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  • Scott Adams
    Scott Adams

    Cancer: Small-Bowel Lymphoma Associated With Unrecognized Celiac Disease

    Eur J Gastroenterol Hepatol 2000;12:645-648.

    Celiac.com 08/13/2000 - According to Drs. Simon D. Johnston and R.G. Peter Watson from Royal Victoria Hospital in Belfast, Northern Ireland, UK, the incidence of undiagnosed celiac disease is higher among those with small bowel lymphoma, as reported in the June issue of the European Journal of Gastroenterology and Hepatology. According to the researchers: It is not clear whether the increased risk of small bowel lymphoma seen in typical celiac disease also applies to unrecognized or screening-detected celiac patients. To find an answer, they retrospectively identified 69 cases of small-bowel adenocarcinoma and 69 cases of small-bowel lymphoma from five pathology laboratories in Northern Ireland.

    From a group composed of one patient with known celiac disease, and 12 with previously unrecognized celiac disease, the clinical presentation of adenocarcinoma and lymphoma patients was similar, but perforation was much more common among lymphoma patients. Further, 13 of the lymphoma patients, but none of the adenocarcinoma patients, had villous atrophy at a distant site, all of which were enteropathy-associated T-cell lymphomas. According to the researchers: Comparing the small-bowel lymphoma group to our random sample of the general Northern Ireland population as controls, the odds ratio of 15.72 for unrecognized celiac disease in the small-bowel lymphoma group, clearly indicates that there is an increased risk of unrecognized celiac disease among small-bowel lymphoma patients. Additionally, (s)ince a protective role for a strict gluten-free diet has been demonstrated, it follows that every effort should be made to diagnose celiac disease at every opportunity and raises the issue of whether population screening for celiac disease should be carried out.



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  • About Me

    In 1994 I was diagnosed with celiac disease, which led me to create Celiac.com in 1995. I created this site for a single purpose: To help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives. Celiac.com was the first site on the Internet dedicated solely to celiac disease. In 1998 I founded The Gluten-Free Mall, Your Special Diet Superstore!, and I am the co-author of the book Cereal Killers, and founder and publisher of Journal of Gluten Sensitivity.

  • Related Articles

    Scott Adams
    JAMA 2002;287:1413-1419.
    Celiac.com 04/12/2002 - According to a report published in the March 20th issue of the Journal of the American Medical Association, people with celiac disease are three times more likely to develop non-Hodgkin lymphoma (NHL) than the normal population. Dr. Carlo Catassi and colleagues from the University of Maryland in Baltimore compared the prevalence of celiac disease in 653 NHL patients with more than 5,000 healthy control subjects to determine the NHL-celiac disease occurrence rate. The results indicate that 1% of NHL patients also have celiac disease, in comparison with 0.42% of the healthy controls. Adjustments were made for age and sex, and the final results indicate that the odds ratios for a patient with celiac disease of developing NHL are: 3.1 for all types of NHL, 16.9 for gut NHL, and 19.2 for T-cell NHL. The overall risk, however, for someone with celiac disease developing NHL is only 0.63%.
    The researchers do not feel that their findings support mass screening for celiac disease, but they do feel that selected NHL patients should be screened for celiac disease. We would also like to add that these findings support the screening of people with celiac disease for NHL, which was not directly addressed by the report.

    Scott Adams
    Gut 2005;54:54-59. Celiac.com 01/20/2005 - A link between untreated celiac disease and a rare enteropathy-type T-cell lymphoma (ETTL) has been well established by several studies. According to Dr. Karin Ekstrom Smedby of the Karolinska Institute in Stockholm and colleagues, there is also an increase in the prevalence of other types of lymphomas in those with celiac disease, such as B cell and non-intestinal lymphomas. In their study the researchers reviewed and reclassified 56 cases of malignant lymphomas that occurred in 11,650 hospitalized celiac disease patients in Sweden. The observed numbers of lymphoma subtypes were compared with those expected in the Swedish population. The researchers discovered that a majority of the lymphomas were not intestinal T-cell lymphomas, but were B-cell non-Hodgkin lymphoma (NHL). In addition, 44% of the patients with B cell NHL had a history of other autoimmune/inflammatory diseases. As expected, the relative risks for T-cell NHL and primary gastrointestinal lymphomas were markedly increased. According to the researchers: "Most lymphomas complicating coeliac disease are indeed related to the disease and are not of the ETTL-type. There was a remarkable aggregation of autoimmune/inflammatory disorders, female sex, coeliac disease, and B cell lymphoma."

