TY - JOUR
T1 - Mucosal healing and risk for lymphoproliferative malignancy in celiac disease
T2 - A population-based cohort study
AU - Lebwohl, Benjamin
AU - Granath, Fredrik
AU - Ekbom, Anders
AU - Smedby, Karin E.
AU - Murray, Joseph A.
AU - Neugut, Alfred I.
AU - Green, Peter H.R.
AU - Ludvigsson, Jonas F.
PY - 2013/8/6
Y1 - 2013/8/6
N2 - Background: Celiac disease (CD) is associated with an increased risk for lymphoproliferative malignancy (LPM). Whether this risk is affected by the results of follow-up intestinal biopsy, performed to document mucosal healing, is unknown. Objective: To examine the association between mucosal healing in CD and subsequent LPM. Design: Population-based cohort study. Setting: 28 pathology departments in Sweden. Patients: 7625 patients with CD who had follow-up biopsy after initial diagnosis. Measurements: The risk for LPM was compared with that of the general population by using expected rates. The rate of LPM in patients with persistent villous atrophy was compared with that of those with mucosal healing by using Cox regression. Results: Among 7625 patients with CD and follow-up biopsy, 3308 (43%) had persistent villous atrophy. The overall risk for LPM was higher than that in the general population (standardized incidence ratio [SIR], 2.81 [95% CI, 2.10 to 3.67]) and was greater among patients with persistent villous atrophy (SIR, 3.78 [CI, 2.71 to 5.12]) than among those with mucosal healing (SIR, 1.50 [CI, 0.77 to 2.62]). Persistent villous atrophy compared with mucosal healing was associated with an increased risk for LPM (hazard ratio [HR], 2.26 [CI, 1.18 to 4.34]). The risk for T-cell lymphoma was increased (HR, 3.51 [CI, 0.75 to 16.34]) but not for B-cell lymphoma (HR, 0.97 [CI, 0.21 to 4.49]). Limitation: No data on dietary adherence. Conclusion: Increased risk for LPM in CD is associated with the follow-up biopsy results, with a higher risk among patients with persistent villous atrophy. Follow-up biopsy may effectively stratify patients with CD by risk for subsequent LPM. Primary Funding Source: National Institutes of Health, The American-Scandinavian Foundation, Celiac Sprue Association, Ö rebro University Hospital, Karolinska Institutet, Swedish Society of Medicine, Swedish Research Council, and Swedish Celiac Society.
AB - Background: Celiac disease (CD) is associated with an increased risk for lymphoproliferative malignancy (LPM). Whether this risk is affected by the results of follow-up intestinal biopsy, performed to document mucosal healing, is unknown. Objective: To examine the association between mucosal healing in CD and subsequent LPM. Design: Population-based cohort study. Setting: 28 pathology departments in Sweden. Patients: 7625 patients with CD who had follow-up biopsy after initial diagnosis. Measurements: The risk for LPM was compared with that of the general population by using expected rates. The rate of LPM in patients with persistent villous atrophy was compared with that of those with mucosal healing by using Cox regression. Results: Among 7625 patients with CD and follow-up biopsy, 3308 (43%) had persistent villous atrophy. The overall risk for LPM was higher than that in the general population (standardized incidence ratio [SIR], 2.81 [95% CI, 2.10 to 3.67]) and was greater among patients with persistent villous atrophy (SIR, 3.78 [CI, 2.71 to 5.12]) than among those with mucosal healing (SIR, 1.50 [CI, 0.77 to 2.62]). Persistent villous atrophy compared with mucosal healing was associated with an increased risk for LPM (hazard ratio [HR], 2.26 [CI, 1.18 to 4.34]). The risk for T-cell lymphoma was increased (HR, 3.51 [CI, 0.75 to 16.34]) but not for B-cell lymphoma (HR, 0.97 [CI, 0.21 to 4.49]). Limitation: No data on dietary adherence. Conclusion: Increased risk for LPM in CD is associated with the follow-up biopsy results, with a higher risk among patients with persistent villous atrophy. Follow-up biopsy may effectively stratify patients with CD by risk for subsequent LPM. Primary Funding Source: National Institutes of Health, The American-Scandinavian Foundation, Celiac Sprue Association, Ö rebro University Hospital, Karolinska Institutet, Swedish Society of Medicine, Swedish Research Council, and Swedish Celiac Society.
UR - http://www.scopus.com/inward/record.url?scp=84881123601&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84881123601&partnerID=8YFLogxK
U2 - 10.7326/0003-4819-159-3-201308060-00006
DO - 10.7326/0003-4819-159-3-201308060-00006
M3 - Article
C2 - 23922062
AN - SCOPUS:84881123601
SN - 0003-4819
VL - 159
SP - 169
EP - 175
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 3
ER -