Complications

Complications of coeliac disease include:

• osteoporosis
  • coeliac disease is associated with reduced bone mineral density
• malignancy:
  • intestinal lymphoma, usually of T-cell derivation
  • 80-fold increase in small bowel carcinoma
  • increased incidence of extra-intestinal carcinoma, particularly, oesophageal carcinoma; rarely, of other organs, for example, bladder, brain, breast
• ulcerative jejunitis - which may precede, accompany, or follow malignancy
• hyposplenism
  • results in an increase in risk of infection from encapsulated bacteria
• collagenous sprue - excessive subepithelial collagen deposition; may cause refractoriness to gluten withdrawal

The increased risk of malignancy appears to be unrelated to disease duration but is reduced in those compliant with a gluten-free diet.

Notes:

• a study examined the risk of malginancy in patients with undiagnosied coeliac disease
  • a population-based adult-representative cohort of 8000 individuals was drawn in 1978-1980. Stored sera of the participants with no history of coeliac disease or any malignancy were tested for immunoglobulin A (IgA) class tissue transglutaminase antibodies (Eu-tTG) in 2001. Positive sera were further analysed by another tissue transglutaminase antibody test (Celikey tTG) and for endomysial antibodies (EMAs). Malignant diseases were extracted from the nationwide database and antibody-positive cases were compared with negative cases during a follow-up of nearly 20 years
  • the study authors concluded that prognosis of adults with unrecognised coeliac disease with positive coeliac disease antibody status is good as regards the overall risk of malignancies (2)

Reference:

• (1) British Society of Gastroenterology (BSG) 2010. The management of adults with coeliac disease
• (2) Lohi S et al.Malignancies in cases with screening-identified evidence of coeliac disease: a long-term population-based cohort study. Gut. 2009 May;58(5):643-7.