{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T16:13:54Z","timestamp":1790784834527,"version":"4.1.0"},"reference-count":21,"publisher":"BMJ","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1989,3]]},"abstract":"<jats:p>Two hundred and ten patients with coeliac disease previously reported from this unit were reviewed at the end of 1985 after a further 11 years of follow up. The initial review at the end of 1974 could not demonstrate that a gluten free diet (GFD) prevented these complications, probably because the time on diet was relatively short. The same series has therefore been kept under surveillance with the particular aim of assessing the effects of diet on malignancy after a further prolonged follow up period. Twelve new cancers have occurred: of which one was a carcinoma of the oesophagus and two lymphomas. Thirty nine cancers developed in 38 patients and of 69 deaths, 33 were the result of malignancy. A two-fold relative risk (RR) of cancer was found and was because of an increased risk of cancer of the mouth and pharynx (RR = 9.7, p less than 0.01, 95% confidence interval (CI) = 2.0-28.3), oesophagus (RR = 12.3, p less than 0.01, CI = 2.5-36.5), and of non-Hodgkin's lymphoma (RR = 42.7, p less than 0.001, CI = 19.6-81.4). The results indicate that for coeliac patients who have taken a GFD for five years or more the risk of developing cancer over all sites is not increased when compared with the general population. The risk is increased, however, in those taking a reduced gluten, or a normal diet, with an excess of cancers of the mouth, pharynx and oesophagus (RR = 22.7, p &lt; 0.001), and also of lymphoma (RR = 77.8, p &lt; 0.001). A significant decreasing trend in the excess morbidity rate over increasing use of a GFD was found. The results are suggestive of a protective role for a GFD against malignancy in coeliac disease and give further support for advising all patients to adhere to a strict GFD for life.<\/jats:p>","DOI":"10.1136\/gut.30.3.333","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"333-338","source":"Crossref","is-referenced-by-count":750,"title":["Malignancy in coeliac disease--effect of a gluten free diet."],"prefix":"10.1136","volume":"30","author":[{"given":"G K","family":"Holmes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Prior","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M R","family":"Lane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Pope","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R N","family":"Allan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1989,3,1]]},"reference":[{"key":"ref_1","article-title":"I Cookc WT. Holmes GiKT. Malignancy. In: Coeliac disease","year":"1984","unstructured":"I Cookc WT. Holmes GiKT. Malignancy. In: Coeliac disease. Edinburgh: Churchill Livingstone. 1984."},{"key":"ref_2","first-page":"375","article-title":"The clinical and biochemical syndrome in lymphadenoma and allied diseases involving the mesenteric glands","volume":"i:","author":"FP, Fairley M.H.Mackie","unstructured":"Fairley MH. Mackie FP. The clinical and biochemical syndrome in lymphadenoma and allied diseases involving the mesenteric glands. Br MWel J 1937: i: 375-80.","journal-title":"Br MWel J 1937"},{"issue":"102","key":"ref_3","first-page":"277","article-title":"Symptomatic sprue","volume":"1939","author":"M, Salvesen H.A.Kobro","unstructured":"Salvesen HA. Kobro M. Symptomatic sprue. Actaed Scand 1939: 102: 277-94.","journal-title":"Actaed Scand"},{"key":"ref_4","first-page":"13","article-title":"Symptomatic sprue - A study of six verified casCs","volume":"137","author":"Bjerkelund, C.J.","unstructured":"Bjerkelund CJ. Symptomatic sprue - A study of six verified casCs. Acta Med Scanid 1950:, 137: 13(-49.","journal-title":"Acta Med Scanid 1950"},{"issue":"3","key":"ref_5","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1136\/gut.3.3.232","article-title":"Read