Malignancy as a long-term complication
Whilst population-based studies have shown individuals with coeliac disease have a lower risk of gastrointestinal malignancy than previously thought, individuals still have a higher risk than the general population1,2. This risk has been demonstrated to fall as time from diagnosis increases, in those individuals who are compliant with a gluten-free diet. One study demonstrated that adherence to a gluten-free diet over five years returned the risk of the individual (with adult coeliac disease) to that of the general population1. Further evidence to support this may be suggested by the fact that there is no reported increase in risk of malignancy in children diagnosed with coeliac disease. This suggest early diagnosis may avoid this complication.
Although many gastrointestinal malignancies are reported non-Hodgkins lymphoma and small bowel adenocarcinoma are particularly recognised as having an increased occurrence in coeliac disease3,4.
References
1. Holmes GKT, Prior P, Lane MR et al. Malignancy in coeliac disease-effect of a gluten-free diet. Gut 1989;38:333-8
2. Mearin ML, Catassi C, Brousse N et al. European multi-centre study on coeliac disease and non-Hodgkin lymphoma. Eur J Gastro & Hepatol 2006;18(2):187-194
3. Catassi C, Fabiani E, Carrao G et al. Risk of non-Hodgkin lymphoma in celiac disease. Journal of the American Medical Association 2002;287:1413-1419
4. Howdle PD, Jalal PK, Holmes GKT et al. Primary small-bowel malignancy in the UK and its association with coeliac disease. QJM: An international journal of medicine. 2003;96:345-353
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