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    No Higher Risk of Colorectal Neoplasia in Celiac Disease


    Jefferson Adams
    Image Caption: New study on colorectal neoplasia and celiac disease

    Celiac.com 09/17/2010 - People with celiac disease have higher risk for developing lymphoma and small bowel malignancy, though most studies have found no higher risk of colorectal cancer.


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    To compare rates of colorectal cancer in celiac disease patients with rates for non-celiac disease control subjects, Dr. Peter Greene and colleagues at Columbia University Medical Center conducted a study. The research team included B. Lebwohl, E. Stavsky, and A. I. Neugut.

    For the study, the team reviewed case data for all celiac disease patients who underwent colonoscopy at Columbia Medical Center during a 44-month period. They matched each patient with non-coeliac disease controls according to age, gender and presiding endoscopist.

    They then compared rates of colorectal adenoma between the groups, and used multivariate analysis to rate any independent association between celiac disease and cancers (adenomas).

    The team found 180 patients with celiac disease and 346 controls. Thirteen percent of celiac patients and seventeen percent of control subjects showed at least one adenoma (P = 0.20).

    Multivariate analysis showed that age and male gender were associated with adenomas in both groups, but showed no connection between celiac disease and adenomas.

    More specifically, relative adenoma risk rose by 4% with each additional year of age, with men facing a 2.33-fold increased risk compared with women.

    Their data showed clearly that celiac disease is not associated with an increased risk of colorectal neoplasia. They also note that the lack of increased risk of colorectal cancer seen in population studies reflects a genuine average risk of colorectal neoplasia, rather than an increase in colonoscopies and associated polypectomies in people with celiac disease.

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  • About Me

    Jefferson Adams is a freelance writer living in San Francisco. He has covered Health News for Examiner.com, and provided health and medical content for Sharecare.com. His work has 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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  • Related Articles

    Scott Adams
    Am J Med. 2003 Aug 15;115(3):191-5
    Celiac.com 09/03/2003 - The results of a study conducted by Dr. Peter Green and colleagues at the College of Physicians and Surgeons in New York City indicate that, despite a gluten-free diet, people with celiac disease still have an elevated risk of getting non-Hodgkins lymphoma. The good news is that the risk of getting other types of cancers like small intestinal adenocarcinoma, esophageal cancer and melanoma were reduced in patients who adhered to a gluten-free diet, as was the overall risk of getting non-Hodgkins lymphoma. The study looked at 381 celiac disease patients, out of which 43 were diagnosed with cancer (11%). The vast majority—34—were diagnosed at or before their celiac disease diagnoses, so it is safe to say that they were not following a gluten-free diet.
    The results of this study emphasize the importance of adhering to a strict gluten-free diet, and of getting regular checkups by your doctor. Cancer screenings may also be advised, especially in cases where unexplained symptoms continue after going gluten-free. There is currently, however, no specific test for non-Hodgkins lymphoma, so one must learn about its warning signs and be on the lookout for any symptoms. - Scott Adams
    Here is the abstract of the study:

    Risk of malignancy in patients with celiac disease.
    Green PH, Fleischauer AT, Bhagat G, Goyal R, Jabri B, Neugut AI.
    Departments of Medicine (PHRG, RG, AIN), College of Physicians and Surgeons, New York, New York, USA
    Studies from Europe have demonstrated an increased risk of malignancy, especially non-Hodgkins lymphoma, in patients with celiac disease. However, there are no data on the risk for similar patients in the United States. Our aim was to estimate the risk of malignancy in a cohort of patients with celiac disease compared with the general U.S. population and to determine if a gluten-free diet is protective. Patients with celiac disease seen between July 1981 and January 2000 at a referral center were included. Standardized morbidity ratios (SMRs) (ratio of observed to expected) and corresponding 95% confidence intervals (CI) were calculated, using data from the National Cancer Institutes Surveillance, Epidemiology, and End Results Program. Forty-three (11%) of 381 celiac disease patients had a diagnosis of cancer; 9 were after the diagnosis of celiac disease, 7 were simultaneous (during same month of admission), and 27 were before the diagnosis. The standardized morbidity ratio for all cancers combined was 1.5 (95% CI: 0.3 to 7.5), with significantly increased values for small bowel cancer (SMR = 34; 95% CI: 24 to 42), esophageal cancer (SMR = 12; 95% CI: 6.5 to 21), non-Hodgkins lymphoma (SMR = 9.1; 95% CI: 4.7 to 13), and melanoma (SMR = 5.0; 95% CI: 2.1 to 12). Following the diagnosis of celiac disease, patients were at increased risk of non-Hodgkins lymphoma only (SMR = 6.2; 95% CI: 2.9 to 14), despite adherence to a gluten-free diet. The non-Hodgkins lymphoma included both T-cell and B-cell types and occurred in both gastrointestinal (n = 5) and extra intestinal sites (n = 4). In this cohort of patients with celiac disease, we observed increased risks of small intestinal adenocarcinoma, esophageal cancer, melanoma, and non-Hodgkins lymphoma. The risk of non-Hodgkins lymphoma persisted despite a gluten-free diet.

