For People With Celiac, Persistent Intestinal Damage Linked With Lymphoma Risk

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CELIAC DISEASE
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Here's another big reason for people with celiac disease to stay away from gluten. A new study suggests that for those with the autoimmune disorder, persistent damage to the intestines raises the risk of the blood cancer lymphoma.

When a person has celiac disease, his or her immune system is triggered in response to gluten, which is found in wheat and other grains. The immune system response leads to inflammation that damages the lining of the small intestines. Researchers noted that when intestinal biopsies are taken when a person is first diagnosed with celiac disease, they show villi -- which are the projections off the small intestines that absorb nutrients -- that are flattened, a phenomenon otherwise known as villous atrophy. By conducting follow-up biopsies of people with celiac disease, doctors can see whether dietary changes -- like elimination of gluten -- has helped to heal the small intestines.

"Our study shows that celiac patients with persistent villous atrophy -- as seen on follow-up biopsy -- have an increased risk of lymphoma, while those with healed intestines have a risk that is significantly lower, approaching that of the general population," study researcher Benjamin Lebwohl, M.D., assistant professor of medicine and member of the Celiac Disease Center at Columbia University Medical Center, said in a statement.

The findings, published in the Annals of Internal Medicine, are based on data from 7,625 people with celiac disease. Everyone in the study had undergone a follow-up biopsy anywhere from six months to five years after their initial diagnostic biopsy (on average, they had the follow-up biopsy 1.3 years after being initially diagnosed). Then, researchers followed the participants an average of 8.9 years after the follow-up biopsy.

At the end of the follow-up period, 57 percent of the participants' small intestines had healed, while 43 percent still had persistent villous atrophy.

Researchers found that in general, people with celiac disease have a 2.81-fold increased risk of developing lymphoma in a year, compared with the general population. But they also found an association between ongoing damage to the small intestines and lymphoma risk: Those with persistent villous atrophy had a much higher risk -- 102.4 out of 100,000 -- than those with healed small intestines -- 31.5 out of 100,000.

However, they noted that even some people who strictly adhered to a gluten-free diet still experienced the persistent villous atrophy, which they said means other factors aside from simply a gluten-free diet might be at play. "Our findings linking the follow-up biopsy result to lymphoma risk will lead us to redouble our efforts to better understand intestinal healing and how to achieve it," Lebwohl said in the statement.

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