With the discovery of precise serologies to identify celiac disease, the likelihood of complications of celiac disease has been changing. In addition, the presentation of celiac disease is different now. Instead of seeing children with malabsorption and abdominal distention, many children and adults are identified with mild or no symptoms. Also, the risk of severe complications including malignancy and autoimmune disease has been reevaluated based on larger cohorts. Twenty years ago, the risk of these complications did serve as a motivator for continuation of a gluten free diet (GFD). While a GFD remains important, these risks are much lower than previously reported. The most recent article to support this contention is the following:
Clinical Gastroenterology and Hepatology 2012; 10: 30-36. This study examined ~45,000 patients with either celiac disease (villous atrophy, Marsh score of 3), duodenal inflammation (Marsh 1 or 2), or latent celiac disease (normal mucosa & positive serology). After the first year, there was no significant increase risk for GI cancers. During the first year, cancers that were identified may not have been causally-related to celiac disease but due to coincident detection.
This article due to its large cohort is very useful, but other articles have come to different conclusions. Irregardless, there are still compelling reasons to continue a GFD. Many individuals feel better on a GFD & did not recognize prior symptoms. Maintaining this diet probably lowers the risk of developing certain autoimmune conditions and definitely improves bone health.
Other recent &/or related articles:
–Gastroenterology 2010; 139: 763. Mortality NOT worsened in undiagnosed celiac disease (identified by review of serology) in Olmstead County, though bone density decreased. n=129 of 16,847. (?milder cases undiagnosed)
–J Pediatrics 2010; 157: 373, 353. Even patients without villous atrophy & positive serology, benefited from GFD with regard to GI symptoms and serological markers.
–JAMA 2009; 302: 1171-78. n=29,096. Mortalitiy increased in celiac disease: 35% for latent, 72% for inflammation, 39% for celiac dz.
–Clin Gastro & Hep 2008; 6: 753. Incidence of autoimmune diseases less in those celiac patients who were compliant with GFD. n=178.
–Gastroenterology 2002; 123; 1428-1435. n=12,000. Risk for cancer 1.3 odds ratio (lower than in previous studies).