title: Non-Hodgkin lymphoma and gluten-sensitive enteropathy: estimate of risk using meta-analyses.
abstract: OBJECTIVE
  Gluten-sensitive enteropathy, including coeliac disease and dermatitis herpetiformis, is associated with non-Hodgkin lymphoma (NHL), and particularly enteropathy-associated T-cell lymphoma (EATCL). We conducted a meta-analysis to quantify the association.
  
  
  METHODS
  Fifty-four risk estimates (range 0.28-300) were pooled using random-effects meta-analysis. Potential sources of variation were examined using sensitivity analyses and meta-regression.
  
  
  RESULTS
  Thirty-one estimates with gluten-sensitive enteropathy diagnosed by serology then biopsy, serology alone, or recorded in medical notes accounted for half the variation in risks, giving a pooled estimate of 4.42 (95% confidence interval (CI) 3.72-5.26, I2 = 0%). Men and women had similar pooled risks. Risks were largest when these conditions were diagnosed using biopsy and lowest when self-reported. Study design, comparison population, geography or gluten-sensitive enteropathy type explained less of the variation. EATCL estimates ranged from 6 to 200; an association with diffuse large B-cell lymphoma (DLBCL) was also observed (pooled risk estimate = 1.97, 95% CI 1.23-3.15).
  
  
  CONCLUSIONS
  Where gluten-sensitive enteropathy was diagnosed using modern techniques, NHL risk was increased fourfold. At this level, one in 2,000 persons with gluten-sensitive enteropathy develops NHL each year. In addition to EATCL, DLBCL and possibly other subtypes may be linked to these conditions, and these weaker associations could be investigated in large population-based cohorts with biological samples.
authors.affiliation: Epidemiology and Genetics Unit, Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK. eleanor.kane@egu.york.ac.uk
authors.forename: Eleanor V
authors.initials: EV
authors.lastname: Kane
authors.forename: Rob
authors.initials: R
authors.lastname: Newton
authors.forename: Eve
authors.initials: E
authors.lastname: Roman
mesh_terms: D016022:Case-Control Studies; D002446:Celiac Disease / Q000150:complications / Q000453:epidemiology*; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000150:complications / Q000453:epidemiology*; D008297:Male; D012044:Regression Analysis; D012306:Risk; D012680:Sensitivity and Specificity