Cancer Causes & Control

, 22:1435

Non-Hodgkin lymphoma and gluten-sensitive enteropathy: estimate of risk using meta-analyses

Authors

    • Epidemiology and Genetics Unit, Department of Health SciencesUniversity of York
  • Rob Newton
    • Epidemiology and Genetics Unit, Department of Health SciencesUniversity of York
    • Hull York Medical SchoolUniversity of York
  • Eve Roman
    • Epidemiology and Genetics Unit, Department of Health SciencesUniversity of York
    • Hull York Medical SchoolUniversity of York
Original paper

DOI: 10.1007/s10552-011-9818-4

Cite this article as:
Kane, E.V., Newton, R. & Roman, E. Cancer Causes Control (2011) 22: 1435. doi:10.1007/s10552-011-9818-4

Abstract

Objectives

Gluten-sensitive enteropathy, including coeliac disease and dermatitis herpetiformis, is associated with non-Hodgkin lymphoma (NHL), and particularly enteropathy-associated T-cell lymphoma (EATCL). We conducted a meta-analysis to quantify the association.

Methods

Fifty-four risk estimates (range 0.28–300) were pooled using random-effects meta-analysis. Potential sources of variation were examined using sensitivity analyses and meta-regression.

Results

Thirty-one estimates with gluten-sensitive enteropathy diagnosed by serology then biopsy, serology alone, or recorded in medical notes accounted for half the variation in risks, giving a pooled estimate of 4.42 (95% confidence interval (CI) 3.72–5.26, I2 = 0%). Men and women had similar pooled risks. Risks were largest when these conditions were diagnosed using biopsy and lowest when self-reported. Study design, comparison population, geography or gluten-sensitive enteropathy type explained less of the variation. EATCL estimates ranged from 6 to 200; an association with diffuse large B-cell lymphoma (DLBCL) was also observed (pooled risk estimate = 1.97, 95% CI 1.23–3.15).

Conclusions

Where gluten-sensitive enteropathy was diagnosed using modern techniques, NHL risk was increased fourfold. At this level, one in 2,000 persons with gluten-sensitive enteropathy develops NHL each year. In addition to EATCL, DLBCL and possibly other subtypes may be linked to these conditions, and these weaker associations could be investigated in large population-based cohorts with biological samples.

Keywords

Non-Hodgkin lymphomaGluten-sensitive enteropathyCoeliac diseaseDermatitis herpetiformisMeta-analysis

Abbreviations

AgA

Antigliadin antibodies

CI

Confidence interval

DH

Dermatitis herpetiformis

DLBCL

Diffuse large B-cell lymphoma

EMA

Endomysial antibodies

EATCL

Enteropathy-associated T-cell lymphoma

IgA

Immunoglobulin antibodies

NHL

Non-Hodgkin lymphoma

PI

Predictive interval

RCD

Refractory coeliac disease

tTGA

Tissue transglutaminase antibodies

Supplementary material

10552_2011_9818_MOESM1_ESM.doc (222 kb)
Supplementary material 1 (DOC 222 kb)
10552_2011_9818_MOESM2_ESM.tif (1.5 mb)
Supplementary Figure 1: Funnel plot of standard errors of log risk estimate versus risk estimates in studies of non-Hodgkin lymphoma and gluten-sensitive enteropathy. Pooled risk estimate and pseudo 95% confidence limits are from the 31 studies with homogeneous risk estimates. (TIFF 1579 kb)

Copyright information

© Springer Science+Business Media B.V. 2011