    Jefferson Adams
    Celiac.com 05/13/2009 - People with silent celiac disease, those who test positive for celiac disease antibodies, yet show no clinical signs of the disease itself, do not face a higher risk for developing malignant cancers, according to results of a recent Finnish study.
    Previous studies done in the 1970s and 1980s indicated that patients with clinically recognized celiac disease face a higher risk for developing malignancies, Dr. Katri Kaukinen, of the University of Tampere, Finland, told reporters from Reuters Health. However, she explained, "it has not been known whether apparently clinically silent unrecognized cases also carry an increased risk of celiac disease-related complications, and thus whether the healthcare system should recognize and treat."
    In an effort to answer that question, Dr. Kaukinen led team of researchers in assessing whether adults with previously unrecognized screening-identified evidence of celiac disease have an increased risk of malignancies.
    Recent screening figures put the prevalence of celiac disease somewhere between 1% and 2% of the population, which means from 7 to 14 million Europeans with gluten intolerance. 75% to 90% of all the celiac disease remains undiagnosed due to absent or atypical symptoms.
    The team examined data from a Finnish population-based adult-representative cohort of 8000 subjects compiled from 1978 to 1980. In 2001, the researchers screened blood samples of people with no history of celiac disease or any malignancy (n = 6849) for immunoglobulin A (IgA) class tissue transglutaminase antibodies. They further screened
    positive samples for IgA class tissue transglutaminase antibodies (Celikey tTG) and for IgA endomysial antibodies (EMA).
    The team analyzed a total of 6849 blood samples. 565 samples showed positive Eu-tTG results. 202 of these subjects showed positive Celikey tTG results ((2.9%) while 73 showed positive EMA screens (1.1%).
    Just over 10% of the study subjects, a total of 694 participants, developed malignancies during the period of the study. Overall malignancy risk was no higher for celiac autoantibody-positive subjects. Adjusted for age and sex, the results showed that the relative risks were 0.91 for those who were Celikey tTG positive, and 0.67 and for those who were EMA positive.
    According to Dr. Kaukinen, the results seem to support the current clinical approach, and suggests that "earlier diagnosis of the disease through serological mass screening would not be beneficial in improving the prognosis of celiac disease as regards malignancies."
    However, before completely ruling out mass screening, Dr Kaukinen noted that it is important to pursue "further prognostic studies [on] mortality and fractures among earlier unrecognized celiac disease cases," as "[t]hese issues should be also addressed" before any official decisions are made regarding the use of mass blood screening for celiac disease.

    Gut 2009; 58:643-647.

