![]() Accordingly, adenomas located distal to the splenic flexure were regarded as left-sided lesions.Ĭolorectal neoplasia risk factors were also compared between groups: age, gender, familiar history of colorectal neoplasia, tabaquism, obesity, and diabetes. Location of the adenomatous lesions found was classified as right-sided adenomas if they were proximal to the splenic flexure. We defined advanced adenoma as any adenomatous lesion with at least one of the following features: (a) a predominant villous component, (b) lesion diameter over 10 mm, and (c) the presence of high-grade dysplasia. Additionally, the prevalence of advanced adenomas was compared. The prevalence of colorectal adenomas and/or colorectal cancer as well as their location throughout the colon were compared between groups. The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki. Since it was a retrospective study, no informed consent was necessary for each patient that was enrolled. The study protocol was approved by our Institution's Internal Review Board (date of approval: April 5, 2017, protocol number #735HB). Randomization was computer-generated using our Endoscopy Unit's database. Asymptomatic subjects undertaking screening colonoscopy were randomly recruited as controls in a 2 : 1 fashion. Those patients with a colonoscopy performed between 6 months before or after the diagnosis of celiac disease and the initiation of a gluten-free diet were considered for inclusion as cases.Ĭeliac disease was defined as the presence of serum IgA or IgG antitissue transglutaminase antibodies and a small-bowel biopsy showing some degree of villous atrophy along with an abnormal increase of intraepithelial lymphocytes (more than 25 intraepithelial lymphocytes per 100 epithelial cells) (Marsh 3A to 3C). Patients with a diagnosis of celiac disease at an age of 45 years or older were initially screened. Medical records from January 2010 to July 2017 as well as from both Endoscopy and Pathology Departments were reviewed. We conducted a retrospective case-control study at our Gastroenterology Department. Hence, we sought to evaluate the prevalence of colorectal adenomas among recently diagnosed celiac disease patients compared to nonceliac, otherwise healthy, controls. The question whether recently diagnosed-and, as a consequence, untreated-celiac disease could imply a significant risk of colorectal adenomas has not been answered. However, most of the adult patients included in these studies were already diagnosed and following a gluten-free diet. The question whether celiac disease may per se increase the risk of colorectal adenomas has been assessed before, showing no significant association. Identifying such factors is important, since they become crucial in the decision-making process of preventive measures such as screening colonoscopy. There is a myriad of risk factors that are behind the development of colorectal adenomas. These lesions can be detected and effectively treated before their progression to adenocarcinoma, and recent evidence shows that polypectomy effectively decreases the risk of developing colorectal adenocarcinoma. Most colorectal cancers derive from benign asymptomatic neoplastic lesions known as adenomas. It should be noted however that most of the studies that assess a possible link between celiac disease and colorectal cancer are retrospective, do not always have a valid comparator, and show a high variability in terms of the way celiac disease is defined: by means of serological findings only or biopsy-based diagnosis. ![]() ![]() , there was no significant association between these two entities. According to a meta-analysis by Han et al. Interestingly, there is a relative scarcity of evidence assessing the risk celiac disease patients exhibit in developing colorectal neoplasia. Celiac disease has been linked to extraintestinal malignant tumors, such as esophageal squamous-cell carcinoma. It has been well described its association with an increased risk of small-bowel adenocarcinoma as well as lymphoproliferative disorders-such as enteropathy-associated T-cell lymphomas. One of the most relevant issues regarding celiac disease is the risk of developing both malignant and nonmalignant tumors. As a consequence, clinical elements such as iron-deficiency anemia or osteoporosis can be the initial features behind the aforementioned disorder. Atypical forms of presentation however may be more common in adult patients with celiac disease. Classically, it has been described as a condition causing malabsorption of nutrients, with diarrhea or failure to thrive as common clinical features among pediatric patients. Celiac disease is a relatively common autoimmune disorder triggered by the intestinal exposure to gluten-a glycoprotein present in wheat, barley, rye, and oat.
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