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We were very interested in the paper by Rampertab et al (Gut 2003;52:1211–14) and the correspondence by Hawdle et al (Gut 2004;53:470). Their data are quite similar to ours, from the Italian Registry of Complications of Coeliac Disease.
We collected information on 1968 patients over 18 years of age (mean age at diagnosis: 36.7 years; female/male ratio 3:1), diagnosed with coeliac diseases between January 1982 and December 2002 at 20 Italian clinical centres specialised in gastrointestinal disease. The diagnosis was made according to revised ESPGHAN criteria.1 We found five (0.25%) patients with a small bowel malignancy at the time of diagnosis of coeliac disease. Age range was 49–69 years (mean 59 years) with a predominance of females (4:1). Survival rate was very poor as three patients died within 36 months of diagnosis.
These results indicate that there is an increased risk of developing small bowel malignancy in patients with coeliac disease. This correlation was confirmed by the female/male ratio. In fact, while small bowel neoplasms are usually more frequent in males, in our population four of five cases were female. Moreover, mean age at diagnosis of these cases was higher than that of patients overall, emphasising that the risk of a neoplasm increases with longstanding coeliac disease.
In conclusion, early diagnosis of coeliac disease should be made to prevent small bowel neoplasms from developing, and screening for this cancer should be carried out at diagnosis of coeliac disease, especially in patients diagnosed during adulthood.
Conflict of interest: None declared.
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