Celiac Disease (cont.)
What are the complications of celiac disease?
The complications of celiac disease include cancers, small bowel ulcers
(ulcerative jejunoileitis), and collagenous celiac disease.
Cancer
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, of esophageal carcinomas (cancers
of the inner lining of the intestine and esophagus). Lymphoma tends to develop in adult patients who have had celiac
disease for longer than 20-30 years and in patients 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 patients with celiac disease, where the disease has been
controlled with a gluten free diet, recurrence of weight loss, anemia, abnormal
pain, and symptoms of intestinal obstruction will lead doctors to search for
intestinal lymphoma and carcinoma.
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 diagnoses 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 patients 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 patients with celiac disease include cancers of the
liver, oral
cavity, and large intestine.
Ulcerative jejunoileitis
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. Patients with ulcerative jejunoileitis are at 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 patients 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.
Next: Can cancer risk be reduced in celiac disease? »
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