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Mucosal healing reduced, did not eliminate malignancy risk in celiac disease
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Patients with celiac disease were at increased risk for lymphoproliferative malignancy, but this risk was greater among patients with persistent villous atrophy, according to recent results.
In a multicenter, population-based cohort study, researchers evaluated data from 7,625 patients with celiac disease (CD) who underwent follow-up biopsy between 6 months and 5 years of initial diagnosis. Median follow-up was 10.6 years from diagnosis and 8.9 years after biopsy. The cohort included 3,308 patients with persistent villous atrophy.
Lymphoproliferative malignancy (LPM) occurred in 0.7% of the cohort (median onset, 4.9 years from follow-up biopsy). Investigators calculated an incidence of 67.9 cases per 100,000 person-years, which was significantly greater in the cohort vs. the general population (standardized IR=2.81; 95% CI, 2.1-3.67), particularly among those with persistent villous atrophy (SIR=3.78; 95% CI, 2.71-5.12). Patients with resolved villous atrophy (mucosal healing) remained at elevated risk compared with the general population, but less so than cohort patients without resolution (SIR=1.5; 95% CI, 0.77-2.62).
Multivariate analysis indicated a significantly increased risk for LPM among those with persistent villous atrophy compared with mucosal healing patients (HR=2.26; 95% CI, 1.18-4.34), particularly within 1 year after biopsy (HR=3.67; 95% CI, 0.8-16.86). This risk was significantly elevated for non-Hodgkin’s lymphoma (HR=2.82; 95% CI, 1.29-6.17) and unspecified non-Hodgkin’s lymphoma (HR=4.31; 95% CI, 1.27-14.61), and trended toward significance for T-cell (HR=3.51; 95% CI, 0.75-16.34), but not B-cell lymphoma (HR=0.97; 95% CI, 0.21-4.49).
Associations between LPM and villous atrophy, along with T-cell lymphoma and villous atrophy were more pronounced with subtotal or total atrophy (HR=3.96; 95% CI, 1.65-9.5 and HR=9.23; 95% CI, 1.66-51.34; respectively) than partial atrophy.
“The increased risk for LPM in CD may be affected by mucosal healing,” the researchers concluded. “This … is most pronounced among patients with persistent villous atrophy and is less pronounced among those with mucosal healing. These findings should prompt further evaluation of mucosal healing as a goal for patients with CD to reduce their risk for LPM.”
Disclosure: See the study for a full list of relevant financial disclosures.
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