Lack of mucosal healing in celiac disease linked with increased risk of lymphoma

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1. Persistent villous atrophy identified on follow-up biopsy for patients with Celiac Disease was associated with an increased risk for lymphoproliferative malignancy. 

Evidence Rating Level: 2 (Good) 

Study Rundown: The increased risk of developing lymphoproliferative malignancy (LPM) in patients with Celiac Disease (CD) has been well established in prior studies.   This study suggested that the presence of persistent villous atrophy on follow-up biopsy in patients with CD is associated with a greater risk of lymphoproliferative malignancy compared to those patients whose biopsies showed mucosal healing.  A key major limitation of this study was the failure to assess and compare adherence to gluten-free diet adherence prior to follow up biopsy.  Results of this study suggest that performing follow-up biopsies in patients with CD may help identify those at higher risk of developing LPM.

Click to read the study, published today in the Annals of Internal Medicine

Relevant Reading: Risk of lymphoproliferative malignancy in relation to small intestinal histopathology among patients with celiac disease

In-Depth [retrospective cohort study]: This Swedish study included biopsy results from pathology reports for 7625 patients with CD who had follow-up intestinal biopsies performed between 6 months and 5 years after their initial diagnostic biopsy. The authors used standardized incidence ratios (SIRs) and Cox regression to compare the risk of developing LPM in patients who demonstrated mucosal healing on their follow-up biopsies to those who had persistent villous atrophy. The association of persistent villous atrophy with LPM was stratified by sex, age, and year of follow-up biopsy.

In the study cohort, 0.7% of patients developed LPM, which represented an increased risk compared to the general population. Persistent villous atrophy on follow up biopsy was associated with an increased risk for LPM compared with patients with mucosal healing (HR 2.26 [CI, 1.08 to 4.12], p=0.015). Subgroup analysis showed that this association was stronger in patients older than 60 years at the time of follow-up biopsy (HR 2.41 [CI 0.97 to 5.97]) but was not significant for patients who had follow-up biopsies in the years after 2000. Furthermore, there was a dose-response relationship whereby degree of villous atrophy (partial, subtotal, or total) was associated with a progressive increase in risk for LPM.

By Sarah Chuzi and Aimee Li, MD

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