    Jefferson Adams
    Celiac.com 02/28/2011 - Celiac disease is associated with an increased risk of lymphoma and small bowel malignancy. Colorectal cancer is the most common gastrointestinal cancers in the United States, but most studies have not found no higher rates of colorectal cancer for people with celiac disease, compared with rates in the general population.
    The results of these studies might in fact be describing a true null relationship between celiac disease and colorectal cancers. However, the results may also be influenced by better health-care among patients with known celiac disease, particularly among those with gastroenterologists who are likely to perform screening colonoscopy.
    Because colonoscopy can decrease the incidence of colorectal cancer via removal of precancerous adenomas during the procedure, and because gastroenterologists usually follow such patients, a possible underlying increased risk of colorectal cancer in patients with celiac disease may remain undetected.
    The team of researchers sought to assess the underlying risk of colorectal cancer in patients with celiac disease by quantifying the relative prevalence of precancerous colorectal adenomas in these patients compared with patients without celiac disease in a cohort of individuals undergoing colonoscopy. The team included B. Lebwohl; E. Stavsky; A. I. Neugut; and P. H. R. Green.
    To isolate the association of celiac disease with colorectal adenomas, the team controlled for three important predictors of adenoma detection on colonoscopy: endoscopist, patient age and patient gender.
    They then identified all celiac disease patients who underwent colonoscopy at their institution during a 44-month period. They matched each celiac disease patient by age, gender and endoscopist, with non-celiac control subject.
    The team then compared the adenoma rates between these groups, and used multivariate analysis to assess the independent association of celiac disease with adenomas.
    The team isolated 180 patients with celiac disease and 346 control subjects. A total of 13% of celiac disease patients and 17% of controls (P = 0.20) showed at least one adenoma.
    Multivariate analysis showed that age (OR per year 1.04, 95% CI 1.02–1.07) and male gender (OR 2.33, 95% CI 1.36–3.98) were both associated with higher rates of adenoma.
    However, there were no higher adenoma rates among people with celiac disease (OR 0.75, 95% CI 0.41–1.34).
    The study provides strong support for the notion that celiac disease is not associated with higher rates of colorectal cancer.
    They conclude that the lack of increased rates of colorectal cancer is related to a true average risk of colorectal neoplasia, rather than reflecting higher colonoscopy and associated polyp removals among people with celiac disease.
    Source:

    Alimentary Pharmacology & Therapeutics 2010;32(8):1037-1043.

  • Recent Articles

    Jefferson Adams
    Celiac.com 06/21/2018 - Would you buy a house advertised as ‘gluten-free’? Yes, there really is such a house for sale. 
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    Read more at Arizonafamily.com.

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    Bakery On Main started in the small bakery of a natural foods market on Main Street in Glastonbury, Connecticut. Founder Michael Smulders listened when his customers with Celiac Disease would mention the lack of good tasting, gluten-free options available to them. Upon learning this, he believed that nobody should have to suffer due to any kind of food allergy or dietary need. From then on, his mission became creating delicious and fearlessly unique gluten-free products that were clean and great tasting, while still being safe for his Celiac customers!
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    Celiac.com 06/20/2018 - Currently, the only way to manage celiac disease is to eliminate gluten from the diet. That could be set to change as clinical trials begin in Australia for a new vaccine that aims to switch off the immune response to gluten. 
    The trials are set to begin at Australia’s University of the Sunshine Coast Clinical Trials Centre. The vaccine is designed to allow people with celiac disease to consume gluten with no adverse effects. A successful vaccine could be the beginning of the end for the gluten-free diet as the only currently viable treatment for celiac disease. That could be a massive breakthrough for people with celiac disease.
    USC’s Clinical Trials Centre Director Lucas Litewka said trial participants would receive an injection of the vaccine twice a week for seven weeks. The trials will be conducted alongside gastroenterologist Dr. James Daveson, who called the vaccine “a very exciting potential new therapy that has been undergoing clinical trials for several years now.”
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    Read more at the website for Australia’s University of the Sunshine Coast Clinical Trials Centre.

