Digestive Health

Updated 11 March 2016

Higher lymphoma risk for unhealed coeliacs

Coeliac disease patients with ongoing intestinal damage have a higher risk for lymphoma, a new study finds.

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Celiac disease patients with ongoing intestinal damage have a higher risk for lymphoma than those with healed intestines, a new study finds.

The intestinal damage in people with celiac disease is caused by a reaction to eating gluten, which is found in wheat, barley and rye. After diagnosis, many patients switch to a gluten-free diet. Patients often are followed up to assess the effects that dietary changes and treatment have on intestinal healing.

Lymphoma is a type of blood cancer that begins in the lymph system, and can eventually spread to other parts of the body.

The study

This study included more than 7 600 people with celiac disease who had follow-up intestinal biopsies six months to five years after their diagnosis, and were then followed for roughly nine years.

At the time of their follow-up biopsy, 57% of the patients had healed intestines while 43% had ongoing intestinal damage, according to the study, which was published in the August 6 issue of the journal Annals of Internal Medicine.

Overall, the patients with celiac disease had an annual lymphoma risk of about 68 of 100 000 people, which is nearly three times higher than the general population's risk rate of about 24 of 100 000.

Meanwhile, the annual risk for patients with ongoing intestinal damage was about 102 of 100 000 people, compared with 31.5 of 100 000 for those with healed intestines.

It's not clear why intestinal healing occurs in some patients with celiac disease but not in others, the Columbia University Medical Center researchers said.

Adherence to diet

"We know from prior studies that healing is more likely among patients who report strict adherence to the gluten-free diet, compared with those who admit to less-than-strict dietary habits," study first author Dr Benjamin Lebwohl, an assistant professor of medicine and epidemiology at the Mailman School of Public Health, said in a medical centre news release.

Ongoing intestinal damage, however, was seen even in patients who strictly adhered to a gluten-free diet. This suggests that other unidentified factors also affect intestinal healing.

"Our findings linking the follow-up biopsy result to lymphoma risk will lead us to redouble our efforts to better understand intestinal healing and how to achieve it," said Lebwohl, a member of the Celiac Disease Center.

More information

The US National Institute of Diabetes and Digestive and Kidney Diseases has more about celiac disease.

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Digestive Health Expert

Dr. Estelle Wilken is a Senior Specialist in Internal Medicine and Gastroenterology at Tygerberg Hospital. She obtained her MBChB in 1976, her MMed (Int) in 1991 and her gastroenterology registration in 1995.

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