Celiac Disease and Malignancy: An Audit

Introduction: Celiac disease is associated with increased risk of malignancies, particularly gastrointestinal lymphoma and carcinoma.

Aim: To investigate the incidence of malignancy in patients with celiac disease in a small general hospital and the relationship to age at that time of presentation of the celiac disease.

Results: We identified 77 patients with celiac disease over the past 10 years via the HIPE system. Review of the clinical records revealed 3 small bowel malignancies (1 lymphoma, 2 adenocarcinoma), 2 esophageal carcinomas, 1 colorectal cancer, 1 myeloma, 1 breast cancer and 1 basal cell carcinoma of the skin. All 3 patients with small bowel malignancies were diagnosed with celiac disease late in life (≥50 years of age); and had positive celiac serology. This represented 10% of patients presenting with 'late-onset' celiac disease (3 of 30). In 2 patients(1 lymphoma 1adenocarcinoma), the malignancy was probably present at the time of initial diagnosis. Small bowel malignancy was difficult to diagnose, requiring multiple radiological investigations and biopsies to make the diagnosis. The1 patient with refractory celiac disease remains free of malignant disease.

Conclusion: In this study, we found that 'late-onset' celiac disease is associated with high risk of small bowel malignancies (10%). There is also significant incidence of the malignancy and celiac disease presenting at the same time in this cohort. The diagnosis of small bowel malignancy can be difficult and may require multiple investigations.