Kingham J G, Ramanaden D, Dawson A
Dept. of Gastroenterology, Singleton Hospital, Swansea, UK.
Scand J Gastroenterol. 1998 Feb;33(2):218-22. doi: 10.1080/00365529850166987.
Coeliac disease is associated with an increased risk of certain gastrointestinal malignancies, especially of the small bowel. Metachronous malignancies are well established in the colon, where adenocarcinoma is common, but are exceptional in the small intestine. We describe a young woman with a long history of malabsorption who was shown to have coeliac disease complicated by a small-bowel adenocarcinoma. The cancer was resected, and the coeliac disease went into complete remission on a strict gluten-free diet. Fifteen years later she developed iron deficiency anaemia. Investigations showed a metachronous small-bowel adenocarcinoma but continuing remission of the coeliac disease. The case provides strong evidence against a causative role for the enteropathy of active coeliac disease in small-bowel adenocarcinoma and against a protective effect of a gluten-free diet in tumour development. Predisposition to adenocarcinoma in coeliac disease is probably genetic.
乳糜泻与某些胃肠道恶性肿瘤风险增加相关，尤其是小肠肿瘤。异时性恶性肿瘤在结肠中很常见，其中腺癌较为普遍，但在小肠中则较为罕见。我们描述了一名有长期吸收不良病史的年轻女性，她被诊断为乳糜泻并发小肠腺癌。肿瘤被切除，严格遵循无麸质饮食后，乳糜泻完全缓解。15年后，她出现缺铁性贫血。检查发现异时性小肠腺癌，但乳糜泻持续缓解。该病例有力地证明了活动性乳糜泻肠病在小肠腺癌中不存在致病作用，以及无麸质饮食对肿瘤发展无保护作用。乳糜泻患者患腺癌的易感性可能与遗传因素有关。
