Adenocarcinoma of the upper small bowel complicating coeliac disease.

Cancer in Coeliac Disease

“…18 cases were found in the lit erature up to 1980 [5], but 19 were reported among 116 carcinomas in the UK survey [6], We found none in our own series of 385 coeliacs [4], The main presenting features are abdominal pain, anaemia, occult bleeding, abdominal mass, and intestinal obstruction. The treatment of choice is surgery, and long term survival is recorded [5], A decreased prevalence of carcinoma of the breast and lung in coeliac patients has been reported [6], There is no evidence that the clinical fea tures, diagnosis, response to treatment, or prognosis of carcinomas in patients with cocliac disease are any different to those in pa tients without coeliac disease. The develop ment of carcinoma does not prevent response to a GFD or cause mucosal relapse in pa tients on a GFD [4],…”

“…A significant excess of gastrointestinal car cinomas occurs [6] due mainly to an in creased prevalence of tumours in the small intestine [5,6], oesophagus [2,3,6], and pharynx [2,6], Adenocarcinoma of the small intestine is more common than had hitherto been thought. 18 cases were found in the lit erature up to 1980 [5], but 19 were reported among 116 carcinomas in the UK survey [6], We found none in our own series of 385 coeliacs [4], The main presenting features are abdominal pain, anaemia, occult bleeding, abdominal mass, and intestinal obstruction.…”

“…Subse quently, the same centre showed a 100-fold increase in observed over expected numbers of lymphomas among 210 patients with coe liac disease [2], while in Australia a 50-fold increase was found among 93 cases [3], The increased risk is similar for men and women. Other malignancies also occur [1,4], and in particular there is a significant increase in carcinomas of the upper small bowel [5,6] and of the oesophagus and pharynx [2,3,6], The precise risk of developing malignancy is not known as the prevalence of coeliac dis ease in the general population is uncertain. As about 30% of lymphomas are not diag nosed during life, many will be missed unless autopsies are carried out routinely in coeliac patients.…”

Capsule Endoscopy in Celiac Disease: Diagnosis and Management

“…Celiac disease is associated with an increased risk of intestinal lymphoma [53,54], typically of a T-cell type [49,55], as well as small intestinal adenocarcinoma that probably arises from adenomas [51,56,57]. It is unclear what group of patients who have celiac disease should undergo surveillance by capsule endoscopy to detect these malignancies.…”

Small bowel neoplasia in coeliac disease

“…4 Similar to the situation in the large bowel, there is evidence that small bowel adenocarcinomas also arise from pre-existing adenomas. 5 6 Although there have been many reported cases of small bowel adenocarcinoma developing in coeliac disease patients, [7][8][9][10][11][12][13][14][15] there has been only one published case of a small bowel adenoma in a patient with coeliac disease. 16 Within our cohort of patients with coeliac disease, we have encountered three patients with a small bowel adenoma and four with adenocarcinoma of the small bowel.…”