Colorectal Cancer in Biopsy-defined Celiac Disease Seen over 30 Years: Rare, Even in Elderly Adults

Hugh J. Freeman^1,

¹Department of Medicine (Gastroenterology), University of British Columbia, Vancouver, British Columbia, Canada

Cite this paper:
Hugh J. Freeman. Colorectal Cancer in Biopsy-defined Celiac Disease Seen over 30 Years: Rare, Even in Elderly Adults. International Journal of Celiac Disease. 2021; 9(3):93-95. doi: 10.12691/ijcd-9-3-5

Abstract

Some malignant disorders, including colorectal cancer (CRC), may be reduced in celiac disease. In this study, 154 older adults, including elderly adults over age 60 years, were seen over 30 years. All patients were biopsy-defined and treated with a gluten-free diet. A single elderly female had an early stage colon cancer in the cecum but a persistent iron deficiency anemia led to later detection of biopsy-defined celiac disease and a gluten-free diet mucosal response. This study indicates that colon cancer is rare in biopsy-defined celiac disease. In this study, there were no gastric, pancreatic or hepato-biliary tract cancers seen. Genetic and environmental dietary factors may play a role, however, the rarity of colorectal cancer in other celiac-associated colonic diseases (eg., collagenous or lymphocytic colitis) suggests that an immune-mediated protective effect may occur.

Keywords:
colorectal cancer celiac disease cancer prevention elderly celiac disease

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References:

[1]	Zauber AG, Winawer SJ, O’Brien MJ, Lansdorp-Vogelaar I, van Bellegoijen M, Hankey BF, Weiji B, Bond JH, Schapiro M, Panish JF, Stewart ET, Waye JD. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366: 687-696.
[2]	Freeman HJ. Natural history and long-term outcome of patients treated for early stage colorectal cancer. Can J Gastroenterol 2013; 27: 409-413.
[3]	Gardiner GW, Goldberg R, Currie D, Murray D. Colonic carcinoma associated with an abnormal collagen table. Collagenous colitis. Cancer 1984; 54: 2973-2977.
[4]	Alikhan M, Cummings OW, Rex D. Subtotal colectomy in a patient with collagenous colitis associated with colon carcinoma and systemic lupus erythematosis. Am J Gastroenterol 1997; 92: 1213-1215.
[5]	Chan JL, Tersmette AC, Offerhaus GI, Gruber SB, Bayless TM, Giardiello FM. Cancer risk in collagenous colitis. Inflamm Bowel Dis 1999; 5: 40-43.
[6]	Freeman HJ, Berean KW. Resolution of paraneoplastic collagenous enterocolitis after resection of colon cancer. Can J Gastroenterol 2006; 20: 357-360.
[7]	Tangri V, Driman DK, Chande N. Latent lymphocytic enterocolitis associated with celiac disease manifesting after resection of colon cancer: case report and review of the literature. Can J Gastroenterol 2008; 22: 771-773.
[8]	Freeman HJ. Collagenous colitis as the presenting feature of biopsy-defined celiac disease. J Clin Gastroenterol 2004; 38: 664-668.
[9]	Wolber R, Owen D, Freeman HJ. Colonic lymphocytosis in patients with celiac sprue. Hum Pathol 1990; 21: 1092-1096.
[10]	Freeman HJ. Collagenous mucosal inflammatory disorders of the gastrointestinal tract. Gastroenterology 2005; 129: 321-333.
[11]	Lewin KJ, Riddell RH, Weinstein WM. Chapter 20. Small bowel mucosal disease. In: Gastrointestinal Pathology and its Clinical Implications. Volume 2. Igaku-Shoin, Tokyo. 1992; 750-811.
[12]	Gujral N, Freeman HJ, Thomson AB. Celiac disease: prevalence, pathogenesis and treatment. World J Gastroenterol 2012; 18: 6036-6059.
[13]	Freeman HJ. Pearls and pitfalls in the diagnosis of adult celiac disease. Can J Gastroenterol 2008; 22: 273-280.
[14]	Freeman HJ. Mucosal recovery and mucosal healing in biopsy-defined adult celiac disease. Inter J Celiac Dis 2017; 5: 14-18.
[15]	Schmidt E, Smyrk TC, Faubion WA, Oxentenko AS. Duodenal intraepithelial lymphocytosis with normal villus architecture in pediatric patients, 2000-2009: the Mayo Clinic experience. J Pediatr Gastroenterol Nutr 2013; 56; 51-55.
[16]	Kakar S, Nehra V, Murray JA, Dayharsh GA, Burgart LJ. Significance of intraepithelial lymphocytosis in small bowel biopsy samples with normal mucosal architecture. Am J Gastroenterol 2003; 98: 2027-2033.
[17]	Freeman HJ, Webber D. Ileal intra-epithelial lymphocytosis: a pathological clue to clinically occult adult celiac disease. Inter J Celiac Dis 2017; 5: 40-42.
[18]	Freeman HJ, Lemoyne M, Pare P. Celiac disease in the elderly. Best Pract Res Clin Gastroenterol 2002; 16: 37-49.
[19]	Freeman HJ. Adult celiac disease in the elderly. World J Gastroenterol 2008; 14: 6911-6914.
[20]	Freeman HJ. Anemia in celiac disease; presentation with iron deficiency anemia masked by colon cancer. Inter J Celiac Dis 2015; 3: 33-36.
[21]	Dickey W. Colon neoplasia co-existing with celiac disease in older patients: coincidental, probably; important, certainly. Scans J Gastroenterol 2002; 37 1054-1056.
[22]	Pereyra L, Gonzalez R, Mohaidle A, Fischer C, Mella JM, Panigadi GN, Manazzoni D, Matoso MD, Lasa JS, Novillo A, De Paula J, Soifer L, Nadales A, Cimmino DG, Pedreira S, Boerr L. Risk of colorectal neoplasia in patients with celiac disease: a multicenter study. J Crohn’s Colitis 2013; 7: e672-e677.
[23]	Iles T, Kaukinen K, Virta LJ, Pukkala E, Collin P. Incidence of malignancies in diagnosed celiac patients: a population-based estimate. Am J Gastroenterol 2014; 109: 1471-1477.
[24]	Volta U, Vincentini O, Quintarelli F, Felli C, Salano M. Low risk of colon cancer in patients with celiac disease. Scans J Gastroenterol 2014; 49: 564-568.
[25]	Freeman HJ. Lymphoproliferative and intestinal malignancies in 214 patients with biopsy-defined celiac disease. J Clin Gastroenterol 2004; 38: 429-434.
[26]	Akobeng AK, Singh P, Kumar M, Al Khodor S. Role of the gut microbiota in the pathogenesis of celiac disease and potential therapeutic implications. Our J Nutr 2020; 59: 3369-3390.
[27]	Buscunan KA, Araya M, Roncoroni L, Doneda L, Eeli L. Dietary gluten as a conditioning factor of the gut microbiota in celiac disease. Adv Nutr 2020; 11: 160-174.
[28]	Loke YL, Chew MT, Ngeow YF, Lim WW, Per SC. Front Cell Infect Microbiol 2020; 10: 603086.