Celiac Disease (cont.)
Bhupinder Anand, MD
In this Article
What are the complications of celiac disease?
The complications of celiac disease include cancers, small bowel ulcers (ulcerative jejunoileitis), and collagenous celiac disease.
Adults with celiac disease have a several-fold higher than normal risk of developing lymphomas (cancers of the lymph glands) in the small intestine and elsewhere. They also have a high risk of small intestinal and, to a lesser degree, esophageal carcinomas (cancers of the inner lining of the intestine and esophagus). Lymphoma tends to develop in adults who have had celiac disease for longer than 20-30 years and in those with refractory celiac disease. Symptoms of small intestinal lymphoma or carcinoma include anemia, bleeding into the intestine, abdominal pain, weight loss, fever, and small intestinal obstruction (with symptoms of abdominal distension, vomiting and crampy abdominal pain). Small intestinal lymphoma and carcinoma are difficult to diagnose. Sometimes in individuals with celiac disease, where the disease has been controlled with a gluten free diet, recurrence of weight loss, anemia, abdominal pain, and symptoms of intestinal obstruction will lead doctors to search for intestinal lymphoma and carcinoma. Some evidence suggest that if atrophy of villi is reversed on a gluten-free diet that the risk of lymphoma is not increased.
Computerized tomography (CT) scans of the abdomen, enteroclysis (one type of barium X-ray of the small intestine), and enteroscopy (inspection of the small intestine using a long, flexible endoscope) are procedures doctors use to diagnose small intestinal lymphoma and carcinoma. Sometimes the diagnosis of intestinal lymphoma or carcinoma can only be made with surgery (open laparotomy) or by laparoscopy (examination of the abdominal cavity with flexible endoscopes). The prognosis for individuals who develop intestinal lymphoma usually is poor. Long-term survival (survival beyond 5 years) of patients with small intestinal lymphoma is estimated to be only 10%. Other cancers that may be increased in individuals with celiac disease include cancers of the liver, oral cavity, and large intestine.
Ulcerative jejunoileitis is a rare complication of celiac disease. In ulcerative jejunoileitis there are recurrent episodes of small intestinal ulcerations and formation of strictures (narrowing of the intestinal lumen). Small intestinal ulcerations and stricture formation can lead to intestinal bleeding, weight loss, abdominal pain, and intestinal obstruction. Individuals with ulcerative jejunoileitis are at a high risk of developing intestinal lymphomas. The diagnosis of ulcerative jejunoileitis is made by enteroclysis of the small intestine, enteroscopy, or CT scan of the abdomen. Treatment involves a gluten free diet and surgical resection of the most diseased portions of the small intestine. The prognosis is poor; long-term survival for individuals with ulcerative jejunoileitis beyond 5 years is less than 50%.
Collagenous celiac disease
Collagenous celiac disease is a rare, but serious complication of celiac disease in which a patient may have the symptoms of celiac disease initially, but they fail to improve on a gluten free diet, and after several years a large amount of scar tissue (collagen) forms just under the intestinal lining. There is no treatment for collagenous celiac disease, and the prognosis is poor.
Reviewed by Bhupinder Anand, MD on 8/12/2013
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