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Celiac Disease and Cancer

The incidence of certain types of cancer is increased among patients with CD. These include non-Hodgkin’s lymphomas (NHL) at any site, enteropathy-associated T-cell lymphoma (EATL) (a rare, high-grade T-cell non- Hodgkin’s lymphoma of the small intestine), for which the outlook is poor, small intestine adenocarcinoma and esophageal and oropharyngeal carcinomas.

 In one large cohort study performed on 4732 celiac disease patients compared with 23 620 matched controls, the authors found in CD, an increased RR factor for mortality of 1.39 with a 95% CI (1.13-1.51) and for malignancy of 1.29, CI-95% (1.06-1.55). The mechanisms responsible for the development of malignancies in celiac disease patients are not known.

The following explanations have been suggested: increased intestinal permeability of environmental carcinogens, chronic inflammation, chronic antigen stimulation, release of pro-inflammatory cytokines, immune surveillance problems and nutritional defi ciencies caused by the disease or the GFD.

Celiac disease is clearly associated with a definite increase in the risk of developing cancer, especially EATL and other gastrointestinal cancers that are partially responsible for the overall increased mortality reported in these patients. However, the magnitude of the overall risk for NHL is much lower than previously thought, with a relative risk most probably ranging between 2 and 4. Strict adherence to a gluten-free diet seems to protect against the development of some types of cancer.

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