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David Sanders - One of the best experts on this subject based on the ideXlab platform.
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Non-Responsive Coeliac Disease: A Comprehensive Review from the NHS England National Centre for Refractory Coeliac Disease
Nutrients, 2020Co-Authors: Hugo A Penny, Elisabeth Mr Baggus, Anupam Rej, John A. Snowden, David SandersAbstract:Coeliac Disease is a common small intestinal enteropathy which manifests following ingestion of gluten in genetically susceptible individuals. Since gluten was identified as the driving factor in Coeliac Disease, the gluten-free diet (GFD) has remained the mainstay of treatment. While most individuals will display improvement in symptoms and signs of Coeliac Disease following institution of the GFD, up to 30% will continue to experience symptoms and/or have persisting intestinal inflammation. These individuals can be classified as having non-responsive Coeliac Disease (NRCD), which may be associated with dietary indiscretion, slow healing, refractory Coeliac Disease, and/or an alternative condition. The purpose of this review is to provide an overview of the causes of NRCD in adults, highlight a systematic approach to investigate these patients, and appraise the latest management aspects of this subset of Coeliac Disease.
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Coeliac Disease: review of diagnosis and management.
The Medical journal of Australia, 2017Co-Authors: Marjorie M. Walker, Jonas F. Ludvigsson, David SandersAbstract:Coeliac Disease is an immune-mediated systemic Disease triggered by exposure to gluten, and manifested by small intestinal enteropathy and gastrointestinal and extra-intestinal symptoms. Recent guidelines recommend a concerted use of clear definitions of the Disease. In Australia, the most recent estimated prevalence is 1.2% in adult men (1:86) and 1.9% in adult women (1:52). Active case finding is appropriate to diagnose Coeliac Disease in high risk groups. Diagnosis of Coeliac Disease is important to prevent nutritional deficiency and long term risk of gastrointestinal malignancy. The diagnosis of Coeliac Disease depends on clinico-pathological correlation: history, presence of antitransglutaminase antibodies, and characteristic histological features on duodenal biopsy (when the patient is on a gluten-containing diet). Human leucocyte antigen class II haplotypes DQ2 or DQ8 are found in nearly all patients with Coeliac Disease, but are highly prevalent in the general population at large (56% in Australia) and testing can only exclude Coeliac Disease for individuals with non-permissive haplotypes. Adhering to a gluten free diet allows duodenal mucosal healing and alleviates symptoms. Patients should be followed up with a yearly review of dietary adherence and a health check. Non-Coeliac gluten or wheat protein sensitivity is a syndrome characterised by both gastrointestinal and extra-intestinal symptoms related to the ingestion of gluten and possibly other wheat proteins in people who do not have Coeliac Disease or wheat allergy recognised by diagnostic tests.
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Emerging drugs for Coeliac Disease
Expert opinion on emerging drugs, 2014Co-Authors: Peter D. Mooney, Marios Hadjivassiliou, David SandersAbstract:Introduction: Coeliac Disease is an autoimmune gluten sensitive enteropathy and is now known to affect 1% of the adult population. A gluten-free diet (GFD) should be curative; however, up to 30% of patients have persistent symptoms and many patients find the diet difficult to fully adhere to. Currently, there are no licensed therapeutic options for patients with Coeliac Disease outside of a GFD.Areas covered: This review will outline the case for alternative treatments and discuss the potential therapeutic targets. The products in the most advanced stage of development will be discussed in detail.Expert opinion: There is clearly an unmet need for alternatives to a GFD for the treatment of Coeliac Disease. Oral glutenase supplements to improve the degradation of gluten into non-toxic peptides appear to be the most likely to provide a breakthrough in the treatment of Coeliac Disease; however, other modalities such as a therapeutic vaccine or zonulin inhibitors to reduce intestinal permeability have shown pr...
