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Risk for Lymphoma and the Results of Follow-up Gut Biopsies in Patients With Celiac Disease FREE

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The full report is titled “Mucosal Healing and Risk for Lymphoproliferative Malignancy in Celiac Disease. A Population-Based Cohort Study.” It is in the 6 August 2013 issue of Annals of Internal Medicine (volume 159, pages 169-175). The authors are B. Lebwohl, F. Granath, A. Ekbom, K.E. Smedby, J.A. Murray, A.I. Neugut, P.H.R. Green, and J.F. Ludvigsson.

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Ann Intern Med. 2013;159(3):I-20. doi:10.7326/0003-4819-159-3-201308060-00002
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What is the problem and what is known about it so far?

Celiac disease (CD) is an illness in which the body's immune system causes damage to the lining of the intestine (gut). It involves a reaction to gluten found in food. Patients may suffer abdominal pain and problems in many other organs and are at risk for cancer of the immune system (called lymphoproliferative malignancy or lymphoma). Eliminating all gluten from food is essential in patients with CD. If the disease is controlled, then the damage to the gut lining usually heals. Diagnosing CD involves a biopsy of the gut, and some patients have follow-up biopsies after they have had treatment to see if the disease has been controlled.

Why did the researchers do this particular study?

To see if the results of follow-up biopsies are associated with the risk for lymphoma in patients with CD.

Who was studied?

7625 patients with CD who had follow-up biopsy after initial diagnosis.

How was the study done?

Researchers collected reports of follow-up gut biopsies performed between 1969 and 2008 in patients with CD in Sweden. They then assessed whether patients whose follow-up biopsies showed ongoing damage to the gut lining had increased risk for lymphoma.

What did the researchers find?

In follow-up biopsies from 7625 patients, 43% had evidence of ongoing damage to the gut lining. Compared with the rest of the population in Sweden, patients with CD who had evidence of ongoing damage to the gut lining on follow-up biopsy had increased risk for lymphoma.

What were the limitations of the study?

The researchers did not have information on whether the patients having follow-up biopsies had followed a gluten-free diet, so they could not tell whether this was the cause of ongoing gut damage. Some of the follow-up biopsies might have been done because of new or ongoing symptoms, so whether the results are similar to what might be expected in patients whose symptoms have been controlled is not known.

What are the implications of the study?

Follow-up biopsies might be useful to help identify patients with CD at increased risk for lymphoma.





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