Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2013 Aug 6;159(3):169-75.
doi: 10.7326/0003-4819-159-3-201308060-00006.

Mucosal healing and risk for lymphoproliferative malignancy in celiac disease: a population-based cohort study

Benjamin Lebwohl  1 , Fredrik Granath, Anders Ekbom, Karin E Smedby, Joseph A Murray, Alfred I Neugut, Peter H R Green, Jonas F Ludvigsson
Affiliations
Multicenter Study

Mucosal healing and risk for lymphoproliferative malignancy in celiac disease: a population-based cohort study

Benjamin Lebwohl et al. Ann Intern Med. .

Abstract

Background: Celiac disease (CD) is associated with an increased risk for lymphoproliferative malignancy (LPM). Whether this risk is affected by the results of follow-up intestinal biopsy, performed to document mucosal healing, is unknown.

Objective: To examine the association between mucosal healing in CD and subsequent LPM.

Design: Population-based cohort study.

Setting: 28 pathology departments in Sweden.

Patients: 7625 patients with CD who had follow-up biopsy after initial diagnosis.

Measurements: The risk for LPM was compared with that of the general population by using expected rates. The rate of LPM in patients with persistent villous atrophy was compared with that of those with mucosal healing by using Cox regression.

Results: Among 7625 patients with CD and follow-up biopsy, 3308 (43%) had persistent villous atrophy. The overall risk for LPM was higher than that in the general population (standardized incidence ratio [SIR], 2.81 [95% CI, 2.10 to 3.67]) and was greater among patients with persistent villous atrophy (SIR, 3.78 [CI, 2.71 to 5.12]) than among those with mucosal healing (SIR, 1.50 [CI, 0.77 to 2.62]). Persistent villous atrophy compared with mucosal healing was associated with an increased risk for LPM (hazard ratio [HR], 2.26 [CI, 1.18 to 4.34]). The risk for T-cell lymphoma was increased (HR, 3.51 [CI, 0.75 to 16.34]) but not for B-cell lymphoma (HR, 0.97 [CI, 0.21 to 4.49]).

Limitation: No data on dietary adherence.

Conclusion: Increased risk for LPM in CD is associated with the follow-up biopsy results, with a higher risk among patients with persistent villous atrophy. Follow-up biopsy may effectively stratify patients with CD by risk for subsequent LPM.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest/Disclosure requirement

All authors declare that they have no conflicts of interest and nothing to declare.

Summary for patients in

References

    1. Green PH, Cellier C. Celiac disease. N Engl J Med. 2007;357(17):1731–43. - PubMed
    1. Mustalahti K, Catassi C, Reunanen A, Fabiani E, Heier M, McMillan S, et al. The prevalence of celiac disease in Europe: results of a centralized, international mass screening project. Ann Med. 2010;42(8):587–95. - PubMed
    1. Rubio-Tapia A, Kyle RA, Kaplan EL, Johnson DR, Page W, Erdtmann F, et al. Increased prevalence and mortality in undiagnosed celiac disease. Gastroenterology. 2009;137(1):88–93. - PMC - PubMed
    1. Catassi C, Kryszak D, Bhatti B, Sturgeon C, Helzlsouer K, Clipp SL, et al. Natural history of celiac disease autoimmunity in a USA cohort followed since 1974. Ann Med. 2010;42(7):530–8. - PubMed
    1. Elfstrom P, Granath F, Ekstrom Smedby K, Montgomery SM, Askling J, Ekbom A, et al. Risk of lymphoproliferative malignancy in relation to small intestinal histopathology among patients with celiac disease. J Natl Cancer Inst. 2011;103(5):436–44. - PubMed

Publication types

MeSH terms