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Treatment Failure in Coeliac Disease: A Practical Guide to Investigation and Treatment of Non-responsive and Refractory Coeliac Disease
Journal of gastrointestinal and liver diseases : JGLD, 2012Co-Authors: Peter D. Mooney, Kate E Evans, Salil Singh, David SandersAbstract:Coeliac Disease is a common condition affecting up to 1% of the European adult population. Whilst the majority of patients will respond to a gluten free diet with resolution of symptoms and an improvement in histology, a significant minority have persistent problems. Refractory Coeliac Disease is a relatively uncommon cause of non-response to gluten free diet with potentially serious consequences of severe malabsorption and a high rate of progression to lymphoma. This review provides a practical guide to the investigation of patients who do not respond to a gluten free diet. We will highlight the differences between the more common non-responsive Coeliac Disease and the rare entity of refractory Coeliac Disease and discuss current management and treatment options for both non-responsive Coeliac Disease and refractory Coeliac Disease.
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Meta-analysis: Coeliac Disease and hypertransaminasaemia.
Alimentary pharmacology & therapeutics, 2011Co-Authors: Anita Sainsbury, David Sanders, Alexander C. FordAbstract:Aliment Pharmacol Ther 2011; 34: 33–40 Summary Background There may be a positive association between Coeliac Disease and serum hypertransaminasaemia but evidence is conflicting. Aims To conduct a systematic review and meta-analysis to determine the prevalence of Coeliac Disease in adults presenting with cryptogenic serum hypertransaminasaemia and the prevalence of hypertransaminasaemia in patients with newly diagnosed Coeliac Disease. Methods MEDLINE and EMBASE were searched up to August 2010. Case series and case–control studies recruiting adults with either cryptogenic hypertransaminasaemia that applied serological tests for Coeliac Disease and/or distal duodenal biopsy to participants or newly diagnosed biopsy-proven Coeliac Disease that assessed serum transaminases were eligible. The pooled prevalence of Coeliac Disease in individuals presenting with abnormal serum transaminases and the pooled prevalence of hypertransaminasaemia in newly diagnosed Coeliac Disease were calculated with 95% confidence intervals (CI). Results Eleven eligible studies were identified. Pooled prevalences of positive Coeliac serology and biopsy-proven Coeliac Disease in cryptogenic hypertransaminasaemia were 6% (95% CI 3% to 10%) and 4% (95% CI 1% to 7%) respectively. Pooled prevalence of abnormal serum transaminases in newly diagnosed Coeliac Disease was 27% (95% CI 13% to 44%). Exclusion of gluten led to normalisation of serum transaminase levels in 63% to 90% of patients within 1 year. Conclusions Undetected Coeliac Disease is a potential cause for cryptogenic hypertransaminasaemia in 3% to 4% of cases. More than 20% of individuals with newly diagnosed Coeliac Disease may have abnormal serum transaminases and these normalise on a gluten-free diet in the majority of cases.
Geoffrey K.t. Holmes - One of the best experts on this subject based on the ideXlab platform.
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Coeliac Disease and malignancy
Digestive and Liver Disease, 2002Co-Authors: Geoffrey K.t. HolmesAbstract:The development of malignancy, particularly lymphoma, is the most serious complication to affect patients with Coeliac Disease. Although the association has been known for about 40 years, there are still gaps in our understanding. The prevalence of lymphoma and why only some Coeliac patients develop this are not clear but environmental and genetic factors must be at work. Based on data from a large Coeliac clinic in Derby, about 55 lymphomas per year would arise in the Coeliac population of the United Kingdom, of which half would affect the small bowel. Whether patients with Coeliac Disease who have atypical or no symptoms at diagnosis, are at the same risk as those who are diagnosed as a result of classical symptoms as was more the case in the past, is not known. Some patients, however, do have Coeliac Disease and lymphoma diagnosed at the same presentation. This consideration has implications for initiating screening programmes to detect Coeliac Disease and thus offer patients a gluten-free diet early that would help to reduce the risk of lymphoma from developing. In this context, case-finding rather than blanket population screening is to be recommended on present evidence. Research into the role of intraepithelial lymphocytes in the genesis of lymphoma has indicated that non-responsive Coeliac Disease (refractory sprue) and ulcerative jejunoileitis (ulcerative jejunitis) are part of the lymphoma spectrum. The diagnosis of lymphoma can be difficult and the prognosis, in general, is poor, although with modern chemotherapeutic regimes and surgery in selected cases, long-term survival is possible. The best option is to try and prevent lymphoma from arising by advising all patients to adhere to a strict gluten-free diet. Malignant complications of Coeliac Disease are uncommon but will continue to challenge clinicians and clinical scientists. Unravelling the mechanisms that contribute to the development of lymphoma and other tumours in Coeliac Disease may well contribute to a wider understanding of oncogenesis.
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Potential and latent Coeliac Disease.
European Journal of Gastroenterology & Hepatology, 2001Co-Authors: Geoffrey K.t. HolmesAbstract:This case report details a child with Coeliac Disease and giardiasis. Treatment of the infection without recourse to a gluten-free diet cured the symptoms of diarrhoea and returned the small intestinal morphology to normal. Thus, the patient moved from active to latent Coeliac Disease. Potential and latent forms of Coeliac Disease are being increasingly recognized, since markers have become available to identify patients and investigations developed to test for gluten sensitivity in the small intestinal mucosa. This case provides an opportunity to consider potential and latent forms of Coeliac Disease and how these impact on clinical practice and the wider understanding of the disorder.
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Coeliac Disease in the elderly.
Gut, 1994Co-Authors: G L Hankey, Geoffrey K.t. HolmesAbstract:Of 228 patients with adult Coeliac Disease, 42 (19%) were diagnosed aged 60 years or over. In this series, of 35 patients who did not have dermatitis herpetiformis, 15 had attended family doctors and hospital outpatient departments for an average of 28 years with unexplained symptoms or abnormalities in blood tests but the diagnosis of Coeliac Disease had been missed. This is unsatisfactory because these patients can both manage and respond to a gluten free diet. Thirty eight patients complied strictly with the diet with resolution of symptoms. Significant improvement in weight, haemoglobin, albumin, calcium, and alkaline phosphatase values after a year on the diet also occurred. Clinicians should be alert to the possibility of Coeliac Disease in the elderly particularly in patients with non-specific complaints in the presence of unexplained anaemia.
Katri Kaukinen - One of the best experts on this subject based on the ideXlab platform.
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Updates on systemic consequences of Coeliac Disease
Nature Reviews Gastroenterology & Hepatology, 2020Co-Authors: Katri KaukinenAbstract:Patients with Coeliac Disease have cognitive defects, signs of worsened mental health and evidence of white matter damage in the brain compared with matched controls^ 2 . Despite improved diagnostics and treatment of Coeliac Disease, diagnosed Coeliac Disease is still associated with increased mortality risk compared with control population, and the increased risk persists beyond 10 years after diagnosis. The risk of death is especially related to cancer and cardiovascular and respiratory Diseases^ 4 . Undiagnosed and therefore untreated Coeliac Disease can have serious long-term health consequences: individuals with untreated Disease have been found to have an increased risk of cardiovascular Diseases and cancers that can occur outside the gastrointestinal tract^ 8 . Important studies published in 2020 highlight that Coeliac Disease is a systemic autoimmune-like disorder with the potential to result in serious long-term health consequences that might also occur outside the gastrointestinal tract. Ultimately, the results of these studies will enable the development of better strategies for the management of Coeliac Disease.
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Coeliac Disease
Nature Reviews Disease Primers, 2019Co-Authors: Katri Lindfors, Joseph Anthony Murray, Carolina Ciacci, Kalle Kurppa, Knut E. A. Lundin, Govind K. Makharia, M. Luisa Mearin, Elena F. Verdu, Katri KaukinenAbstract:Coeliac Disease is an immune-mediated enteropathy against dietary gluten present in wheat, rye and barley and is one of the most common lifelong food-related disorders worldwide. Coeliac Disease is also considered to be a systemic disorder characterized by a variable combination of gluten-related signs and symptoms and Disease-specific antibodies in addition to enteropathy. The ingestion of gluten leads to the generation of harmful gluten peptides, which, in predisposed individuals, can induce adaptive and innate immune responses. The clinical presentation is extremely variable; patients may have severe gastrointestinal symptoms and malabsorption, extraintestinal symptoms or have no symptoms at all. Owing to the multifaceted clinical presentation, diagnosis remains a challenge and Coeliac Disease is heavily underdiagnosed. The diagnosis of Coeliac Disease is achieved by combining Coeliac Disease serology and small intestinal mucosal histology during a gluten-containing diet. Currently, the only effective treatment for Coeliac Disease is a lifelong strict gluten-free diet; however, the diet is restrictive and gluten is difficult to avoid. Optimizing diagnosis and care in Coeliac Disease requires continuous research and education of both patients and health-care professionals. Coeliac Disease is an immune-mediated enteropathy driven by dietary gluten present in wheat, rye and barley. This Primer discusses the risk factors and immune mechanisms of Coeliac Disease and highlights future treatment options beyond the gluten-free diet.
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Refractory Coeliac Disease in a country with a high prevalence of clinically-diagnosed Coeliac Disease.
Alimentary pharmacology & therapeutics, 2014Co-Authors: Tuire Ilus, Kalle Kurppa, Katri Kaukinen, Markku Mäki, Lauri J. Virta, Heini Huhtala, Markku Heikkinen, M Heikura, E. Hirsi, K. JantunenAbstract:Summary Background Refractory Coeliac Disease (RCD) is thought to be a rare disorder, but the accurate prevalence is unknown. Aim We aimed to identify the prevalence of and the risk factors for developing RCD in a Finnish population where the clinical detection rate of Coeliac Disease is high. Methods The study involved 11 hospital districts in Finland where the number of treated RCD patients (n = 44), clinically diagnosed Coeliac Disease patients (n = 12 243) and adult inhabitants (n = 1.7 million) was known. Clinical characteristics at diagnosis of Coeliac Disease between the RCD patients and patients with uncomplicated Disease were compared. Results The prevalence of RCD was 0.31% among diagnosed Coeliac Disease patients and 0.002% in the general population. Of the enrolled 44 RCD patients, 68% had type I and 23% type II; in 9% the type was undetermined. Comparing 886 patients with uncomplicated Coeliac Disease with these 44 patients that developed RCD later in life, the latter were significantly older (median 56 vs 44 years, P
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Latent Coeliac Disease or Coeliac Disease beyond villous atrophy
Gut, 2007Co-Authors: Katri Kaukinen, Pekka Collin, Markku MäkiAbstract:New diagnostic criteria for Coeliac Disease are warranted Coeliac Disease is an autoimmune-mediated enteropathy triggered in genetically susceptible persons by the ingestion of a single dietary factor – wheat, rye and barley-derived gluten. The permanency of gluten intolerance was suggested in early studies, which showed that symptoms and intestinal lesions recurred usually within 2 years when gluten was reintroduced to the diet.1,2 Later it was recognised that the process of gluten-induced mucosal deterioration may take years or even decades in some individual cases.3,4 The paper by Matysiak-Budnik et al 5 in the present issue of Gut brings new aspects into the natural history of Coeliac Disease (see page 1379) . They studied 61 adult patients who had had the diagnosis of Coeliac disase in childhood, and who had regarded themselves as asymptomatic despite remaining on a gluten-containing diet for 11 years (median, range 3–21 years). In the follow-up examination, 48 out of these 61 patients had, as expected, developed small bowel mucosal villous atrophy with crypt hyperplasia; 70% of them were also suffering from osteopenia or osteoporosis, which may well have been due to untreated Coeliac Disease. However, the remaining 13 patients showed normal small bowel mucosal morphology. Surprisingly, two out of the 13 patients evinced mucosal atrophy shortly after the beginning of the gluten challenge, but their mucosa eventually normalised when the gluten ingestion continued. The authors concluded that there might be some patients with Coeliac Disease who may develop true latency and tolerance against dietary gluten. The current diagnostic criteria of Coeliac Disease require the presence of small intestinal mucosal villous atrophy …
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The hunt for Coeliac Disease in primary care.
