title: Risk of malignancy in patients with celiac disease.
abstract: OBJECTIVE
  Studies from Europe have demonstrated an increased risk of malignancy, especially non-Hodgkin's lymphoma, in patients with celiac disease. However, there are no data on the risk for similar patients in the United States. Our aim was to estimate the risk of malignancy in a cohort of patients with celiac disease compared with the general U.S. population and to determine if a gluten-free diet is protective.
  
  
  METHODS
  Patients with celiac disease seen between July 1981 and January 2000 at a referral center were included. Standardized morbidity ratios (SMRs) (ratio of observed to expected) and corresponding 95% confidence intervals (CI) were calculated, using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program.
  
  
  RESULTS
  Forty-three (11%) of 381 celiac disease patients had a diagnosis of cancer; 9 were after the diagnosis of celiac disease, 7 were simultaneous (during same month or admission), and 27 were before the diagnosis. The standardized morbidity ratio for all cancers combined was 1.5 (95% CI: 0.3 to 7.5), with significantly increased values for small bowel cancer (SMR = 34; 95% CI: 24 to 42), esophageal cancer (SMR = 12; 95% CI: 6.5 to 21), non-Hodgkin's lymphoma (SMR = 9.1; 95% CI: 4.7 to 13), and melanoma (SMR = 5.0; 95% CI: 2.1 to 12). Following the diagnosis of celiac disease, patients were at increased risk of non-Hodgkin's lymphoma only (SMR = 6.2; 95% CI: 2.9 to 14), despite adherence to a gluten-free diet. The non-Hodgkin's lymphoma included both T-cell and B-cell types and occurred in both gastrointestinal (n = 5) and extraintestinal sites (n = 4).
  
  
  CONCLUSIONS
  In this cohort of patients with celiac disease, we observed increased risks of small intestinal adenocarcinoma, esophageal cancer, melanoma, and non-Hodgkin's lymphoma. The risk of non-Hodgkin's lymphoma persisted despite a gluten-free diet.
authors.affiliation: Department of Medicine, College of Physicians and Surgeons, New York, New York, USA. pg11@columbia.edu
authors.forename: Peter H R
authors.initials: PH
authors.lastname: Green
authors.forename: Aaron T
authors.initials: AT
authors.lastname: Fleischauer
authors.forename: Govind
authors.initials: G
authors.lastname: Bhagat
authors.forename: Rishi
authors.initials: R
authors.lastname: Goyal
authors.forename: Bana
authors.initials: B
authors.lastname: Jabri
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
mesh_terms: D000328:Adult; D017677:Age Distribution; D002446:Celiac Disease / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008223:Lymphoma / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D009518:New York / Q000453:epidemiology; D018570:Risk Assessment