complications

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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:

Last reviewed 08/2019

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