QJM : monthly journal of the Association of Physicians, 2002Co-Authors: P. Collin, M. Rasmussen, Sinikka Kyrönpalo, Pekka Laippala, Katri KaukinenAbstract:Background: Serological screening suggests that most Coeliac Disease goes undetected. Aim: To determine how often Coeliac Disease is found in patients referred for gastroscopy by general practitioners. Design: Testing of 9971 consecutive patients referred to a single health centre for their first open‐access gastroscopy over a 10‐year period, without previously‐diagnosed Coeliac Disease or dermatitis herpetiformis. Methods: Endoscopy and routine duodenal biopsy were in use throughout the study period. The occurrence of Coeliac Disease was evaluated in patients with dyspepsia, in those with regurgitation, and in those with symptoms suggestive of Coeliac Disease. Results: Altogether, 147 (1.47%) patients had Coeliac Disease: 18/2974 (0.61%) with regurgitation, 41/5347 (0.77%) with dyspepsia, and 88/1650 (5.33%) with suspected Coeliac Disease. Increasing age reduced the risk very slightly (OR 0.98; 95%CI 0.97–0.99). Risk was significantly increased when there was a suspicion of Coeliac Disease (OR 9.085; 95%CI 5.371–15.369), while no difference was found between patients with dyspepsia and those with reflux Disease (OR 1.33; 95%CI 0.75–2.34). The risk in women was not increased (OR 0.97; 95%CI 0.69–1.38). Discussion: In this primary‐care setting,
Anita Sainsbury - One of the best experts on this subject based on the ideXlab platform.
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Meta-analysis: Coeliac Disease and Hypertransaminasaemia.
Alimentary Pharmacology and Therapeutics, 2011Co-Authors: Anita Sainsbury, David S. Sanders, Alexander FordAbstract:SUMMARY Background: There may be a positive association between Coeliac Disease and serum hypertransaminasaemia, but evidence is conflicting. Aims: To conduct a systematic review and meta-analysis to determine the prevalence of Coeliac Disease in adults presenting with cryptogenic serum hypertransaminasaemia, and the prevalence of hypertransaminasaemia in patients with newly-diagnosed Coeliac Disease. Methods: MEDLINE and EMBASE were searched up to August 2010. Case series and case-control studies recruiting adults with either cryptogenic hypertransaminasaemia that applied serological tests for Coeliac Disease and/or distal duodenal biopsy to participants, or newly-diagnosed biopsy-proven Coeliac Disease that assessed serum transaminases were eligible. The pooled prevalence of Coeliac Disease in individuals presenting with abnormal serum transaminases, and the pooled prevalence of hypertransaminasaemia in newly-diagnosed Coeliac Disease were calculated with 95% confidence intervals (CI). Results: Eleven eligible studies were identified. Pooled prevalences of positive Coeliac serology and biopsy-proven Coeliac Disease in cryptogenic hypertransaminasaemia were 5.9% (95% CI 2.7% to 10.3%) and 3.6% (95% CI 1.4% to 7.0%), respectively. Pooled prevalence of abnormal serum transaminases in newly-diagnosed CD was 27.0% (95% CI 13.0% to 44.0%). Exclusion of gluten led to normalisation of serum transaminase levels in 63% to 90% of patients within 1 year. Conclusions: Undetected CD is a potential cause for cryptogenic hypertransaminasaemia in 3% to 4% of cases. More than 20% of individuals with newly-diagnosed CD may have abnormal serum transaminases, and these normalise on a gluten-free diet in the majority of cases.
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Meta-analysis: Coeliac Disease and hypertransaminasaemia.
Alimentary pharmacology & therapeutics, 2011Co-Authors: Anita Sainsbury, David Sanders, Alexander C. FordAbstract:Aliment Pharmacol Ther 2011; 34: 33–40 Summary Background There may be a positive association between Coeliac Disease and serum hypertransaminasaemia but evidence is conflicting. Aims To conduct a systematic review and meta-analysis to determine the prevalence of Coeliac Disease in adults presenting with cryptogenic serum hypertransaminasaemia and the prevalence of hypertransaminasaemia in patients with newly diagnosed Coeliac Disease. Methods MEDLINE and EMBASE were searched up to August 2010. Case series and case–control studies recruiting adults with either cryptogenic hypertransaminasaemia that applied serological tests for Coeliac Disease and/or distal duodenal biopsy to participants or newly diagnosed biopsy-proven Coeliac Disease that assessed serum transaminases were eligible. The pooled prevalence of Coeliac Disease in individuals presenting with abnormal serum transaminases and the pooled prevalence of hypertransaminasaemia in newly diagnosed Coeliac Disease were calculated with 95% confidence intervals (CI). Results Eleven eligible studies were identified. Pooled prevalences of positive Coeliac serology and biopsy-proven Coeliac Disease in cryptogenic hypertransaminasaemia were 6% (95% CI 3% to 10%) and 4% (95% CI 1% to 7%) respectively. Pooled prevalence of abnormal serum transaminases in newly diagnosed Coeliac Disease was 27% (95% CI 13% to 44%). Exclusion of gluten led to normalisation of serum transaminase levels in 63% to 90% of patients within 1 year. Conclusions Undetected Coeliac Disease is a potential cause for cryptogenic hypertransaminasaemia in 3% to 4% of cases. More than 20% of individuals with newly diagnosed Coeliac Disease may have abnormal serum transaminases and these normalise on a gluten-free diet in the majority of cases.
Peter H R Green - One of the best experts on this subject based on the ideXlab platform.
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Coeliac Disease: To biopsy or not?
Nature Reviews Gastroenterology and Hepatology, 2018Co-Authors: Norelle R. Reilly, Steffen Husby, David S. Sanders, Peter H R GreenAbstract:Coeliac Disease is increasingly recognized as a global problem in both children and adults. Traditionally, the findings of characteristic changes of villous atrophy and increased intraepithelial lymphocytosis identified in duodenal biopsy samples taken during upper gastrointestinal endoscopy have been required for diagnosis. Although biopsies remain advised as necessary for the diagnosis of Coeliac Disease in adults, European guidelines for children provide a biopsy-sparing diagnostic pathway. This approach has been enabled by the high specificity and sensitivity of serological testing. However, these guidelines are not universally accepted. In this Perspective, we discuss the pros and cons of a biopsy-avoiding pathway for the diagnosis of Coeliac Disease, especially in this current era of the call for more biopsies, even from the duodenal bulb, in the diagnosis of Coeliac Disease. In addition, a contrast between paediatric and adult guidelines is presented.
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Extraintestinal manifestations of Coeliac Disease
Nature Reviews Gastroenterology & Hepatology, 2015Co-Authors: Daniel A. Leffler, Peter H R Green, Alessio FasanoAbstract:Coeliac Disease is a common disorder that can arise at any age and typically presents with a broad spectrum of symptoms. The Disease is thought to be underdiagnosed, in part owing to the fact that Coeliac Disease is often characterized by associated conditions and extraintestinal manifestations that can misdirect and impede diagnosis. Some of these manifestations are direct consequences of autoimmunity, such as dermatitis herpetiformis or gluten ataxia, whereas others are indirectly related to inflammation and/or malabsorption including anaemia, osteoporosis, short stature and delayed puberty. Any organ from the central nervous system to joints, liver or teeth can be affected. In some cases, extraintestinal symptoms are the only clinical manifestations of Coeliac Disease or occur in conjunction with diarrhoea and malabsorptive symptoms. An increased awareness among medical practitioners of the variety of extraintestinal manifestations of Coeliac Disease is essential to improve diagnosis and treatment. Coeliac Disease is common, but remains under-diagnosed, partly because it can present with extraintestinal symptoms that do not immediately enable an accurate diagnosis of the underlying Disease. In this Review, Leffler and colleagues