People who have poorly controlled celiac disease may have a higher risk of developing lymphoma, according to a study published in the journal Annals of Internal Medicine.
Researchers from Sweden carried out a population-based cohort study of 7,625 patients with celiac disease (CD) between 2006 and 2008. The study looked at patients who had a follow-up biopsy of the gut after their initial diagnosis.
Data of patient's biopsies was collected from 28 of Sweden's pathology departments, conducted between 1969 to 2008.
Researchers say that previous studies have already shown there is an increased risk of lymphoma in patients suffering from celiac disease, but the reason is unknown. However, it has been suggested that mucosal healing - the treatment of CD through a gluten-free diet - could be a contributor.
The researchers looked at the risk of lymphoproliferative malignancy (LPM) in patients who had CD with persistent villous atrophy - this is the erosion of villi in the intestines, which impairs the body's ability to take in nutrients from food. The follow-up biopsies revealed that 43% of the patients suffered from this.
These patients were compared to those with diet-controlled mucosal healing - CD that has responded to a gluten-free diet, as well as lymphoma risk in patients without the disease.
Results of the study revealed that CD patients suffering from persistent villous atrophy had an increased risk of lymphoma compared with the general population and CD patients who demonstrated mucosal healing.
The study authors explain:
"The risk was heightened among those with persistent villous atrophy but was less prominent and did not meet statistical significance among those with mucosal healing.
Compared with patients with mucosal healing, those with persistent villous atrophy had an increased risk for LPM."
The authors add that the increased risk was most prominent in the first year after the follow-up biopsy, and was less prominent the following 4 years. But there was no sign of a dramatically reduced risk when compared to the risk of the general population.
The researchers add:
"This phenomenon has several potential explanations. Many studies of morbidity and mortality associated with CD have found that the increased risk diminishes toward the null over time, and this has been attributed to the effect of a gluten-free diet.
The risk for LPM in patients with CD also lessens with time, although it remains significantly elevated compared with that of the general population in the long term."
The researchers conclude that increased risk of lymphoma in patients with CD may be affected by mucosal healing, adding:
"This frequently reported increased risk is most pronounced among patients with persistent villous atrophy and is less pronounced among those with mucosal healing.
These findings should prompt further evaluation of mucosal healing as a goal for patients with CD to reduce their risk for LPM."