Risk of Small-Bowel Cancer Increased in Celiac Disease

By Will Boggs, MD

August 17, 2020

NEW YORK (Reuters Health) - Patients with celiac disease have an increased risk of small-bowel cancer, although the absolute risk is low, according to a new study.

"Clinicians should be aware of the increased risk and investigate the small bowel in celiac patients with malignant symptoms in a timely fashion," Dr. Louise Emilsson of the University of Oslo, in Norway, told Reuters Health by email. "However, absolute risks are so low that screening for small-bowel cancers in asymptomatic celiac patients should not be recommended."

Adenocarcinomas and carcinoids account for the majority of small bowel cancers but only about 2-3% of all gastrointestinal cancers. Earlier studies have suggested an association between celiac disease and an increased risk of gastrointestinal malignancy.

Dr. Emilsson and colleagues used data from linked Swedish national registries to examine the risk of future small-bowel adenocarcinomas, adenomas and carcinoids in 48,119 individuals with celiac disease and more than 239,000 matched individuals who were free of celiac disease, with a median follow-up of 11 years.

Overall, 29 individuals with celiac disease (0.06%) developed small-bowel adenocarcinoma, compared with 45 matched controls (0.02%), a difference that corresponds to one extra case of small-bowel adenocarcinoma for every 2,944 individuals with celiac disease followed for 10 years.

The 0.06% absolute risk among individuals with celiac disease was much lower than the 0.65% risk reported in another recent publication.

Compared with controls, individuals with celiac disease had a 5.73-fold increased risk of small-bowel adenoma. But there was no significant difference in the risk of carcinoids between individuals with celiac disease and controls, the researchers report in Gastroenterology.

Small bowel adenocarcinoma occurred in 0.01% of individuals with celiac disease with mucosal healing versus 0.18% of individuals with celiac disease who had persistent villous atrophy. This difference fell short of statistical significance.

"This is the first publication from a larger project to increase our understanding of small-bowel cancer epidemiology and prognosis," Dr. Emilsson said. "Through the project, we hope to improve and create new knowledge in a broad range of topics relating to small-bowel cancer."

SOURCE: https://bit.ly/30GkKSM Gastroenterology, online July 14, 2020.

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