title: Meta-analysis: coeliac disease and the risk of all-cause mortality, any malignancy and lymphoid malignancy.
abstract: BACKGROUND
  Coeliac disease has been associated with an increased risk of mortality and malignancy. However, the strength of this association is conflicting among different studies.
  
  
  OBJECTIVE
  To perform a systematic review and quantitative meta-analysis to determine the risk of all-cause mortality, any malignancy and lymphoid malignancy in coeliac disease patients.
  
  
  METHODS
  Four electronic databases (Medline, PubMed, Embase and Current Contents Connect) were searched to 4 January 2012, with no language restrictions. From 8698 citations identified, a total of 17 studies met our inclusion criteria.
  
  
  RESULTS
  The all-cause mortality meta-analysis showed an increased risk for all-cause mortality in coeliac patients [odds ratio (OR) 1.24; 95% confidence interval (CI) 1.19-1.30]. A subgroup analysis showed that patients identified by positive serology alone were also at an increased risk of all-cause mortality (OR 1.16; 95% CI 1.02-1.31). The non-Hodgkin lymphoma (NHL) meta-analysis showed an increased risk for NHL in coeliac patients (OR 2.61; 95% CI 2.04-3.33). A subgroup analysis showed that patients identified by positive serology alone were also at an increased risk of NHL (OR 2.55; 95% CI 1.02-6.36). The T-cell non-Hodgkin lymphoma (TNHL) meta-analysis showed an increased risk of TNHL (OR 15.84; 95% CI 7.85-31.94). The any malignancy meta-analysis showed no increased risk (OR 1.07; 95% CI 0.89-1.29).
  
  
  CONCLUSIONS
  Patients with coeliac disease are at an increased risk of mortality and non-Hodgkin lymphoma, particularly T-cell non-Hodgkin lymphoma; they do not have an increased risk of any malignancy overall. Serologically defined patients with coeliac disease have an elevated risk of mortality and non-Hodgkin lymphoma.
authors.affiliation: The Whiteley-Martin Research Centre, The Discipline of Surgery, The University of Sydney, Sydney Medical School, Nepean, Penrith, NSW, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Tio
authors.forename: M R
authors.initials: MR
authors.lastname: Cox
authors.forename: G D
authors.initials: GD
authors.lastname: Eslick
mesh_terms: D002423:Cause of Death; D002446:Celiac Disease / Q000401:mortality*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality; D016399:Lymphoma, T-Cell / Q000401:mortality*; D012307:Risk Factors; D018709:Statistics, Nonparametric