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Risk of Duodenal Adenoma in Celiac Disease

Scand J Gastroenterol. 2003 Aug;38(8):831-3.

Celiac.com 09/29/2003 - In the following abstract the authors point out that in endoscopic screenings, adenocarcinoma is found less often than statistics from studies suggest it should be, implying that routine endoscopic examinations are not adequate to detect it. If this interpretation of the study is correct, other methods of screening for it need to be utilized or developed. Another possible way to look at this is that celiac patients do not have an elevated risk of adenocarcinoma when compared to the normal population, but given the numerous studies that have shown otherwise this possibility seems unlikely. I would also like to point out that the 60- to 80-fold increased risk of small bowel adenocarcinoma in patients with celiac disease that the author mentions is true for untreated celiacs. -Scott Adams

Here is the abstract:

Rampertab SD, Fleischauer A, Neugut AI, Green PH.
Dept. of Medicine and Herbert Irving Comprehensive Cancer Center, Columbia
University College of Physicians and Surgeons, New York, USA.

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BACKGROUND: There is a 60- to 80-fold increased risk of small bowel adenocarcinoma in patients with celiac disease. While the adenoma-carcinoma sequence appears to operate in the small bowel as in the large bowel, the risk of duodenal adenomas in celiac patients is unknown.

METHODS: The records of 381 patients (245 F, 136 M) with biopsy-proven celiac disease were reviewed to determine the prevalence of duodenal adenoma found during esophagogastroduodenoscopy (EGD). We conducted an extensive literature review to find data for estimates of the prevalence of duodenal adenoma in a comparable general population; we used data from a study at another New York City medical center of 7,346 EGDs conducted between 1976 and 1982 (Ghazi et al., 1984). We estimated the relative risk, expressed as a standard morbidity ratio (SMR), by calculating the observed to expected (O/E) ratio.

RESULTS: Duodenal adenomas were found in 3 celiac patients (0.78%), with 24 adenomas (0.33%) in the reference population, giving an SMR of 2.39 (95% CI 0.67-8.48).

CONCLUSION: We did not find a significantly increased risk of duodenal adenoma in celiac patients compared to a non-celiac endoscoped population. Thus, despite the previously described elevated risk of small bowel adenocarcinoma in these patients, routine endoscopic examination of the duodenum may not be adequate for screening.

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