Malignant Complications of Celiac Disease

The complications of celiac disease can be divided into malignant and nonmalignant complications. In addition, the malignant complications of celiac disease are most commonly that of non-Hodgkin's lymphoma of a T cell variety. This particular tumor occurs in patients who have not been compliant with the diet or within 3 years of diagnosis. The risk of lymphoma or other malignancies appears to drop once a gluten-free diet has been instituted. While the relative risk of malignancy in celiac disease is greatly increased for specific diseases, the actual absolute risk is relatively small. The presentation of lymphomas in the small intestine can be acute with a surgical emergency such as obstruction, perforation, and bleeding, or gradual with insidious return or progress of severe malabsorptive symptoms, often associated with hypoalbuminemia and severe weight loss and malnutrition. The treatment for lymphoma is often unsuccessful. Those patients presenting acutely and managed surgically appear to do better than those who have a slow insidious onset. Occasional cases of response to stem cell transplantation have been reported.

The second most common malignancy occurring in celiac disease is that of adenocarcinoma of the small intestine. This adenocarcinoma seems to occur in the setting of the chronic inflammation of celiac disease. It is associated with defects and mismatch repair and whilst this is an unusual tumor, the survival with aggressive surgical therapy may be better than that for small bowel adenocarcinomas that occur sporadically. Usually, these patients present with iron deficiency anemia, gastrointestinal bleeding, obstruction, or pain. Other malignancies such as eso-phageal cancer or melanoma are increased in frequency in celiac disease, though again the absolute risk is low. Some recent evidence suggests that risk of breast cancer may be reduced in patients with celiac disease, though this is yet to be confirmed.

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Gluten Free Living Secrets

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