A Challenging Diagnosis of Jejunal Adenocarcinoma in a Celiac Patient: Case Report and Systematic Review of the Literature

Abstract

Celiac disease (CD) is a common and chronic disorder requiring a long-life gluten-free diet. There is evidence that asymptomatic or subclinical presentation of CD has increased in the last decades, so that several cases are diagnosed during adulthood or even in the elderly. Celiac disease patients are at an increased risk of developing malignancies, particularly when the disease is diagnosed in the elderly. We describe a case of a challenging diagnosis of small bowel adenocarcinoma which developed in a patient with CD discovered only in the elderly. We also performed a systematic review of the literature. A tailored follow-up in a sub-group of CD patients at an increased risk of developing intestinal adenocarcinoma could be implemented.Abbreviations: CD: Celiac disease; GP: General Practitioner; FOBT: faecal occult blood test; EMA: anti-endomysial antibodies; tTG: anti-tissue transglutaminase antibodies; Hgb: hemoglobin; VCE: videocapsule endoscopy.

Small Bowel Adenocarcinoma, Version 1.2020, NCCN Clinical Practice Guidelines in Oncology

“…10 Additionally, although the data are mostly limited to case studies and literature reviews, cases of SBA have been reported in patients with celiac disease, suggesting a possible link between these conditions. [14][15][16] The association with celiac disease is poorly understood and a distinct difference from CRC, for which celiac disease is not a risk factor.…”

High Concordance between Trained Nurses and Gastroenterologists in Evaluating Recordings of Small Bowel Video Capsule Endoscopy (VCE)

“…According to the current European guidelines, VCE is recommended for patients with obscure gastrointestinal bleeding (OGIB), suspected Crohn's disease with negative ileocolonoscopy, suspected small-bowel tumours, and inherited polyposis syndromes [1]. Other potential indications are u n e x p l ai n e d c h ron i c d i a r r h o e a , d r u g -r e l a t e d enteropathy, and some forms of coeliac disease [1][2][3]. The major limitation of VCE is the time required to review the recording, which may range from 60 to 120 minutes [4].…”