Cancer incidence and factors associated with malignancies in coeliac disease during long‐term follow‐up

Abstract

Background The increased risk of malignancies in coeliac disease is well recognised, but data on incidence and predisposing factors are scarce. Our aim was to determine cancer incidence and its prognostic factors in coeliac disease during a long‐term follow‐up. Methods The study cohort comprised all (n = 1460) coeliac patients diagnosed in Tampere University Hospital catchment area during the period 1960‐2000. Demographic data (age, gender, decade of diagnosis) and coeliac disease characteristics (presenting symptoms, signs of malabsorption, severity of villous atrophy) were obtained from medical records, and patients were stratified into subgroups accordingly. Standardised incidence ratios (SIRs) compared to general population of the same area were calculated for malignancies altogether and according to stratifications. Results The overall risk of malignancy was not increased (SIR 0.97; 95% confidence interval (CI) 0.84‐1.11). The risk of non‐Hodgkin lymphoma was elevated (SIR 3.0; 1.88‐4.54) but less so after ≥15 years of follow‐up (SIR 1.75; 0.70‐3.60). Screen‐detected coeliac disease or malabsorption at diagnosis was not associated with increased risk of non‐Hodgkin lymphoma. The increased risk of gastrointestinal malignancies (SIR 1.42; 95% CI 1.07‐1.85), particularly that of stomach and liver cancers, was associated with females, coeliac disease diagnosis before year 1981 and dermatitis herpetiformis. Conclusions The overall risk of malignancy was not increased in any coeliac disease phenotype. The risk of non‐Hodgkin lymphoma was increased but not in screen‐detected coeliac disease.

Mortality and causes of death in different celiac disease phenotypes during long-term follow-up

“…All patients (n = 1,460) with biopsy-proven celiac disease including dermatitis herpetiformis diagnosed in the Tampere University Hospital catchment area between January 1960 and December 20 0 0 were prospectively collected to form the celiac disease cohort [18] . Sixty-eight patients were excluded from further analysis: two patients had died before the start of follow-up (January 1, 1978) and 66 patients had inadequate baseline data preventing selection of reference individuals.…”

Malignant complications of celiac disease: a case series and review of the literature

“…The overall risk of malignancy is not increased in CD [standardized incidence ratio (SIR) 0.97], but there is an increased risk of gastrointestinal malignancies (SIR 1.42) according to a recent study [ 11 ]. Malignant complications of CD are rare but have a very poor prognosis.…”