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Unhealed intestines in celiac disease tied to lymphoma

By Genevra Pittman

NEW YORK (Reuters Health) - People with celiac disease whose intestines are slow to heal are at increased risk of cancer of the immune system, or lymphoma, according to a new study.

Researchers found that people with celiac disease who had persistent damage to their intestines after being diagnosed - possibly due to lack of adherence to a gluten-free diet - had rates of lymphoma almost four times higher than the general public.

However, it's not clear whether everyone with celiac disease should have follow-up biopsies to look for such damage, according to Dr. Daniel Leffler, from The Celiac Center at Beth Israel Deaconess Medical Center in Boston.

"It's still only worth doing a test for a problem if you can fix the problem when you find it," said Leffler, who wasn't involved in the new research. "Right now the only treatment we have (for intestinal damage) is a gluten-free diet."

Among people with celiac disease - about one percent of Americans - the immune system reacts to gluten, a protein found in wheat, barley and rye. Eating foods with gluten damages the small intestine and keeps the immune system on overdrive, so patients are advised to adopt a permanent gluten-free diet at diagnosis.

The new study included 7,625 people in Sweden who were diagnosed with celiac disease and had their intestines biopsied a year or so later. Of those people, 43 percent still had damage to their intestines on the follow-up exam.

Dr. Peter Green from the Celiac Disease Center at Columbia University in New York and his colleagues tracked the Swedish patients for an average of nine years after their follow-up biopsy. During that span, 53 were diagnosed with lymphoma.

Based on biopsy results, the researchers found that people whose intestines had healed after their diagnosis were not at any higher risk of lymphoma than average. However, those with persistent damage developed lymphoma 3.8 times more often than would be expected among the general public.

Leffler told Reuters Health it's impossible to know whether everyone in the study who had intestinal damage had strayed from a gluten-free diet.

"We don't actually know whether the only issue in these people who didn't heal was gluten exposure. Some people may take a longer time to heal," he said, such as those who were diagnosed at an older age.

Although it's still up for debate whether people with celiac disease should get regular biopsies - in part because there's not always much doctors can do with the results - Leffler said they should continue to follow up with their gastroenterologist and dietician, even if they are feeling fine. But any extra risk of lymphoma should not make those patients overly concerned, he added.

Among 3,308 people in the study with persistent intestinal damage, 41 - just over one percent - were diagnosed with lymphoma, according to findings published in the Annals of Internal Medicine.

"Even with the significantly increased risk of lymphoma, it's still a small risk," Leffler said. "I would caution against an undue paranoia about the increased risk of lymphoma."

SOURCE: http://bit.ly/13IKKH9 Annals of Internal Medicine, online August 5, 2013.

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