Poor Celiac Disease Control May Up Lymphoma Risk.( Ref Medscape)

In patients with celiac disease (CD), persistent villous atrophy may be associated with certain types of lymphoma, according to the findings of a population-based cohort study. One expert says the new results will change how he manages patients with CD.

In the study, the researchers collected data from 28 pathology departments in Sweden, analyzing biopsy reports for 7625 patients with CD who underwent a follow-up biopsy after the initial diagnosis. They identified 3308 patients with persistent intestinal damage.

In multivariate analysis adjusted for age at follow-up biopsy, sex, duration of CD at the time of follow-up biopsy, year of follow-up biopsy, and education, patients with persistent villous atrophy continued to have a greater risk for Lympho Proliferative malignancy than those with mucosal healing. In addition, persistent villous atrophy was linked to a higher risk for non-Hodgkin lymphoma.

“We conclude that the increased risk for LPM in CD may be affected by mucosal healing,” the authors write. “These findings should prompt further evaluation of mucosal healing as a goal for patients with CD to reduce their risk for LPM.”

“As a clinician and practising gastroenterologist, this study will alter my practice,” David S Sanders, MD, MBChB, FRCP, from the Royal Hallamshire Hospital and the University of Sheffield in the United Kingdom, told Medscape Medical News by email. “For some time, a second or follow-up duodenal biopsy has not been undertaken by many clinicians internationally. This study reasserts the importance of a second-look biopsy to ensure histological remission.”