Spotlight on celiac disease and risk for other conditions
Recent studies looked at the relationship between celiac disease and eosinophilic esophagitis, digestive cancer, and frailty.
Three recent studies examined the relationship between celiac disease and risk for other conditions.
The first study, published Nov. 29 by the Journal of Clinical Gastroenterology, used data from a global population database to examine the association between celiac disease and eosinophilic esophagitis (EoE). A total of 46,398 pediatric and adult patients had EoE and 84,383 had celiac disease. Incidence and prevalence of celiac disease (2.76% and 329/100,000 persons/year) were higher in those with EoE than in those without (0.21% and 146/100,000 persons/year). Adults with concurrent diagnoses of both conditions had a higher risk for asthma (relative risk [RR], 1.82), allergic rhinitis (RR, 1.81), atopic dermatitis (RR, 2.07), and rheumatoid arthritis (RR, 1.41). Patients with celiac disease with EoE were at higher risk for iron-deficiency anemia (adjusted hazard ratio, 1.789; 95% CI, 1.166 to 2.745) but not for osteoporosis or fractures, vitamin D deficiency, or malnutrition. The researchers concluded that both incidence and prevalence of EoE are elevated in patients with celiac disease and vice versa and that concurrent diagnoses increase risk of complications in celiac disease.
A second study, published as a research letter Dec. 16 by Clinical Gastroenterology and Hepatology, looked at the risk for digestive cancer in 27,114 patients with celiac disease (mean age, 37.1 years; 72.7% women) and 27,114 matched controls who were hospitalized between 2011 and 2019 in France. Over nine years of follow-up, patients with celiac disease were at high risk for non-Hodgkin's lymphoma, as anticipated (odds ratio [OR], 4.08; 95% CI, 2.76 to 6.24), but were also at risk for small-bowel (OR, 13.95; 95% CI, 7.52 to 29.57), pancreatic (OR, 2.41; 95% CI, 1.78 to 3.31), esophageal (OR, 1.72; 95% CI, 1.08 to 2.77), colon (OR, 1.69; 95% CI, 1.39 to 2.06), and gastric (OR, 1.52; 95% CI, 1.06 to 2.20) cancer. Risk was also elevated for pernicious anemia (OR, 11.28; 95% CI, 7.33 to 18.41), Crohn's disease (OR, 4.18; 95% CI, 3.44 to 5.13), ulcerative colitis (OR, 3.27; 95% CI, 2.65 to 4.06), noninfectious enterocolitis including microscopic colitis (OR, 4.52; 95% CI, 4.10 to 4.99), and nonalcoholic chronic pancreatitis (OR, 1.67; 95% CI, 1.23 to 2.29). “Our results confirm high risks of lymphoma and small bowel cancer in celiac patients, but also indicate increased risks of pancreatic, esophageal, gastric and colonic cancers,” the authors wrote. They said that their findings support both gastric and duodenal biopsies at celiac disease diagnosis and follow-up, screening colonoscopy in patients with celiac disease, and continued lifetime follow-up with endoscopy.
Finally, a nationwide cohort study in Sweden matched 4,645 adults 60 years of age and older with celiac disease (mean age at diagnosis, 71 years; 52% women) to 21,944 controls to examine risk for frailty. The results, published Nov. 21 by The American Journal of Gastroenterology, found that baseline frailty was higher in patients with celiac disease compared with controls, overall (54.4% vs. 29.7%; P<0.001) and across all frailty categories (low risk, 43.4% vs. 23.8%; intermediate risk, 10.3% vs. 5.4%; high risk, 0.8% vs. 0.6%). Celiac disease patients who did not have frailty at baseline had a 66% increased risk for frailty over five years. The researchers concluded that older patients with celiac disease are at higher risk for frailty versus population-matched controls. “By identifying patients with CeD [celiac disease] who have frailty, providers may be able to develop more targeted interventions in the management of older adults with CeD,” they wrote. “Overall, older patients with CeD are a group that may be particularly vulnerable, as supported by this analysis, and future research evaluating this patient population are needed.”