Original article 187 European multi-centre study on coeliac disease and non-Hodgkin lymphoma M. Luisa Mearin a,c , Carlo Catassi d , Nicole Brousse e , Ronald Brand b , Pekka Collin f , Elisabetta Fabiani d , Joachim J. Schweizer a,c , Mohamed Abuzakouk g , Hania Szajewska h , Claes Hallert i , Carme Farre ´ Masip j and Geoffrey K.T. Holmes k on behalf of the Biomed Study Group on Coeliac Disease and Non-Hodgkin Lymphoma* Introduction Coeliac disease (CD) is associated with an increased risk of non-Hodgkin lymphoma (NHL), but there is little information about whether this is true for clinically silent CD. Objective To investigate the frequency of CD in two European populations; one with NHL and another derived from the general population. Methods A prospective, multi-centre, case–control study in 10 European countries was conducted between May 1998 and April 2001. A total of 1446 consecutive patients with newly diagnosed NHLaged over 18 years was collected. The control group consisted of a population of 9676 individuals who were screened for CD. The number of patients with a previous diagnosis of CD and those with silent CD detected by screening were determined in the two groups. Results The patients with CD had a significantly increased risk of developing NHL [odds ratio (OR) 2.6, 95% confidence interval (CI) 1.4–4.9]. This risk was only present in patients with CD diagnosed clinically before the study (OR 3.3, 95% CI 1.4–7.9), but not in those with silent CD detected by screening (OR 1.3, 95% CI 0.6–2.7). Conclusion Patients with CD have an increased risk of developing NHL, although this is lower than previously thought. Clinically silent CD is rare in patients with NHL. Eur J Gastroenterol Hepatol 18:187–194  c 2006 Lippincott Williams & Wilkins. European Journal of Gastroenterology & Hepatology 2006, 18:187–194 Keywords: cancer, coeliac disease, non-Hodgkin lymphoma, prevalence, screening Departments of a Paediatrics, b Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands, c Department of Paediatrics, Amsterdam Free University Medical Center, Amsterdam, The Netherlands, d Department of Paediatrics, University of Ancona, Ancona, Italy, e Department of Pathology, Necker-Enfants Malades Hospital, Paris V University, Paris, France, f Departments of Internal Medicine, Hospital and Medical School, University of Tampere, Tampere, Finland, g Department of Immunology, St James’s Hospital and Trinity College, Dublin, Ireland, h Department of Paediatric Gastroenterology and Nutrition, The Medical University of Warsaw, Warsaw, Poland, i Department of Internal Medicine, Norrko ¨ ping Hospital, Norrko ¨ ping, Sweden, j Department of Biochemistry, Hospital Sant Joan de De ´ u, Esplugues, Barcelona, Spain and k Department of Gastroenterology, Derbyshire Royal Infirmary, Derby, UK Correspondence and requests for reprints to M. Luisa Mearin, Department of Paediatrics, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands Tel: + 31 71 5262824/5262806; fax: + 31 71 5248198; e-mail: m.l.mearin_manrique@lumc.nl Sponsorship: This study was funded by grants from: Biomed 2 Programme, Concerted Action BMH4-CT98-3091; ERB IC20-CT98-0203 (BMH4-CT98- 3091) (PL-96 3091); Assistance Publique, Ho ˆ pitaux de Paris, INSERM, Fonds de Recherches de la Socie ´te ´ Nationale Franc ¸ aise de Gastroente ´ rologie, Comite ´ de Paris de la Ligue Nationale Contre le Cancer; Fondos de Investigaciones Sanitarias (FIS) 98/0066 and 00/1060E, Ministry of Health, Spain; the Medical Research Council of Southeast Sweden; the Medical Research Fund of Tampere University Hospital, Finland; the Research Committee (Komitet Badan Naukowych) KBN grant 4PO5B 076 16, Poland; the Dutch Digestive Diseases Foundation (WS97-29); the Dutch Organization for Health Research and Development (2100.00.38); and Nutricia NV, The Netherlands. Introduction Coeliac disease (CD) is an inflammatory condition of the small intestine in which dietary gluten causes damage to the mucosa in genetically susceptible individuals [1,2]. It is a common disorder affecting one in a hundred to two in a hundred of the general population [3,4], and is associated with many complications, including osteo- porosis [5,6], infertility and unfavourable outcomes of pregnancy [7,8], autoimmune diseases [9] and malig- nancies [10–14]. The overall risk of developing cancer has been estimated as two to threefold; for cancers of the mouth, pharynx and oesophagus, two to threefold; for enteropathy-associated T-cell lymphoma (EATL), 30–40- fold; and for small intestinal adenocarcinoma 83-fold [15–17]. Studies on patients with untreated CD suggest that they are also at high risk of developing non-Hodgkin lymphoma (NHL) of any primary site [18]. A recent Swedish population-based study showed that the risk of developing cancer is increased in cases of CD (standar- dized incidence ratio 1.3), but that it is lower than that found in studies from referral centres [19]. However, the study concerned patients with clinically overt CD [20]. * See Appendix for other members of the study group. 0954-691X  c 2006 Lippincott Williams & Wilkins Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.