AE. Naish JM. Intestinal reticulosis Holmes, Prior, Lane, Pope, and Allan as a complication of idiopathic steatorrhoea","volume":"1962","author":"Gough, K.R.","unstructured":"Gough KR. Read AE. Naish JM. Intestinal reticulosis  Holmes, Prior, Lane, Pope, and Allan as a complication of idiopathic steatorrhoea. Gut 1962; 3: 232-9.","journal-title":"Gut"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1007\/BF02233180","article-title":"McCarthy CF. Read AE. Steatorrhoea and malignant lymphoma. The relationship of malignant tumours of lymphoid tissue and coeliac disease","volume":"12","author":"Austad, W.I.; Gough, Cornes J.S.; K.R.","year":"1967","unstructured":"Austad WI, Cornes JS. Gough KR. McCarthy CF. Read AE. Steatorrhoea and malignant lymphoma. The relationship of malignant tumours of lymphoid tissue and coeliac disease. Am J Dig Dis 1967; 12: 475-90.","journal-title":"Am J Dig Dis"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1016\/0002-9343(67)90071-X","article-title":"Malignancy in adult coeliac disease and idiopathic steatorrhoea","volume":"42","author":"Harris, O.D.; Waterhouse, Cooke W.T.Thompson H.; J.A.H.","year":"1967","unstructured":"Harris OD, Cooke WT. Thompson H. Waterhouse JAH. Malignancy in adult coeliac disease and idiopathic steatorrhoea. 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Lancet 1983; i: 111-5.","journal-title":"Lancet"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1136\/gut.17.8.612","article-title":"Coeliac disease, gluten free diet and malignancy","volume":"17","author":"Holmes, G.K.T.; Sorahan, Stokes P.L.; TM, Prior P.Waterhouse; JAH, Cooke; W.T.","year":"1976","unstructured":"Holmes GKT, Stokes PL. Sorahan TM, Prior P. Waterhouse JAH, Cooke WT. Coeliac disease, gluten free diet and malignancy. Gut 1976; 17: 612-9.","journal-title":"Gut"},{"key":"ref_11","article-title":"Definition and epidemiology. In: Coeliac disease","author":"Cooke, W.T.; Holmes, G.K.T.","year":"1984","unstructured":"Cooke WT, Holmes GKT. Definition and epidemiology. In: Coeliac disease. Edinburgh: Churchill Livingstone. 1984."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1093\/ije\/15.1.134","article-title":"Cohort study analysis with a FORTRAN computer program","volume":"15","author":"Coleman, M.P.; Peto, Douglas A.Hermon C.; J.","year":"1986","unstructured":"Coleman MP, Douglas A. Hermon C. Peto J. Cohort study analysis with a FORTRAN computer program. Int J Epidemiol 1986; 15: 134-7.","journal-title":"Int J Epidemiol"},{"key":"ref_13","article-title":"Epidemiological analysis with a programmable calculator","author":"Rothman, K.J.; JD, Jr, Boice","year":"1979","unstructured":"Rothman KJ, Boice JD Jr. Epidemiological analysis with a programmable calculator. Washington: US Government Printing Office. 1979."},{"key":"ref_14","first-page":"249","article-title":"Coeliac discase and malignancy","volume":"59","author":"WT, Cooper B.T.Holmcs G.K.T.Ferguson R.Cookc","year":"1980","unstructured":"Cooper BT. Holmcs GKT. Ferguson R. Cookc WT. 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Gut 1980; 21: 381-6."}],"container-title":["Gut"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/gut.30.3.333","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T08:49:47Z","timestamp":1765615787000},"score":1,"resource":{"primary":{"URL":"https:\/\/gut.bmj.com\/lookup\/doi\/10.1136\/gut.30.3.333"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1989,3]]},"references-count":21,"journal-issue":{"issue":"3","published-online":{"date-parts":[[1989,3,1]]},"published-print":{"date-parts":[[1989,3]]}},"alternative-id":["10.1136\/gut.30.3.333"],"URL":"https:\/\/doi.org\/10.1136\/gut.30.3.333","relation":{},"ISSN":["0017-5749","1468-3288"],"issn-type":[{"value":"0017-5749","type":"print"},{"value":"1468-3288","type":"electronic"}],"subject":[],"published":{"date-parts":[[1989,3]]}}}