The new connection between celiac disease and lymphoma
Do you think you might be celiac or know someone who is? If so, new research may offer the impetuous to seek medical attention and to make sure you stick to that gluten-free diet. For those of you who may not be familiar with this serious autoimmune disease, celiac causes damage to the small intestine and can make sufferers quite ill. What’s more: it can put you at a higher risk for lymphoma, a cancer of the blood. The Annals of Internal Medicine study shows that risk may exist even in the absence of other symptoms.
Researchers from the Celiac Disease Center at Columbia University Medical Center (CUMC) studied 7,625 patients with celiac disease who underwent follow-up biopsies between 6 months and 5 years after their initial diagnosis. They found that the villi (hair-like cells in the small intestines that tend to be damaged during celiac flare-ups) in 57% of participants had healed on the follow-up biopsy, while the remaining 43% of patients still had damage, even when they reported strict adherence to a gluten-free diet.
"This is the first study that shows follow up biopsy results have a clear, meaningful impact on a patient's disease course and that not everyone has healing even if they feel quite well," says Benjamin Lebwohl, MD, MS, of the Celiac Disease Center at CUMC. "It seems to answer a longstanding question, which is: Does healing lower the risk of lymphoma?"
The answer: Yes, it does. All patients with celiac disease had an increased risk for lymphoma that was 2.8 times higher than that of the general (non-celiac) population. Among those with persistent villous atrophy, or villi that had not healed, the risk was 4.3 times higher, while those with healed intestines had a risk only 1.3 times higher than the normal population. In other words, if you're celiac is well-controlled enough to heal your intestines, your risk of lymphoma is not much higher than the general population.
"Breaking these results down shows it's crucial to track healing in a definitive manner," says Dr. Lebwohl. "A patient can have villi that is not healed and they don't realize it because there is not necessarily a correlation between healing and symptoms. You have to look under the microscope to see if there is damage."
At this time, says Dr. Lebwohl, there isn't much a person with celiac can do to minimize damage other than strictly adhering to a gluten-free diet. The take home message of this study is that a definitive diagnosis of damage via biopsy, as opposed to relying on reported symptoms, can more accurately detect damaged villi. This can help the medical provider to be alert for possible symptoms of lymphoma in celiac patients with persistent abnormalities of the small intestine.
And, for those who cheat on their gluten-free diet, it may be a wakeup call to treat their condition with the seriousness it deserves.
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Published August 2013, Prevention