People suffering from celiac disease who have intestinal damage are at a higher risk of developing lymphoma, according to researchers at Columbia University.
Celiac disease is a common autoimmune disease described as damage to the lining of the small intestine from a reaction to eating gluten, found in products that contain wheat, barely and rye. The damage caused by celiac's disease effect's the body's ability to absorb components of common foods.
The findings were published in the Aug. 6, issue of Annals of Internal Medicine:
In this study, researchers identified patients with celiac disease who underwent a follow-up biopsy between 6 months and 5 years after their initial diagnosis; the median duration between celiac disease diagnosis and follow-up biopsy was 1.3 years. The patients were then followed for an average of 8.9 years after their follow-up biopsy. Of 7,625 patients with celiac disease, 4,317 (57 percent) had healed on the follow-up biopsy, while the remaining 3,308 patients (43 percent) had persistent villous atrophy.
The investigators found that overall, patients with celiac disease had an annual lymphoma risk of 67.9 per 100,000, a 2.81-fold increase compared with the general population risk of 24.2 per 100,000. Those with persistent villous atrophy had a larger annual risk: 102.4 per 100,000, compared with those with healed intestines, whose risk was 31.5 per 100,000. According to the authors, these findings support the end-point of mucosal healing as a goal for patients with celiac disease so as to reduce lymphoma risk.
"When a patient with celiac disease is initially diagnosed, intestinal biopsy shows flattening of villi, the long, fingerlike projections that normally absorb nutrients and fluid," the University said in a news release.
Those who have the disease experience symptom such as diarrhea, weight loss, and iron-deficiency anemia, result from damaged villi. Some physicians will have their patients undergo a follow-up biopsy to intestinal healing.
Researchers stated in a the news release they known for years that patients with celiac disease have an increased risk of lymphoma, but the intestinal healing and its timing affect that risk. There has not be confirmed link between healing on intestinal biopsy and clinical risk factors until now.
"Our study shows that celiac patients with persistent villous atrophy-as seen on follow-up biopsy-have an increased risk of lymphoma, while those with healed intestines have a risk that is significantly lower, approaching that of the general population," said study first author Benjamin Lebwohl, MD, MS, assistant professor of medicine, member of the Celiac Disease Center, and assistant professor of epidemiology at the Mailman School of Public Health, at CUMC, and a gastroenterologist at NewYork-Presbyterian/Columbia.
Lymphoma is a type of blood cancer that occurs when white blood cells (lymphocytes), which help protect the body from infection, divide faster than normal or surpass their typical life expectancy. The cancer can develop in the blood, bone marrow, lymph nodes, spleen, and other organs; Lymphoma may form tumors.
"Guidelines about routine follow-up biopsy are inconclusive, but this study may convince physicians that the follow-up biopsy can carry important prognostic information," Lebwohl said.