Malignancy and mortality in people with coeliac disease: population based cohort study

Division of Epidemiology and Public Health, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH.
BMJ (online) (Impact Factor: 17.45). 10/2004; 329(7468):716-9. DOI: 10.1136/bmj.38169.486701.7C
Source: PubMed

ABSTRACT To quantify the risks of malignancy and mortality in people with coeliac disease compared with the general population.
Population based cohort study.
General practice research database.
4732 people with coeliac disease and 23,620 matched controls.
Hazard ratios for malignancy and mortality.
Of the 4732 people with coeliac disease, 134 (2.8%) had at least one malignancy and 237 (5.0%) died. The overall hazard ratios were: for any malignancy 1.29 (95% confidence interval 1.06 to 1.55), for mortality 1.31 (1.13 to 1.51), for gastrointestinal cancer 1.85 (1.22 to 2.81), for breast cancer 0.35 (0.17 to 0.72), for lung cancer 0.34 (0.13 to 0.95), and for lymphoproliferative disease 4.80 (2.71 to 8.50). The increased risk was primarily in the first year after diagnosis, with the risk for only lymphoproliferative disease remaining significantly raised thereafter. After excluding events in the year after diagnosis, the hazard ratio for malignancy was 1.10 (0.87 to 1.39) and for mortality was 1.17 (0.98 to 1.38), giving absolute excess rates of 6 and 17 per 10,000 person years, respectively.
People with coeliac disease have modest increases in overall risks of malignancy and mortality. Most of this excess risk occurs in the year of follow up after diagnosis. People with coeliac disease also have a noticeably reduced risk of breast cancer. The mechanism of this merits further attention as it may provide insights into the cause of this common malignancy.

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Available from: Timothy R Card, Sep 27, 2015
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    • "Celiac disease (CD) is characterized by small intestinal inflammation and is triggered by gluten exposure in genetically sensitive individuals [1]. CD occurs in 1-2% of the Western population [2,3], and has been linked to a number of disorders including type 1 diabetes [4], sepsis [5], lymphoproliferative malignancy [6], and excess mortality [7]. "
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    ABSTRACT: Background Smoking status has been linked to several chronic inflammatory conditions but earlier research on smoking and celiac disease (CD) is contradictive. There are little data on moist snuff use and CD. The purpose of this study was to investigate the association between smoking, moist snuff use and later CD. Methods We identified individuals with biopsy-verified CD (villous atrophy, histopathology stage Marsh III) through biopsy-reports from Sweden’s 28 pathology departments. Data on smoking and moist snuff were collected from the Swedish construction worker database “Bygghälsan” that includes preventive health care check-up data. Through poisson regression we calculated relative risks (RRs) for later CD according to smoking status (n = 305,722), and moist snuff status (n = 199,200) adjusting for age, sex and decade. Results During follow-up 488 individuals with smoking data, and 310 with moist snuff data had a diagnosis of CD. The risk of CD was independent of smoking status with all RRs being statistically insignificant and ranging between 0.9 and 1.0. Compared to non-smokers, neither current smokers (RR = 0.93; 95% CI = 0.76-1.14) nor ex-smokers (RR = 0.98; 95% CI = 0.75-1.28) were at increased or decreased risk of CD. Risk estimates were similar in moderate smokers (RR = 0.92; 0.72-1.16) and heavy smokers (RR = 0.95; 0.74-1.24), and did not change when we examined the risk more than ten years after health examination (RR-moderate: 0.90; and RR-heavy: 0.95; both p > 0.05). Moist snuff use was not associated with later CD (RR = 1.00; 0.78-1.28), or with CD after more than ten years of follow-up (RR = 1.05; 0.80-1.38). Conclusions We found no association between smoking, moist snuff use and future CD.
    BMC Gastroenterology 07/2014; 14(1):120. DOI:10.1186/1471-230X-14-120 · 2.37 Impact Factor
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    • "Both CD and autoimmune hepatitis are associated with specific class II HLA molecules encoding for HLA complex genes on chromosome 6 (38). The effects of a GFD on natural history of autoimmune hepatitis are not clear but a GFD is necessary to improve any symptoms due to CD (39, 40). "
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    ABSTRACT: Context Celiac disease (CD) is defined as a permanent intolerance to ingested gluten. The intolerance to gluten results in immune-mediated damage of small intestine mucosa manifested by villous atrophy and crypt hyperplasia. These abnormalities resolve with initiationa gluten-free diet. Evidence Acquisition PubMed, Ovid, and Google were searched for full text articles published between 1963 and 2012. The associated keywords were used, and papers described particularly the impact of celiac disease on severity of liver disorder were identified. Results Recently evidence has emerged revealingthat celiac disease not only is associated with small intestine abnormalities and malabsorption, but is also a multisystem disorder affecting other systems outside gastrointestinal tract, including musculo-skeletal, cardiovascular and nervous systems. Some correlations have been assumed between celiac and liver diseases. In particular, celiac disease is associated with changes in liver biochemistry and linked to alter the prognosis of other disorders. This review will concentrate on the effect of celiac disease and gluten-free diets on the severity of liver disorders. Conclusions Although GFD effect on the progression of CD associated liver diseases is not well defined, it seems that GFD improves liver function tests in patients with a hypertransaminasemia.
    Hepatitis Monthly 10/2013; 13(10):e11893. DOI:10.5812/hepatmon.11893 · 1.93 Impact Factor
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    • "Al momento attuale la maggioranza dei soggetti celiaci, dal bambino all'adulto, non viene riconosciuta da un'appropriata diagnosi e non riceve il trattamento dietetico che sappiamo essere risolutivo. I casi dei celiaci misconosciuti, quindi non indirizzati alla dieta aglutinata , sono associati a una maggiore morbilità e mortalità per il rischio di sviluppo di complicanze a lungo termine (osteoporosi , infertilità, linfoma intestinale ecc.) [6]. Elementi fondamentali per la diagnosi sono i marker anticorpali (positività per anticorpi della classe IgA anti-transglutaminasi e anti-endomisio) e la biopsia duodenale (gold standard ), mentre l'indagine genetica è utile per escludere con certezza quasi assoluta la diagnosi in assenza di HLA- DQ2/DQ8. "
    05/2013; 1(2):1. DOI:10.4081/itjm.2007.2.1
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