Mucosal healing and risk for lymphoproliferative malignancy in celiac disease: a population-based cohort study.
BACKGROUND
Celiac disease (CD) is associated with an increased risk for lymphoproliferative malignancy (LPM). Whether this risk is affected by the results of follow-up intestinal biopsy, performed to document mucosal healing, is unknown.


OBJECTIVE
To examine the association between mucosal healing in CD and subsequent LPM.


METHODS
Population-based cohort study.


METHODS
28 pathology departments in Sweden.


METHODS
7625 patients with CD who had follow-up biopsy after initial diagnosis.


METHODS
The risk for LPM was compared with that of the general population by using expected rates. The rate of LPM in patients with persistent villous atrophy was compared with that of those with mucosal healing by using Cox regression.


RESULTS
Among 7625 patients with CD and follow-up biopsy, 3308 (43%) had persistent villous atrophy. The overall risk for LPM was higher than that in the general population (standardized incidence ratio [SIR], 2.81 [95% CI, 2.10 to 3.67]) and was greater among patients with persistent villous atrophy (SIR, 3.78 [CI, 2.71 to 5.12]) than among those with mucosal healing (SIR, 1.50 [CI, 0.77 to 2.62]). Persistent villous atrophy compared with mucosal healing was associated with an increased risk for LPM (hazard ratio [HR], 2.26 [CI, 1.18 to 4.34]). The risk for T-cell lymphoma was increased (HR, 3.51 [CI, 0.75 to 16.34]) but not for B-cell lymphoma (HR, 0.97 [CI, 0.21 to 4.49]).


CONCLUSIONS
No data on dietary adherence.


CONCLUSIONS
Increased risk for LPM in CD is associated with the follow-up biopsy results, with a higher risk among patients with persistent villous atrophy. Follow-up biopsy may effectively stratify patients with CD by risk for subsequent LPM.
Columbia University College of Physicians and Surgeons, New York, New York, USA.
Benjamin
B
Lebwohl
Fredrik
F
Granath
Anders
A
Ekbom
Karin E
KE
Smedby
Joseph A
JA
Murray
Alfred I
AI
Neugut
Peter H R
PH
Green
Jonas F
JF
Ludvigsson
D000293:Adolescent; D000328:Adult; D001284:Atrophy; D001706:Biopsy; D002446:Celiac Disease / Q000150:complications* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007413:Intestinal Mucosa / Q000473:pathology*; D007421:Intestine, Small / Q000473:pathology*; D008223:Lymphoma / Q000150:complications / Q000453:epidemiology*; D016393:Lymphoma, B-Cell / Q000453:epidemiology; D016399:Lymphoma, T-Cell / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult