Intestinal erosion points to lymphoma risk in celiac patients
By Joanna Lyford, Senior medwireNews Reporter
09 August 2013
Ann Intern Med 2013; 159: 169–175

medwireNews: The presence of persistent villous atrophy is a risk factor for lymphoproliferative malignancy (LPM) in people with celiac disease, a population-based cohort study suggests.

The finding supports the use of routine follow-up biopsies in celiac disease patients in order to identify those at high risk for developing lymphoma, say Jonas Ludvigsson (Örebro University Hospital, Sweden) and co-authors writing in the Annals of Internal Medicine.

The team obtained data on 7625 patients with celiac disease who had undergone an intestinal biopsy on average 1.3 years after the initial diagnosis. The patients’ median age was 25 years, 63% were female, and the frequency of persistent villous atrophy was 43%, report Ludvigsson et al.

The median duration of follow-up was 10.6 years, during which time 53 (0.7%) patients developed LPM, giving a standardized incidence ratio of 2.81. The median time to onset of lymphoma post-biopsy was 4.9 years.

In multivariate analysis, persistent villous atrophy on biopsy was significantly associated with the development of LPM, with an adjusted hazard ratio (HR) of 2.26 and an absolute excess risk of 57 cases per 100,000 person–years.

Interestingly, the increased risk was most pronounced in the first year after biopsy, with a HR of 3.67, and declined thereafter. This may be an effect of adopting a gluten-free diet, suggest the researchers.

Further analysis showed that the association between biopsy findings and lymphoma was consistent in men and women and stronger in older than younger patients. Also, persistent villous atrophy was associated with certain subtypes of LPM, namely, non-Hodgkin lymphoma (HR=2.82), T-cell lymphoma (HR=3.51), and unspecified non-Hodgkin lymphoma (HR=4.31) but not with B-cell lymphoma (HR=0.97).

Noting that the “strengths of this study include its population-based setting and the extensive follow-up time,” the team concludes: “These findings should prompt further evaluation of mucosal healing as a goal for patients with Celiac disease to reduce their risk for LPM.”

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

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