Clinical Research
Copyright ©2007 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jan 7, 2007; 13(1): 146-151
Published online Jan 7, 2007. doi: 10.3748/wjg.v13.i1.146
Malignancy and mortality in a population-based cohort of patients with coeliac disease or ‘gluten sensitivity’
LA Anderson, SA McMillan, RGP Watson, P Monaghan, AT Gavin, C Fox, LJ Murray
LA Anderson, P Monaghan, LJ Murray, Queen’s University Belfast, Centre for Clinical and Population Sciences, Belfast, United Kingdom
SA McMillan, Royal Group of Hospitals, Regional Immunology Service, Belfast, United Kingdom
RGP Watson, Royal Group of Hospitals, Institute of Clinical Science, Belfast, United Kingdom.
AT Gavin, C Fox, Queen’s University Belfast, Northern Ireland Cancer Registry, Belfast, United Kingdom
Author contributions: All authors contributed equally to the work.
Supported by the Research and Development Office, Northern Ireland who funded Dr. Anderson to undertake the research through the Ireland-Northern Ireland-National Cancer Institute Cancer Consortium Cancer Prevention Fellowship Programme. The Northern Ireland Cancer Registry is funded by the Department of Health, Social Services & Public Safety Northern Ireland
Correspondence to: Dr. Lesley A Anderson, Centre for Clinical and Population Sciences, Mulhouse Building, Grosvenor Road, Belfast, BT12 6BJ, United Kingdom,
Telephone: +44-28-90632602 Fax: +44-28-90231907
Received: September 9, 2006
Revised: October 8, 2006
Accepted: October 23, 2006
Published online: January 7, 2007

AIM: To determine the risk of malignancy and mortality in patients with a positive endomysial or anti-gliadin antibody test in Northern Ireland.

METHODS: A population-based retrospective cohort study design was used. Laboratory test results used in the diagnosis of coeliac disease were obtained from the Regional Immunology Laboratory, cancer statistics from the Northern Ireland Cancer Registry and mortality statistics from the General Registrar Office, Northern Ireland. Age standardized incidence ratios of malignant neoplasms and standardized mortality ratios of all-cause and cause-specific mortality were calculated.

RESULTS: A total of 13 338 people had an endomysial antibody and/or an anti-gliadin antibody test in Northern Ireland between 1993 and 1996. There were 490 patients who tested positive for endomysial antibodies and they were assumed to have coeliac disease. There were 1133 patients who tested positive for anti-gliadin antibodies and they were defined as gluten sensitive. Malignant neoplasms were not significantly associated with coeliac disease; however, all-cause mortality was significantly increased following diagnosis. The standardized incidence and mortality ratios for non-Hodgkin’s lymphoma were increased in coeliac disease patients but did not reach statistical significance. Lung and breast cancer incidence were significantly lower and all-cause mortality, mortality from malignant neoplasms, non-Hodgkin’s lymphoma and digestive system disorders were significantly higher in gluten sensitive patients compared to the Northern Ireland population.

CONCLUSION: Patients with coeliac disease or gluten sensitivity had higher mortality rates than the Northern Ireland population. This association persists more than one year after diagnosis in patients testing positive for anti-gliadin antibodies. Breast cancer is significantly reduced in the cohort of patients with gluten sensitivity.

Keywords: Coeliac disease, Cancer, Mortality, Gluten sensitivity