Celiac
Disease and Risk of Cancer
Diarrhea
is not a topic most of us like to think about too much.
In most instances, it arises from acute infections or
minor indiscretions in our eating. However, in the United
States, there are some children and adults who develop
significant diarrhea as a result of malabsorption that
occurs when they consume foods that contain gluten,
a protein found in certain grains including wheat, barley,
and rye. This condition is called celiac disease.
About
Celiac Disease
Celiac
disease (also known as gluten-sensitive enteropathy) is
an autoimmune disorder affecting the small bowel. It can
be diagnosed on biopsy and on the basis of certain blood
tests. Patients who present with diarrhea are thought
to be just the tip of the celiac iceberg; in fact, the
majority may not have severe diarrhea. Anemia, osteoporosis,
and symptoms suggestive of irritable bowel syndrome may
be the only manifestations of the disease. Celiac disease
is a common disorder in Great Britain and certain parts
of Europe, but its exact prevalence in the United States
is uncertain - estimates place the number of individuals
with celiac disease between 500,000 and several million.
In many cases, avoidance of gluten is sufficient for controlling
the symptoms and the disease. Clearly, however, practitioners
often overlook this patient population.
Research
and Awareness
Peter
Green, M.D., Clinical Professor of Medicine and Attending
Physician in the Division of Digestive and Liver Disorders
at New York-Presbyterian Hospital, has taken a special
interest in celiac disease. Over the past 20 years, Dr.
Green has established a Center for the diagnosis, treatment,
and study of people with celiac disease, and has collected
data on overt 400 patients, including follow-up on gluten-free
diets.
A
major interest has been the risk of malignancy in the
people with celiac disease. While cancers of the large
bowel are common in the United States and Western Europe,
adenocarcinoma of the small bowel is a very rare disorder,
occurring at a rate of 1/50th that of large bowel cancer.
Yet, studies in the United Kingdom have recently demonstrated
that the risk for small bowel adenocarcinoma in people
with celiac disease is 50 to 100 times the normal rate
- which makes this condition virtually as common in people
with celiac disease as the risk of colorectal cancer in
the general population. Dr. Green suspects that the condition
may have different characteristics, particularly based
on the lower frequency of celiac disease in the United
States. However, Dr. Green and his colleagues have recently
published data in which the risk of small bowel adenocarcinoma
in patients with celiac disease within his Center was
approximately 70-fold the average risk of small bowel
adenocarcinoma.
Dr.
Green has also conducted further studies in which the
risk of non-Hodgkin’s lymphoma was shown to be dramatically
elevated in people with celiac disease. Furthermore, many
of these lymphomas occurred within the small bowel itself.
Other findings confirmed earlier reports that esophageal
carcinoma was also elevated in these patients, although
the reasons are unknown. More importantly, while preliminary,
Dr. Green’s studies suggest that adherence to a gluten-free
diet can rapidly diminish the risk for these cancers.
For
entry to Dr. Green’s Center or for further information,
please call 212-305-5590.