    Source:
    FoodProcessing.com.au

    Jefferson Adams
    Celiac.com 06/19/2018 - Could baking soda help reduce the inflammation and damage caused by autoimmune diseases like rheumatoid arthritis, and celiac disease? Scientists at the Medical College of Georgia at Augusta University say that a daily dose of baking soda may in fact help reduce inflammation and damage caused by autoimmune diseases like rheumatoid arthritis, and celiac disease.
    Those scientists recently gathered some of the first evidence to show that cheap, over-the-counter antacids can prompt the spleen to promote an anti-inflammatory environment that could be helpful in combating inflammatory disease.
    A type of cell called mesothelial cells line our body cavities, like the digestive tract. They have little fingers, called microvilli, that sense the environment, and warn the organs they cover that there is an invader and an immune response is needed.
    The team’s data shows that when rats or healthy people drink a solution of baking soda, the stomach makes more acid, which causes mesothelial cells on the outside of the spleen to tell the spleen to go easy on the immune response.  "It's most likely a hamburger not a bacterial infection," is basically the message, says Dr. Paul O'Connor, renal physiologist in the MCG Department of Physiology at Augusta University and the study's corresponding author.
    That message, which is transmitted with help from a chemical messenger called acetylcholine, seems to encourage the gut to shift against inflammation, say the scientists.
    In patients who drank water with baking soda for two weeks, immune cells called macrophages, shifted from primarily those that promote inflammation, called M1, to those that reduce it, called M2. "The shift from inflammatory to an anti-inflammatory profile is happening everywhere," O'Connor says. "We saw it in the kidneys, we saw it in the spleen, now we see it in the peripheral blood."
    O'Connor hopes drinking baking soda can one day produce similar results for people with autoimmune disease. "You are not really turning anything off or on, you are just pushing it toward one side by giving an anti-inflammatory stimulus," he says, in this case, away from harmful inflammation. "It's potentially a really safe way to treat inflammatory disease."
    The research was funded by the National Institutes of Health.
    Read more at: Sciencedaily.com

    Jefferson Adams
    Celiac.com 06/18/2018 - Celiac disease has been mainly associated with Caucasian populations in Northern Europe, and their descendants in other countries, but new scientific evidence is beginning to challenge that view. Still, the exact global prevalence of celiac disease remains unknown.  To get better data on that issue, a team of researchers recently conducted a comprehensive review and meta-analysis to get a reasonably accurate estimate the global prevalence of celiac disease. 
    The research team included P Singh, A Arora, TA Strand, DA Leffler, C Catassi, PH Green, CP Kelly, V Ahuja, and GK Makharia. They are variously affiliated with the Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Lady Hardinge Medical College, New Delhi, India; Innlandet Hospital Trust, Lillehammer, Norway; Centre for International Health, University of Bergen, Bergen, Norway; Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Gastroenterology Research and Development, Takeda Pharmaceuticals Inc, Cambridge, MA; Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy; Department of Medicine, Columbia University Medical Center, New York, New York; USA Celiac Disease Center, Columbia University Medical Center, New York, New York; and the Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.
    For their review, the team searched Medline, PubMed, and EMBASE for the keywords ‘celiac disease,’ ‘celiac,’ ‘tissue transglutaminase antibody,’ ‘anti-endomysium antibody,’ ‘endomysial antibody,’ and ‘prevalence’ for studies published from January 1991 through March 2016. 
    The team cross-referenced each article with the words ‘Asia,’ ‘Europe,’ ‘Africa,’ ‘South America,’ ‘North America,’ and ‘Australia.’ They defined celiac diagnosis based on European Society of Pediatric Gastroenterology, Hepatology, and Nutrition guidelines. The team used 96 articles of 3,843 articles in their final analysis.
    Overall global prevalence of celiac disease was 1.4% in 275,818 individuals, based on positive blood tests for anti-tissue transglutaminase and/or anti-endomysial antibodies. The pooled global prevalence of biopsy-confirmed celiac disease was 0.7% in 138,792 individuals. That means that numerous people with celiac disease potentially remain undiagnosed.
    Rates of celiac disease were 0.4% in South America, 0.5% in Africa and North America, 0.6% in Asia, and 0.8% in Europe and Oceania; the prevalence was 0.6% in female vs 0.4% males. Celiac disease was significantly more common in children than adults.
    This systematic review and meta-analysis showed celiac disease to be reported worldwide. Blood test data shows celiac disease rate of 1.4%, while biopsy data shows 0.7%. The prevalence of celiac disease varies with sex, age, and location. 
    This review demonstrates a need for more comprehensive population-based studies of celiac disease in numerous countries.  The 1.4% rate indicates that there are 91.2 million people worldwide with celiac disease, and 3.9 million are in the U.S.A.
    Source:
    Clin Gastroenterol Hepatol. 2018 Jun;16(6):823-836.e2. doi: 10.1016/j.cgh.2017.06.037.