Onwuzo Somtochukwu, Boustany Antoine, Saleh Mustafa, Gupta Riya, Onwuzo Chidera, Mascarenhas Monteiro Jessy, Lawrence Favour, Emeshiobi Chinenye, Odu Juliana, Asaad Imad
Internal Medicine, Cleveland Clinic Foundation, Cleveland, USA.
Faculty of Medical Sciences, Lebanese University, Beirut, LBN.
Cureus. 2023 Mar 31;15(3):e36964. doi: 10.7759/cureus.36964. eCollection 2023 Mar.
The association between celiac disease (CD) and the development of small bowel lymphoproliferative disorders and esophageal adenocarcinoma has been established in the literature. However, there is only a little evidence demonstrating an increased risk of colorectal cancer (CRC) in patients with CD. Hence, we conducted a cross-sectional population-based study to evaluate the risk of developing CRC in patients who have had a diagnosis of CD.
We used a commercial database (Explorys Inc, Cleveland, OH), which includes electronic health records from 26 major integrated US healthcare systems. Patients aged 18-65 years were included. Patients with inflammatory bowel disease (IBD) were excluded. Multivariate analysis using backward stepwise logistic regression was performed to calculate the risk of developing CRC in potential confounders. A two-sided P-value <0.05 was considered statistically significant.
79,843,332 individuals were screened in the database and 47,400,960 were selected in the final analysis after accounting for inclusion and exclusion criteria. Using a stepwise multivariate regression analysis, the odds of having CRC among patients with CD was 10.18 (95% CI 9.72-10.65) (P-value <0.001). The odds also remained high among males 1.49 (95% CI 1.36-1.63), African Americans 1.51 (95% CI 1.35-1.68), patients who have type 2 diabetes mellitus (T2DM) 2.71 (95% CI 2.66-2.76), are smokers 2.49 (95% CI 2.44-2.54), are obese 2.21 (95% CI 2.17-2.25), and are alcoholic 1.72 (95% CI 1.66-1.78).
Our study demonstrates that patients with CD are frequently found to have CRC even when adjusting for common risk factors. This adds to the literature and helps spread awareness to clinicians that the effects of CD are not only limited to the small bowel as the disease tends to involve other parts of the gastrointestinal tract also, especially the colon. The threshold to screen patients with CD should be considered to be lowered.
乳糜泻（CD）与小肠淋巴增生性疾病及食管腺癌发生之间的关联已在文献中得到证实。然而，仅有少量证据表明CD患者患结直肠癌（CRC）的风险增加。因此，我们开展了一项基于人群的横断面研究，以评估已确诊CD的患者发生CRC的风险。
我们使用了一个商业数据库（俄亥俄州克利夫兰市的Explorys公司），该数据库包含来自美国26个主要综合医疗系统的电子健康记录。纳入年龄在18 - 65岁的患者，排除炎症性肠病（IBD）患者。采用向后逐步逻辑回归进行多变量分析，以计算潜在混杂因素中发生CRC的风险。双侧P值<0.05被认为具有统计学意义。
数据库中筛查了79,843,332人，在考虑纳入和排除标准后，最终分析中选择了47,400,960人。通过逐步多变量回归分析，CD患者患CRC的比值比为10.18（95%置信区间9.72 - 10.65）（P值<0.001）。男性（比值比1.49，95%置信区间1.36 - 1.63）、非裔美国人（比值比1.51，95%置信区间1.35 - 1.68）、2型糖尿病（T2DM）患者（比值比2.71，95%置信区间2.66 - 2.76）、吸烟者（比值比2.49，95%置信区间2.44 - 2.54）、肥胖者（比值比2.21，95%置信区间2.17 - 2.25）以及酗酒者（比值比1.72，95%置信区间1.66 - 1.78）患CRC的比值比也仍然较高。
我们的研究表明，即使对常见风险因素进行调整，CD患者仍经常被发现患有CRC。这为文献增添了内容，并有助于向临床医生传播意识，即CD的影响不仅限于小肠，因为该疾病还倾向于累及胃肠道的其他部位，尤其是结肠。应考虑降低对CD患者进行筛查的阈值。
