van Gils, Tom; Nijeboer, Petula; Overbeek, Lucy IH; Hauptmann, Michael; Castelijn, Daan AR; Bouma, Gerd; Mulder, Chris JJ; van Leeuwen, Flora E; de Jong, Daphne
• Is Part Of: United European Gastroenterology journal. Volume 6:Issue 10(2018)
• Page Start: 1485
• Page End: 1495
• Publication Date: 2018-12
• Subjects: Celiac disease -- enteropathy-associated T-cell lymphoma -- small bowel adenocarcinoma -- squamous cell carcinoma -- follow-up; Gastroenterology -- Periodicals; Periodicals; 616.33005
• DOI: 10.1177/2050640618800540
• Languages: English
• ISSNs: 2050-6406

Abstract

Background: The association between celiac disease (CD) and the development of lymphoid and gastrointestinal (GI) malignancies have been reported. However, data are scarce yet needed to develop evidence-based follow-up programs. Objective: The objective of this article is to assess relative (RR) and absolute risks of lymphoma and GI carcinoma for newly diagnosed patients. Methods: A case-control design to determine RR was performed with cases (lymphoma or GI carcinoma) and controls (melanoma or basal cell carcinoma) diagnosed 1994–2014, retrieved from the Dutch nationwide population-based pathology database (PALGA). Within this population, individuals with histologically proven CD before or simultaneously diagnosed with the malignancy were identified. Results: A total of 349/301, 425 cases (0.1%) and 282/576, 971 (0.05%) controls were diagnosed with CD. Risk of T-cell lymphoma, predominantly enteropathy-associated T-cell lymphoma (EATL), was strongly associated with CD diagnosis (RR = 35.8 (95% CI 27.1–47.4)). Although most often synchronously diagnosed, T-cell lymphoma RR ≥ 1 year after CD diagnosis was still elevated (RR = 12.7 (95% CI 7.6–21.3)). Other CD-associated malignancies were small bowel adenocarcinoma (RR = 11.9 (95% CI 8.2–17.2)) and esophageal squamous cell carcinoma (RR = 3.5 (95% CI 2.1–5.8)). Absolute risks were relatively low. Other types of lymphomas and GI carcinomas were not associated with CD. Conclusion: Increased risk for specific malignancies in CD should alert physicians for EATL (both intestinal and extraintestinal) and small bowel adenocarcinoma in patients with CD diagnosed at age ≥ 50 years.