Coeliac Disease and Lymphoma

Monica Acalovschi

3rd Medical Clinic, University of Medicine and Pharmacy Cluj-Napoca

Abstract

The incidence of malignancy is approximately twofold greater in coeliac disease than in the general population. Lymphomas of the small intestine, often multifocal and diffuse, were found in 0-18% of coeliac patients, representing about 50% of all malignancies. Most of lymphomas are of T-cell origin. Enteropathy-associated T-cell lymphomas (EATL) usually occur in older patients with long-lasting disease who do not strictly adhere to a gluten-free diet. It was shown that an appropriate diet, early instituted and rigorously followed, could prevent the development of lymphomas, supporting the view that coeliac disease is a risk factor for lymphoma. In rare cases, lymphomas can be diagnosed concurrently or at short time after coeliac disease, and debate continues as to whether adult-onset coeliac disease is itself a form of low-grade lymphoma, at least in some patients.
Controversy has recently emerged regarding the magnitude of lymphoma as a complication of coeliac disease. The previous studies, necessarily limited to symptomatic coeliac patients, might have lead to biased estimates of risk. A large Italian multicentre study in patients with non-Hodgkin lymphoma indicates that the risk to develop lymphoma in coeliac disease, although greater than in the general population, is lower than previously