Association between coeliac disease and gastrointestinal cancers: a narrative review

Abstract

Background and Objective: Coeliac disease (CD) is a chronic immune-mediated enteropathy, characterized by small intestine mucosal inflammation due to ingestion of gluten protein products. Less than 1% of patients have CD associated with severe complications that dramatically increase mortality and overall mortality seems to be more relevant near the time of diagnosis. It has been demonstrated that CD is correlated to intestinal cancers such as enteropathy-associated T-cell lymphoma (EATL) and small bowel cancers (SBCs). In the present study we performed a literature review to provide a complete overview of CD and any association with gastrointestinal (GI) tumors. Methods: A comprehensive literature search in the PubMed database was performed on 1st of April 17, 2022. The research was limited to the English language. Duplicated papers, case reports, and letters were excluded. Key Content and Findings: Thirty studies were included and divided based on the relationship between CD and different cancers. CD patients have a higher risk of developing EATL or SBC compared to the general population. Particularly, CD patients had a risk of 30-time fold to develop a hematological cancer, 15-time fold for SBC, and two-time fold for the other GI tumors. Gluten-free diet (GFD) seems to have a protective role due to its anti-inflammatory effects even if it seems not to be relevant to hematological cancers. Conclusions: Association between CD and cancer has been widely investigated for years, and the associations between CD patients and higher risk of EATL and SBC were discovered. The literature is still too controversial regarding other tumors and needs more data to analyze this topic further. The overall risk of GI cancer seems to be influenced by the temporal distance from the time of CD diagnosis, suggesting a possible correlation with GFD. However, further high-quality studies need to be published to support this hypothesis.