    Jefferson Adams
    Celiac.com 08/14/2007 - It has long been documented that there is a connection between celiac disease and neoplasm. In fact, in the 1960s, a population-based study reported a 100-fold increase in risk of non-Hodgkins lymphoma in patients with celiac disease.
    It has also been shown that people with celiac disease are at greater risk for developing small bowel adenocarcinoma. Also, studies have shown an increased mortality rate from cancer among celiac patients, and there is mounting, but not conclusive evidence that a gluten-free diet provides a measure of protection against the development of malignancies. Strangely, several studies have documented a lower risk of breast cancer among celiac patients.
    However, to date, very little is known about the associated factors, particularly with regard to the development of gastrointestinal malignancies and their corresponding risk levels. A study recently published in BMC Gastroenterology documents the efforts of a team of Italian doctors to evaluate the risks of developing various types of gastrointestinal neoplasms associated with delayed diagnosis of celiac disease and the resulting consumption of gluten over time.
    The team was made up of doctors Marco Silano; Umberto Volta; Anna Maria Mecchia; Mariarita Dessì; Rita Di Benedetto; and Massimo De Vincenzi. The team studied a group of 1,968 celiac patients from 20 GE referral centers between 01 January 1982 & 31 March 2005.
    Study Shows Higher Rates of Gastrointestinal Malignancy that Increase with Age in Patients with Delayed Diagnosis of Celiac Disease
    According to the results of the study celiac patients have an increased risk of developing cancer which corresponds directly with the age of diagnosis of celiac disease. This increased risk applies to gastro-intestinal malignancies. An accurate screening for tumors should be performed in patients diagnosed with celiac disease in adulthood. On average, the mean age of celiac patients who developed a neoplasm, either sooner or later, was 47.6 +/- 10.2 years, compared with 28.6 =/- 18.2 years in those did not develop neoplasm.
    BMC Gastroenterology 2007, 7:8 (9 March 2007)
    health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.

    Jefferson Adams
    Celiac.com 04/13/2010 - A team of clinicians recently described a case of immune modulation by non-Hodgkin lymphoma in a patient with two primary intestinal T-Cell lymphomas and long-standing celiac disease.
    F. Mühr-Wilkenshoff, M. Friedrich, H. D. Foss, M. Hummel, M. Zeitz, and S. Daum made up the research team. They are variously affiliated with the  Medical Clinic I, Gastroenterology, Rheumatology and Infectious Diseases, and with the Department of Pathology, Charité of the Campus Benjamin Franklin of University Medicine Berlin, Germany.
    About 20–30% of all non-Hodgkin lymphomas (NHLs) are gastrointestinal in nature. Of these gastrointestinal lymphomas, about 20–30% occur in small intestine
    The clinical team recently reported the case of a 72-year-old patient who had been diagnosed with celiac disease when he was 52-years old. The man had not followed a gluten-free diet, yet showed no evidence of enteropathy or celiac-associated antibodies, but still developed a jejunal T-cell lymphoma.
    Doctors resected the lymphoma due to perforation and treated the patient with four courses of IMVP-16. The patient began and maintained a strict gluten-free diet.
    Two years later, the patient appeared with weight loss and a clonally divergent refractory sprue type II with loss of antigen (CD8; T-cell receptor-) expression in intraepithelial lymphocytes.
    At this time, he showed high titers of celiac-associated antibodies, although he was on a strict GFD.
    The research team notes that the missing enteropathy under a gluten-containing diet supports the idea of immune suppression in malignant diseases, especially non-Hodgkin lymphoma.
    They also note that the fact that, even while maintaining a strict gluten-free diet, the patient developed refractory sprue type II, an early form of another independent T-cell lymphoma, along with celiac-associated antibodies, suggests that clonal intraepithelial lymphocytes might be stimulating antibody production.
    Thus, they conclude that isolated detection of celiac-associated antibodies in patients with celiac disease does not prove that patients have deviated from their gluten-free diets.
    Source:

    Digestion 2010;81:231–234 DOI: 10.1159/000269810

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    I guess I should have added that she already had an endoscopy and biopsy as follow up to an eosinophilic esophagitis diagnosis. The doctor ordered the bloodwork after getting the results back. She is a picky eater and I swear only eats gluten lol It is going to be a struggle if we have to go gluten free.
    If any tests for celiac disease are positive, it generally means that follow up tests, perhaps a biopsy, are needed to confirm CD. Be sure that your daughter continues to eat gluten until all testing is completed, as not eating it could skew future test results.
    Thank you for your reply. I have just edited my post to add nausea! Another big symptom.  Did your doctor send you straight for endoscopy with negative blood results? Or do those other blood tests first? 
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