New Study Reveals High Risk of Digestive Cancers in Patients with Celiac Disease

Celiac.com 03/06/2025 - Celiac disease, a chronic autoimmune condition triggered by gluten ingestion, is widely recognized for its impact on the digestive system. Beyond its more common symptoms, the disease has been linked to an elevated risk of certain cancers, particularly those of the digestive tract. This summary reviews a large French cohort study that investigated cancer risks and related inflammatory conditions in patients with celiac disease over a nine-year period.

Study Design and Population

The study analyzed data from the French PMSI (Programme de Médicalisation des Systèmes d’Information) database, covering hospitalizations from 2011 to 2019. Researchers included 27,114 patients diagnosed with celiac disease and matched them with an equal number of individuals without the disease. Participants were monitored over nine years, with demographic and medical information meticulously recorded. This approach allowed for a robust comparison of cancer and comorbidity risks between the two groups.

Key Findings on Cancer Risks

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The study confirmed that individuals with celiac disease face a significantly heightened risk for several types of cancers. Below are the most notable findings:

1. Increased Risk of Lymphomas

Enteropathy-associated T-cell lymphoma (EATL): This rare but severe type of lymphoma was exclusively observed in the celiac group, underscoring its strong association with the disease.

Non-Hodgkin lymphoma: The odds ratio (OR) for this cancer was 4.08, indicating more than a fourfold increased risk compared to the control group.

2. Elevated Risks of Digestive Cancers

• Small bowel cancer: This cancer exhibited the highest risk, with an OR of 13.95, making it the most strongly associated digestive cancer in celiac patients.
• Pancreatic cancer: Patients with celiac disease had an OR of 2.41, reflecting a significant increase in risk.
• Esophageal cancer: The risk was elevated with an OR of 1.72.
• Colonic cancer: This cancer showed an OR of 1.69, confirming an increased but moderate risk.
• Gastric cancer: Patients had an OR of 1.52, indicating a slightly higher risk.

3. No Significant Associations

No increased risk was found for rectal cancer, hepatocellular carcinoma, or melanoma.

Interestingly, celiac patients had a lower risk of breast cancer, with an OR of 0.76.

Inflammatory Diseases and Their Role in Cancer Risks

The study also examined the relationship between celiac disease and inflammatory conditions that may predispose patients to cancer. Key findings include:

1. Pernicious Anemia and Gastric Cancer

Celiac patients were over 11 times more likely to develop pernicious anemia (OR: 11.28), a condition strongly linked to gastric cancer. In those with both conditions, the odds of developing gastric cancer increased dramatically (OR: 9.01).

2. Chronic Pancreatitis and Pancreatic Cancer

Nonalcoholic chronic pancreatitis was more common in the celiac group (OR: 1.67) and significantly raised the risk of pancreatic cancer (OR: 5.90) in affected patients.

3. Colonic Cancer and Microscopic Colitis

While Crohn’s disease and ulcerative colitis did not increase colonic cancer risk in celiac patients, microscopic colitis—another inflammatory condition—was associated with a higher risk (OR: 1.84).

Other Comorbidities in Celiac Patients

As expected, the study found higher incidences of autoimmune and metabolic conditions in the celiac group, which serve as internal validation for the results. These include:

• Type 1 diabetes (OR: 2.80)
• Thyroiditis (OR: 5.04)
• Rheumatoid arthritis (OR: 1.41)
• Osteoporosis (OR: 2.16)
• Implications for Clinical Practice

The findings of this study have several important implications:

1. Need for Vigilance and Screening

The high risks of small bowel, pancreatic, and gastric cancers emphasize the importance of regular screening and follow-up in celiac patients. For example, gastric biopsies may be warranted at the time of celiac diagnosis to detect early signs of malignancy.

2. Management of Inflammatory Conditions

Addressing associated inflammatory diseases, such as pernicious anemia and chronic pancreatitis, could mitigate cancer risks. Similarly, identifying and managing microscopic colitis may help reduce the risk of colonic cancer.

3. Role of a Gluten-Free Diet

While a strict gluten-free diet has been shown to reduce the risk of intestinal lymphomas, its effect on other cancers remains less clear. Continued dietary adherence and regular medical evaluations are essential.

Conclusion

This large-scale French cohort study provides compelling evidence of elevated cancer risks in celiac disease patients, particularly for lymphomas and digestive tract cancers. Additionally, it highlights the role of comorbid inflammatory conditions in driving these risks. For individuals with celiac disease, these findings underscore the importance of proactive medical care, including regular screenings and diligent management of associated conditions. By doing so, patients and healthcare providers can work together to reduce long-term health complications and improve overall outcomes.

Read more at: cghjournal.org