Risk of Small Bowel Adenocarcinoma, Adenomas, and Carcinoids in a Nationwide Cohort of Individuals With Celiac Disease

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 159; no. 5; pp. 1686 - 1694.e2
• Main Authors: Emilsson, Louise, Semrad, Carol, Lebwohl, Benjamin, Green, Peter H.R., Ludvigsson, Jonas F.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2020; American Gastroenterology Association Institute
• Subjects: Adenocarcinoma - epidemiology; Adenocarcinoma - pathology; Adenoma - epidemiology; Adenoma - pathology; Adult; Aged; Aged, 80 and over; Carcinoid Tumor - epidemiology; Carcinoid Tumor - pathology; Celiac Disease - epidemiology; Celiac Disease - pathology; Databases, Factual; Etiology; Female; Gluten; Humans; Intestinal Neoplasms - epidemiology; Intestinal Neoplasms - pathology; Intestine; Intestine, Small - pathology; Male; Medicin och hälsovetenskap; Middle Aged; Neoplasm; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Sweden - epidemiology; Time Factors; Young Adult; Sweden; Neoplasm; CD; ESPRESSO; Intestine; Etiology; CI; HR; ICD; SnoMed; Gluten
• ISSN: 0016-5085; 1528-0012; 1528-0012
• DOI: 10.1053/j.gastro.2020.07.007

The incidence of small bowel cancers is increasing. Associations have been made between celiac disease (CD) and small bowel cancers, but there have been no detailed studies of large cohorts.
Through the nationwide Epidemiology Strengthened by Histopathology Reports in Sweden cohort study, we retrieved data from Sweden’s 28 pathology departments on all individuals who received a diagnosis of CD from 1965 through 2017. Individuals with CD, defined as duodenal or jejunal villous atrophy (stage 3 Marsh score), were matched with as many as 5 randomly selected reference individuals from the general population. We used stratified Cox regression to calculate hazard ratios (HRs) for small bowel adenocarcinoma, adenomas, and carcinoids.
During a median follow-up of 11 years, we identified 48,119 individuals with CD (patients) and 239,249 reference individuals. Beginning at 1 year after a diagnosis of CD, 29 patients (0.06%) received a diagnosis of small bowel adenocarcinoma vs 45 reference individuals (0.02%), 7 patients received a diagnosis of carcinoids vs 31 reference individuals, and 48 patients received a diagnosis of adenomas vs 50 reference individuals. Corresponding HRs were small bowel adenocarcinoma 3.05 (95% confidence interval [CI], 1.86–4.99), carcinoids 0.59 (95% CI, 0.16–2.10), and adenomas 5.73 (95% CI, 3.70–8.88). HRs were independent of sex and age. Overall, there was 1 extra case of small bowel adenocarcinoma in every 2944 patients with CD followed for 10 years. There was an inverse association between mucosal healing risk of future small bowel adenocarcinoma (HR, 0.18; 95% CI, 0.02–1.61), although the HR failed to attain statistical significance.
In an analysis of a nationwide pathology database in Sweden, we found the absolute risk of small bowel adenocarcinoma is low in individuals with CD. However, risks of small bowel adenocarcinoma and adenomas (but not carcinoids) are significantly increased in people with CD compared to people without this disease.
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