Risk of duodenal adenoma in celiac disease.
BACKGROUND
There is a 60- to 80-fold increased risk of small-bowel adenocarcinoma in patients with celiac disease. While the adenoma-carcinoma sequence appears to operate in the small bowel as in the large bowel, the risk of duodenal adenomas in celiac patients is unknown.


METHODS
The records of 381 patients (245 F, 136 M) with biopsy-proven celiac disease were reviewed to determine the prevalence of duodenal adenoma found during esophagogastroduodenoscopy (EGD). We conducted an extensive literature review to find data for estimates of the prevalence of duodenal adenoma in a comparable general population; we used data from a study at another New York City medical center of 7346 EGDs conducted between 1976 and 1982 (Ghazi et al., 1984). We estimated the relative risk, expressed as a standard morbidity ratio (SMR), by calculating the observed to expected (O/E) ratio.


RESULTS
Duodenal adenomas were found in 3 celiac patients (0.78%), with 24 adenomas (0.33%) in the reference population, giving an SMR of 2.39 (95% CI 0.67-8.48).


CONCLUSIONS
We did not find a significantly increased risk of duodenal adenoma in celiac patients compared to a non-celiac endoscoped population. Thus, despite the previously described elevated risk of small-bowel adenocarcinoma in these patients, routine endoscopic examination of the duodenum may not be adequate for screening.
Rampertab
S Devi
SD
Dept. of Medicine and Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, USA.
Fleischauer
A
A
Neugut
A I
AI
Green
P H R
PH
D000236:Adenoma / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D000328:Adult; D002446:Celiac Disease / Q000150:complications* / Q000473:pathology; D004379:Duodenal Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment