METACHRONOUS SMALL-BOWEL ADENOCARCINOMA IN CELIAC-DISEASE - GLUTEN-FREE DIET IS NOT PROTECTIVE

Coeliac disease is associated with an increased risk of certain gastro intestinal malignancies, especially of the small bowel. Metachronous m alignancies are well established in the colon, where adenocarcinoma is common, but an exceptional in the small intestine. We describe a youn g woman with a long history of malabsorption who was shown to have coe liac disease complicated by a small-bowel adenocarcinoma. The cancer w as resected, and the coeliac disease went into complete remission on a strict gluten-free diet. Fifteen years later she developed iron defic iency anaemia. Investigations showed a metachronous small-bowel adenoc arcinoma but continuing remission of the coeliac disease. The case pro vides strong evidence against a causative role for the enteropathy of active coeliac disease in small-bowel adenocarcinoma and against a pro tective effect of a gluten-free diet in tumour development. Predisposi tion to adenocarcinoma in coeliac disease is probably genetic.