Maligancy and mortality in a population-based cohort of patients with celiac disease or ‘gluten sensitivity’

Centre for Clinical and Population Sciences, Mulhouse Building, Grosvenor Road, Belfast, BT12 6BJ, United Kingdom, .
World Journal of Gastroenterology (Impact Factor: 2.37). 02/2007; 13(1):146-51.
Source: PubMed


To determine the risk of malignancy and mortality in patients with a positive endomysial or anti-gliadin antibody test in Northern Ireland.
A population-based retrospective cohort study design was used. Laboratory test results used in the diagnosis of coeliac disease were obtained from the Regional Immunology Laboratory, cancer statistics from the Northern Ireland Cancer Registry and mortality statistics from the General Registrar Office, Northern Ireland. Age standardized incidence ratios of malignant neoplasms and standardized mortality ratios of all-cause and cause-specific mortality were calculated.
A total of 13 338 people had an endomysial antibody and/or an anti-gliadin antibody test in Northern Ireland between 1993 and 1996. There were 490 patients who tested positive for endomysial antibodies and they were assumed to have coeliac disease. There were 1133 patients who tested positive for anti-gliadin antibodies and they were defined as gluten sensitive. Malignant neoplasms were not significantly associated with coeliac disease; however, all-cause mortality was significantly increased following diagnosis. The standardized incidence and mortality ratios for non-Hodgkin's lymphoma were increased in coeliac disease patients but did not reach statistical significance. Lung and breast cancer incidence were significantly lower and all-cause mortality, mortality from malignant neoplasms, non-Hodgkin's lymphoma and digestive system disorders were significantly higher in gluten sensitive patients compared to the Northern Ireland population.
Patients with coeliac disease or gluten sensitivity had higher mortality rates than the Northern Ireland population. This association persists more than one year after diagnosis in patients testing positive for anti-gliadin antibodies. Breast cancer is significantly reduced in the cohort of patients with gluten sensitivity.

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    • "Perhaps of as much interest as studies reporting an increased risk of malignancy associated with CD are studies that suggest that CD may reduce the likelihood of developing certain malignancies; obesity predisposes to certain malignancies. CD may reduce the likelihood of developing obesity and women with CD may be at a reduced risk of breast cancer and gynecological malignancies (34, 35). Table 1 showed the prevalence of CD and lymphomas in different studies. "
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    ABSTRACT: Celiac disease is an autoimmune disorder that affects genetically predisposed individuals upon the ingestion of gluten. It is now considered one of the most common genetic disorders in Europe and Asian Pacific region with a prevalence of up to 2.67% of the population. The true prevalence of celiac disease may still be underestimated. Studies remain limited by sample size and selection bias. Celiac disease predisposes to the development of gastrointestinal malignancies, especially lymphomas and small bowel adenocarcinoma. The risk of developing a celiac disease associated malignancies remains uncertain, despite numerous studies. In Middle Eastern countries, the literature regarding celiac disease has expanded significantly in recent years. These studies reported have largely concentrated on the epidemiology of Celiac disease and there is an absolute and relative paucity of published research regarding celiac disease associated malignancy. The aim of this article is to review the current literature and evaluate the risk of gastrointestinal malignancies among patients with celiac disease and then review studies from the Asian Pacific region of the world.
    Gastroenterology and hepatology from bed to bench 03/2013; 6(4):170-177.
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    • "Until recently the terms GS and CD were used synonymously in literature. New investigations showed that in addition to CD, there is case of gluten reactions in which neither allergic nor autoimmune mechanism is involved and this is in general defined as gluten sensitivity (GS) (3, 4). GS patients are intolerant to gluten and when eating gluten that usually, adverse reactions will develop. "
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    ABSTRACT: Gluten associated disorders and the question around these associations has recently attracted attentions of many health professionals. This is because of high prevalence of undiagnosed gluten related disorders presenting with a multitude of symptoms and complications inside and outside small bowel. While the environmental factors associated with a complex genetics are leading to destructions of the small intestinal villi resulting in malabsorption syndrome in CD, GS is characterised by negative antibodies and grossly normal histology. The association between celiac disease and other disorders has been clearly established and there have been many reports of numerous intestinal and extra intestinal coexistent disorders with CD. But there is little information available regarding the clinical behavior of gluten sensitivity. In this review we discuss the clinical presentation of non-celiac GS and the prospect of current and the future diagnostic pathway.
    Gastroenterology and hepatology from bed to bench 03/2012; 5(Suppl 1):S1-S7.
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    • "The risk of other malignancies such as cancers of oropharynx and esophagus, and intestinal adenocarcinomas has also been found to be elevated, but it is not clear whether the gluten-free diet will decrease these complications. The risk for malignancies outside the gastrointestinal system has also been reported to be increased [Goldacre et al. 2008; Anderson et al. 2007; Smedby et al. 2005; West et al. 2004]. Although the risk for non-Hodgkin lymphomas has been shown to be increased in some studies, the increased risk was only found in patients who were already diagnosed with celiac disease [Mearin et al. 2006; Farre et al. 2004; Catassi et al. 2002]. "
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    ABSTRACT: The prevalence of celiac disease is rising. As a result there is increasing interest in the associated mortality and morbidity of the disease. Screening of asymptomatic individuals in the general population is not currently recommended; instead, a strategy of case finding is the preferred approach, taking into account the myriad modes of presentation of celiac disease. Although a gluten-free diet is the treatment of choice in symptomatic patients with celiac disease, there is no consensus on whether institution of a gluten-free diet will improve the quality of life in asymptomatic screen-detected celiac disease patients. A review of the studies that have been performed on this subject is presented. Certain patient groups such as those with autoimmune diseases may be offered screening in the context of an informed discussion regarding the potential benefits, with the caveat that the data on this issue are sparse. Active case finding seems to be the most prudent option in most clinical situations.
    Therapeutic Advances in Gastroenterology 01/2012; 5(1):37-47. DOI:10.1177/1756283X11417038 · 3.93 Impact Factor
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