Risks of Lymphoma and Digestive Cancers in Patients with Celiac Disease: Cohort Study

BACKGROUND: The association between celiac disease (CD) and the development of various malignant tumors, in particular gastrointestinal cancers, has been reported by several studies. However, the close relative risks (Odds Ratio) of these complications compared to the population are still insufficiently known and estimates of the risk factors for the development of these complications in patients followed for CD remain controversial. Objective: To estimate the close relative risks of malignant complications in a cohort of patients with celiac disease compared to the Moroccan population and to determine the risk factors for the development of these complications. Methods: Our work is a retrospective, descriptive and analytical study, carried out within the Department of Medicine C of the CHU IBN SINA Mohammed V University of Rabat, over a period of 23 years - between 1995 and 2018 -, and on a basis of 284 cases of celiac disease, from which we have extracted a series of 16 cases of celiac disease with at least one malignant gastrointestinal complication. Using a case-control study, we were able to determine the risk of these complications compared to the general Moroccan population. Results: We gathered a population of 16 celiac patients with one or more malignant gastrointestinal complications, out of a total of 284 cases of CD, the prevalence was 5.6%. We found a significant increase in the risk of developing digestive malignancies during CD with an Odds Ratio (OR) of 46 (95% confidence interval [CI] 34–63) and p value <0.0001). This risk was higher during the period of per diagnosis, we also objectified a significant increase in risk of all types of cancers found in our series compared to those of control cases. The two risk factors for malignant complications found in our study are non-compliance with the gluten-free diet and delayed diagnosis. Conclusions: There is a significant increase in the risk of malignancy in patients diagnosed with CD. Particularly during the period of per diagnosis. This risk according to this cohort can be reduced by the good observance of the gluten-free diet and an early diagnosis in the face of the most severe symptoms of this pathology.