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Mucosal Healing and Risk for Lymphoproliferative Malignancy in Celiac Disease
Jefferson Adams is a freelance writer living in San Francisco. His poems, essays and photographs have appeared in Antioch Review, Blue Mesa Review, CALIBAN, Hayden's Ferry Review, Huffington Post, the Mississippi Review, and Slate among others.
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Celiac.com 09/25/2013 - People with celiac disease have higher rates of lymphoproliferative malignancy. Currently, doctors just don't know whether risk levels are affected by the results of follow-up intestinal biopsy, performed to document mucosal healing.
A team of researchers recently tried to find out if overall risk for lymphoproliferative malignancy in people with celiac disease is connected with levels of mucosal healing. The research team included Benjamin Lebwohl, MD, MS; Fredrik Granath, PhD; Anders Ekbom, MD, PhD; Karin E. Smedby, MD, PhD; Joseph A. Murray, MD; Alfred I. Neugut, MD, PhD; Peter H.R. Green, MD; and Jonas F. Ludvigsson, MD, PhD.
The are variously affiliate with the Columbia University College of Physicians and Surgeons, New York, New York; Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden; Mayo Clinic College of Medicine, Rochester, Minnesota; and Örebro University Hospital, Örebro, Sweden.
For their population-based cohort study, the team looked at data from all 28 pathology departments in Sweden. They evaluated at data for 7625 patients with celiac disease who received follow-up biopsy after initial diagnosis.
Measurements: They used expected rates to assess risk for LPM, compared with that of the general population. They then used Cox regression to compare rates of LPM in patients with persistent villous atrophy against rates for patients with mucosal healing.
Of the 7625 patients with celiac disease and follow-up biopsy, 3308 (43%) showed persistent villous atrophy. Overall risk levels for LPM were higher for celiac patients who had received biopsy (standardized incidence ratio [SIR], 2.81 [95% CI, 2.10 to 3.67]) than for the general population. LPM risk levels were higher for celiac patients with persistent villous atrophy (SIR, 3.78 [CI, 2.71 to 5.12]) than for those with mucosal healing (SIR, 1.50 [CI, 0.77 to 2.62]).
Compared with mucosal healing, persistent villous atrophy was associated with an increased risk for LPM (hazard ratio [HR], 2.26 [CI, 1.18 to 4.34]). Risk for T-cell lymphoma was higher (HR, 3.51 [CI, 0.75 to 16.34]), but not for B-cell lymphoma (HR, 0.97 [CI, 0.21 to 4.49]).
One limitation of the study is that it gathered no data about patient adherence to a gluten-free diet.
Higher risk for LPM in celiac disease is connected with follow-up biopsy results, with a higher risk among patients with persistent villous atrophy.
Follow-up biopsy may be an effective way to classify celiac disease patients by risk for subsequent LPM.
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