Abstract
The incidence of small bowel cancers is increasing. Associations have been made between celiac disease (CD) and small bowel cancers, but there have been no detailed studies of large cohorts. Through the nationwide Epidemiology Strengthened by Histopathology Reports in Sweden cohort study, we retrieved data from Sweden's 28 pathology departments on all individuals who received a diagnosis of CD from 1965 through 2017. Individuals with CD, defined as duodenal or jejunal villous atrophy (stage 3 Marsh score), were matched with as many as 5 randomly selected reference individuals from the general population. We used stratified Cox regression to calculate hazard ratios (HRs) for small bowel adenocarcinoma, adenomas, and carcinoids. During a median follow-up of 11 years, we identified 48,119 individuals with CD (patients) and 239,249 reference individuals. Beginning at 1 year after a diagnosis of CD, 29 patients (0.06%) received a diagnosis of small bowel adenocarcinoma vs 45 reference individuals (0.02%), 7 patients received a diagnosis of carcinoids vs 31 reference individuals, and 48 patients received a diagnosis of adenomas vs 50 reference individuals. Corresponding HRs were small bowel adenocarcinoma 3.05 (95% confidence interval [CI], 1.86-4.99), carcinoids 0.59 (95% CI, 0.16-2.10), and adenomas 5.73 (95% CI, 3.70-8.88). HRs were independent of sex and age. Overall, there was 1 extra case of small bowel adenocarcinoma in every 2944 patients with CD followed for 10 years. There was an inverse association between mucosal healing risk of future small bowel adenocarcinoma (HR, 0.18; 95% CI, 0.02-1.61), although the HR failed to attain statistical significance. In an analysis of a nationwide pathology database in Sweden, we found the absolute risk of small bowel adenocarcinoma is low in individuals with CD. However, risks of small bowel adenocarcinoma and adenomas (but not carcinoids) are significantly increased in people with CD compared to people without this disease.
Highlights
BACKGROUND & AIMSThe incidence of small bowel cancers is increasing
We present hazard ratio (HR) according to follow-up (0–1, 1–5, 5–10, 10–15, 15–20, and >20 years) and with outcome of small bowel adenocarcinoma stratified by location in the small bowel
29 individuals with celiac disease (CD) (0.06%) and 45 reference individuals (0.02%) developed small bowel adenocarcinoma (HR, 3.05; 95% confidence interval (CI), 1.86–4.99). This risk increase corresponds to 1 extra case of small bowel adenocarcinoma for every 2944 individuals with CD followed for 10 years
Summary
BACKGROUND & AIMSThe incidence of small bowel cancers is increasing. Associations have been made between celiac disease (CD) and small bowel cancers, but there have been no detailed studies of large cohorts. We used stratified Cox regression to calculate hazard ratios (HRs) for small bowel adenocarcinoma, adenomas, and carcinoids. Corresponding HRs were small bowel adenocarcinoma 3.05 (95% confidence interval [CI], 1.86–4.99), carcinoids 0.59 (95% CI, 0.16–2.10), and adenomas 5.73 (95% CI, 3.70–8.88). There was 1 extra case of small bowel adenocarcinoma in every 2944 patients with CD followed for 10 years. CONCLUSIONS: In an analysis of a nationwide pathology database in Sweden, we found the absolute risk of small bowel adenocarcinoma is low in individuals with CD. Risks of small bowel adenocarcinoma and adenomas (but not carcinoids) are significantly increased in people with CD compared to people without this disease. Associations have been made between celiac disease and small bowel cancers, but there have been no detailed studies of large cohorts
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