Gut Feeling About Cancer

Celiac disease patients with persistent intestine damage had higher lymphoma risk

(RxWiki News) In patients with celiac disease, the immune system attacks the patient's own body and causes damage to the lining of the gut. The disease has been linked to a higher risk of lymphoma, a type of blood cancer.

In lymphoma, white blood cells become cancerous, divide faster than normal and do not function properly. The exact reason for this link between celiac disease and lymphoma is unknown but some scientists believe it could be due to intestinal damage.

A recent study found that celiac disease patients whose intestines had healed had a lower risk of developing lymphoma as compared to those who had persistent damage in their intestines.

According to one of the study's authors, past research has shown that patients who strictly follow a gluten-free diet may have a better chance of healing their intestines than patients who don't follow such a strict diet. Gluten is a substance found in wheat, barely and rye.

"Ask your doctor about dietary changes and treatment for celiac disease"

This study was conducted by Benjamin Lebwohl, MD, MS, assistant professor of medicine at the Mailman School of Public Health at Columbia University Medical Center, and his colleagues.

The aim of this study was to find out the risk of developing lymphoma in celiac disease patients whose intestines had not healed.

On biopsy (removal of a tissue sample) of the gut, celiac disease patients usually have flattening of villi, the long finger shaped projections in the intestine that help absorb nutrients from food. The damage usually occurs due to a reaction to gluten.

Patients with celiac disease usually experience diarrhea, weight loss and anemia due to poor digestion. A gluten-free diet can help lessen these symptoms and limit complications. A gluten-free diet avoids products containing wheat, barley, and rye, including breads, cakes, cookies, pastas and cereals. When in doubt, patients can look for a gluten-free label on the food item.

"We have known for many years that patients with celiac disease have an increased risk of lymphoma, but we did not know whether intestinal healing and its timing affect that risk," said Dr. Lebwohl in a press statement.

The researchers looked at 7,625 celiac disease patients who underwent a follow-up biopsy after they were diagnosed with celiac disease. Of these patients, 4,317 showed healed villi on biopsy, whereas the remaining 3,308 patients showed persistent damage of their villi.

The researchers then followed these patients for around nine years to see if they developed lymphoma.

On analysis of the data, the researchers found that patients with celiac disease had an overall higher chance of developing lymphoma (67.9 lymphoma cases per 100,000 population) each year as compared to the general population (24.2 lymphoma cases per 100,000 population).

Among those with villi damage on follow-up biopsy, patients with persistent damage to their villi had a higher risk (102.4 lymphoma cases per 100,000 population) as compared to those whose intestines had healed (31.5 lymphoma cases per 100,000 population).

According to the study's authors, these findings may mean that the healing of the intestine is an important treatment goal for patients with celiac disease in order to decrease the risk of developing lymphoma.

"We know from prior studies that healing is more likely among patients who report strict adherence to the gluten-free diet, compared with those who admit to less-than-strict dietary habits," Dr. Lebwohl said. But since the researchers found that persistent villi damage was seen even when a strict gluten-free diet was followed, there may be other factors that affect healing.

"Our findings linking the follow-up biopsy result to lymphoma risk will lead us to redouble our efforts to better understand intestinal healing and how to achieve it," Dr. Lebwohl said.

The results of this study were published in the August 6 issue of the Annals of Internal Medicine.

The study was funded by grants from the National Institutes of Health, the American Scandinavian Foundation, the Celiac Sprue Association, Örebro University Hospital, Karolinska Institutet, the Swedish Society of Medicine, the Swedish Research Council, the Swedish Celiac Society and the Stockholm County Council.

Review Date: 
August 5, 2013