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  • Jefferson Adams
    Jefferson Adams

    Study Shines Light on Small Bowel Adenocarcinoma and Celiac Disease

    Reviewed and edited by a celiac disease expert.

    A new study shows that patients with celiac disease-related small bowel adenocarcinoma are younger at onset, likely female, and face better odds of survival compared to sporadic, Crohn- and hereditary syndrome-related SBA.

    Study Shines Light on Small Bowel Adenocarcinoma and Celiac Disease - Image: CC BY 2.0--416style
    Caption: Image: CC BY 2.0--416style

    Celiac.com 9/26/2019 - Small bowel adenocarcinoma is a rare abnormal tissue growth, that can happen alone, or can also be the result of predisposing conditions, including hereditary syndromes and immune-mediated intestinal disorders, such as celiac disease. 

    However, researchers still don't know very much about small bowel adenocarcinoma in the context of celiac disease. To get some answers, a research team recently set out to show the main clinical features, diagnostic procedures and management options of small bowel adenocarcinoma cases detected in a large cohort of celiac patients diagnosed in a single tertiary care center.

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    The research team included Giacomo Caio, Umberto Volta, Francesco Ursini, Roberto Manfredini, and Roberto De Giorgio.

    They are variously affiliated with the Department of Medical Sciences, University of Ferrara, St. Anna Hospital in Ferrara, Italy; the Mucosal Immunology and Biology Research Center and Celiac Center, Massachusetts General Hospital- Harvard Medical School, Boston, MA, USA; the Department of Medical and Surgical Sciences, University of Bologna in Bologna, Italy; and the Department of Medical Sciences, University of Ferrara, St. Anna Hospital, Ferrara, Italy.

    The team retrospectively reviewed all small bowel adenocarcinoma cases from a group of 770 celiac disease patients of the Celiac Disease Referral Center at the University Hospital in Bologna, Italy from January 1995 to December 2014. The group included nearly 600 females, spanned 18 to 80 years of age, and averaged 36 years old at diagnosis.

    A total of five of the 770 celiac disease patients developed small bowel adenocarcinoma. All were female, and about 53 years old on average, though the individuals ranged from 38 to 72 years old. 

    The small bowel adenocarcinoma was diagnosed along with the celiac disease in three cases. It was localized to the jejunum in four cases, and to the duodenum in one case. 

    The clinical presentation of small bowel adenocarcinoma was characterized by intestinal sub-occlusion in two cases, while the main presentation in the other three cases were iron deficiency anaemia, abdominal pain and acute intestinal obstruction, respectively. 

    All the patients underwent surgery, while three patients with advanced stage neoplasia also received chemotherapy. The overall survival rate at 5 years was 80% for the group.

    The observed celiac disease-related small bowel adenocarcinoma cases were marked by a younger age of onset, were mainly female, and faced better odds of survival, compared with sporadic, Crohn- and hereditary syndrome-related small bowel adenocarcinoma.

    Read more in BMC Gastroenterology volume 19, Article number: 45 (2019)

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    I was diagnosed  simultaneously with celiac and an adenocarcinoma of the jejunum 8 years ago. After few surgeries and control of the celiac, I still feel very tired all the time. My body needs to shut down at least one time during the day. I cannot do prolonged activities but still feel happy surviving this ordeal.

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    I was diagnosed with Celiac in 2007 and in 2009 with small bowel adenocarcinoma (about a foot from the stomach). I felt tired all the time and my doctor found my iron level was extremely low, he prescribed vitamin B12 and iron supplements and I feel much better now. 

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  • About Me

    Jefferson Adams

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,500 articles on celiac disease. His coursework includes studies in science, scientific methodology, biology, anatomy, medicine, logic, and advanced research. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

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    Scott Adams
    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.
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    Jefferson Adams
    Celiac.com 01/02/2012 - To properly diagnose celiac disease doctors must observe classic histological changes to small bowel mucosa. Success rates can vary among clinics and practitioners. A clinical team recently compared biopsy interpretation between different pathology practice types.
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    The researchers included Carolina Arguelles-Grande, Christina A. Tennyson, Suzanne K. Lewis, Peter H. R. Green, and Govind Bhagat.
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    Data showed very good agreement for primary diagnosis between the authors and university hospitals (k=0.888), but only moderate agreement compared with community hospitals (k=0.465) or commercial labs (k=0.419).
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    Dr. Rodney Ford M.D.
    Celiac.com 04/20/2016 - I am likely to be accused of gluten heresy. That is because I propose that celiac disease and gluten sensitivity usually coexist. By this I mean that they are not mutually exclusive entities.
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    My observations show that the distinction between celiac disease and gluten-sensitivity (the gluten syndrome) is blurred. The purpose of published algorithms and decision trees are designed to separate out celiac disease from other gluten-illnesses. I suggest that this thinking is flawed.
    For example, most flow charts go something like this: (See Flow Chart 1 at left).
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    Such simplistic algorithms (decision trees) strike problems at every decision point. Such as: Who should be tested? Who should be re-tested? When should these tests be done? At what age? On how much gluten? What tests should be done? What are the cut-off levels? How important is carrying the DQ2/8 genes? What about sero-negative celiac disease? How accurate are endoscopic biopsies? Who interprets the Marsh scale? How long should a gluten challenge be?
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    Jefferson Adams
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