discuss the most common extraintestinal manifestations, including dermatitis herpetiformis, gluten ataxia, anaemia, osteoporosis and others, to raise additional awareness among clinicians. Coeliac Disease is often accompanied by extraintestinal manifestations, which can be the result of aberrant immune responses but also malabsorption These concurrent conditions can affect various systems and organs, and include manifestations in the skin, musculoskeletal and central nervous system Anaemia, osteoporosis, dermatitis herpetiformis and gluten ataxia are among the most commonly seen characteristics In the paediatric population, Coeliac Disease can lead to severe growth disorders, such as short stature and delayed puberty due to hypogonadism
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Extraintestinal manifestations of Coeliac Disease
Nature reviews. Gastroenterology & hepatology, 2015Co-Authors: Daniel A. Leffler, Peter H R Green, Alessio FasanoAbstract:Coeliac Disease is a common disorder that can arise at any age and typically presents with a broad spectrum of symptoms. The Disease is thought to be underdiagnosed, in part owing to the fact that Coeliac Disease is often characterized by associated conditions and extraintestinal manifestations that can misdirect and impede diagnosis. Some of these manifestations are direct consequences of autoimmunity, such as dermatitis herpetiformis or gluten ataxia, whereas others are indirectly related to inflammation and/or malabsorption including anaemia, osteoporosis, short stature and delayed puberty. Any organ from the central nervous system to joints, liver or teeth can be affected. In some cases, extraintestinal symptoms are the only clinical manifestations of Coeliac Disease or occur in conjunction with diarrhoea and malabsorptive symptoms. An increased awareness among medical practitioners of the variety of extraintestinal manifestations of Coeliac Disease is essential to improve diagnosis and treatment.
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Risk of colorectal adenomas in patients with Coeliac Disease.
Alimentary pharmacology & therapeutics, 2010Co-Authors: Benjamin Lebwohl, E. Stavsky, Alfred I. Neugut, Peter H R GreenAbstract:Aliment Pharmacol Ther 2010; 32: 1037–1043 Summary Background Coeliac Disease is associated with an increased risk of lymphoma and small bowel malignancy, but most studies have found no increased risk of colorectal cancer. Aim To compare the prevalence of colorectal adenomas in Coeliac Disease patients with that in non-Coeliac Disease controls. Methods We identified all Coeliac Disease patients who underwent colonoscopy at our institution during a 44-month period. We matched each patient with non-Coeliac Disease controls by age, gender and endoscopist. We compared the adenoma prevalence between these groups, and used multivariate analysis to assess the independent association of Coeliac Disease with adenomas. Results We identified 180 patients with Coeliac Disease and 346 controls. At least one adenoma was present in 13% of Coeliac Disease patients and 17% of controls (P = 0.20). On multivariate analysis, age (OR per year 1.04, 95% CI 1.02–1.07) and male gender (OR 2.33, 95% CI 1.36–3.98) were associated with adenomas, while the relationship between Coeliac Disease and adenomas remained null (OR 0.75, 95% CI 0.41–1.34). Conclusions Coeliac Disease is not associated with an increased risk of colorectal neoplasia. The lack of increased risk of colorectal cancer observed in population studies is related to a true average risk of colorectal neoplasia, rather than artifactually reflecting increased colonoscopy and associated polypectomies in the Coeliac population.
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Small bowel neoplasia in Coeliac Disease
Gut, 2003Co-Authors: S D Rampertab, K A Forde, Peter H R GreenAbstract:There is an increased risk of small bowel adenocarcinoma in patients with Coeliac Disease compared with the normal population. It has been suggested that adenocarcinoma of the small intestine in Coeliac Disease arises through an adenoma-carcinoma sequence but there has been only one reported case of a small bowel adenoma in a patient with Coeliac Disease. We report three additional cases of a small bowel adenoma in the setting of Coeliac Disease. In addition, four cases of small bowel adenocarcinoma are also reported, one of which was found adjacent to a jejunal villous adenoma. These cases emphasise the risk of the development of small bowel neoplasia for patients with Coeliac Disease and support the concept that small bowel adenocarcinoma in Coeliac Disease arises from adenomas.