Adenocarcinoma in the Small Intestine in Celiac Disease over more than 30-years

Hugh J. Freeman^1,

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

Cite this paper:
Hugh J. Freeman. Adenocarcinoma in the Small Intestine in Celiac Disease over more than 30-years. International Journal of Celiac Disease. 2023; 11(1):19-22. doi: 10.12691/ijcd-11-1-4

Abstract

A variety of malignancies may complicate the clinical course of adult celiac disease. In a cohort of 154 patients with celiac disease (55 males, 99 females, aged over 30 years) also defined by a single case of cecal cancer, 4 males were observed to have small bowel adenocarcinoma in the duodenum or jejunum during a period of more than 30 years. This far exceeded the cumulative rate for this cancer in the background population (8.6 males per 100,000 over 10 years) indicating that patients with celiac disease, even after treatment with a gluten-free diet, remain at risk for development of small intestinal adenocarcinoma.

Keywords:
small bowel cancer epithelial carcinogenesis celiac disease gluten-free diet

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References:

[1]	Harris OD, Cooke WT, Thompson H, Waterhouse JA. Malignancy in adult celiac disease and idiopathic steatorrhea. Am J Med 1967; 42: 899-912.
[2]	Cooper BT, Holmes GK, Ferguson R, Cooke WT, Celiac disease and malignancy. Medicine 1980; 59: 249-261.
[3]	Freeman HJ. Lymphoproliferative and intestinal malignancies in 214 patients with biopsy-defined celiac disease. J Clin Gastroenterol 2004; 38: 429-434.
[4]	Freeman HJ, Weinstein WM, Shnitka TK, Piercey JR, Wensel RH. Primary abdominal lymphoma: presenting manifestation of celiac sprue or complicating dermatitis herpetiformis. Am J Med 1977; 63: 585-594.
[5]	Freeman HJ. Fulminant liver failure with necrotizing foci in the liver, spleen and lymph nodes in celiac disease due to malignant lymphoma. Can J Gastroenterol 1996; 10: 225-229.
[6]	Askling J, Linet M, Gridley G, Halstensen TS, Ekstrom K, Ekbom A. Cancer incidence in a population-based cohort of individuals hospitalized with celiac disease or dermatitis herpetiformis. Gastroenterol 2002; 123: 1428-1435.
[7]	Emilsson L, Semrad C, Lebwohl B, Green PH, Ludvigsson JF. Risk of small bowel adenocarcinoma, adenomas, and carcinoids in a nationwide cohort of individuals with celiac disease. Gastroenterology 2020; 159: 1686-1694.
[8]	Freeman HJ. Colorectal cancer in biopsy-defined celiac disease seen over 30 years: rare, even in elderly adults. Inter J Celiac Dis 2021; 9: 93-95.
[9]	Freeman HJ. Mucosal recovery and mucosal healing in biopsy-defined celiac disease. Inter J Celiac Dis 2017; 5: 14-18.
[10]	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.
[11]	Freeman HJ. Occult celiac disease in an octogenarian presenting with a small intestinal adenocarcinoma. Can J Gastroenterol 1994; 8: 354-357.
[12]	Case records of the Massachusetts General Hospital (44362). N Engl J Med 1958; 259:491-495.
[13]	Pelizzaro F, Marsilio I, Fassan M, Piazza F, Barber B, D’Odorico A, Sabatino EV, Farinati F, Zingone F. The risk of malignancies in celiac disease—a literature review. Cancers 2021; 13: 5288.
[14]	Girdwood RH, Delamore IW, Williams AW. Jejunal biopsy in malaborption disorders of the adult. Br Med J 1961; 1: 319-323.
[15]	Dannenberg A, Godwin T, Rayburn J, Goldin H, Leonard M. Multifocal adenocarcinoma of the proximal small intestine in a patient with celiac sprue. J Clin Gastroenterol 1989; 11: 73-76.
[16]	Brunt PW, Sircus W, MacLean N. Neoplasia and the celiac syndrome in adults. Lancet 1969; I: 180-184.
[17]	Barry RE, Read AE. Celiac disease and malignancy. Q J Med 1973; 42: 665-675.
[18]	Gilat T, Fischel B, Danon J, Loewenthal M. Morphology of small bowel mucosa in malignancy. Digestion 1973; 7: 147-155.