Persistent Damage from Celiac Disease Can Raise Cancer Risk

Gluten-Free Food

Celiac disease is a genetic condition in which a patient cannot properly digest gluten, a protein in wheat, rye and barley. Unless the patient adopts a strict gluten-free diet, intestinal damage can occur leading not only to difficult digestive symptoms, but may also increase the risk of certain types of cancer.

Researchers publishing in the Annals of Internal Medicine have studied the effects of long-term intestinal damage on patients with celiac disease. The study included data on over 7,600 patients who underwent follow-up biopsy between 6 months and five years (median 1.3 years) after initial diagnosis. The patients received additional follow-up for an average of 8.9 years thereafter.

The researchers knew that celiac patients had an increased risk of Non-Hodgkins Lymphoma, a type of cancer that begins when a type of white blood cell becomes abnormal. Celiac patients have an annual lymphoma risk of 67.9 per 100,000 – a 2.8-fold increase over the general population. When patients present with persistent intestinal damage due to celiac disease, the risk increases to 102.4 per 100,000 compared to those with healed intestines.

Dr. Jonas Ludvigsson MD Phd, a pediatrician and professor of clinical epidemiology at the Karolinska Institute maintains that dietary diligence is critical for reducing the risk of lymphoma among celiac disease patients.


“We know from prior studies that healing is more likely among patients who report strict adherence to the gluten-free diet, compared with those who admit to less-than-strict dietary habits,” adds Dr. Benjamin Lebwohl MD MS, assistant professor of medicine at Columbia University Medical Center and gastroenterologist at New York Presbyterian/Columbia.

Celiac disease is a common autoimmune disease, affecting approximately one percent of individuals in Western nations. Symptoms vary widely but can include abdominal cramping/bloating, anemia, diarrhea, energy loss, fatigue, and weight loss.

Following a gluten free diet can be difficult, as wheat ingredients can be found in many unusual products as fillers – including deli meats, processed foods, canned soups, marinades, and even medicines, lipsticks, and vitamin/mineral supplements. The Children’s Digestive Health and Nutrition Foundation offers a Gluten-Free Diet Guide for Families online at

To assist families in identifying appropriate foods, the FDA has announced a new definition for products that carry the label of “gluten-free.” A food product cannot carry more than 20 ppm of gluten in order to be labeled gluten-free or any variation such as without gluten, free of gluten, or no gluten.

Journal reference:
Lebwohl B, et al "Mucosal healing and risk for lymphoproliferative malignancy in celiac disease: A population-based cohort study" Ann Intern Med 2013; 159: 1-8.

Additional Resources:
National Institutes of Health
Celiac Sprue Association
Children’s Digestive Health and Nutrition Foundation (CDHNF)


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