Risk of malignancy and surveillance of premalignant gastrointestinal lesions in adult celiac disease

Celiac disease is a systemic autoimmune affliction triggered by dietary gluten in genetically predisposed subjects. Current estimation of the prevalence of celiac disease is approximately 1% for the global population. These data are consistent with current figures from the Czech Republic (prevalence of 1.06% in 2023). Celiac disease can be associated with several complications including malignancy. Exact epidemiology data on T-cell lymphoma and small intestinal adenocarcinoma in the Czech Republic over the period 2010–2023 are also provided. Unlike the no-biopsy approach in children, despite current non-conclusive discussion and besides serology, upper gastrointestinal endoscopy, biopsies, and histology are mandatory for proper diagnosis and initial assessment of the severity of celiac disease in adults. However, there are so far no unified and integrated recommendations for the follow-up of adult celiac disease. Although the risk of malignancy in celiac disease is relatively low, especially in a strict gluten-free diet, it might nevertheless be further decreased by an individualized surveillance. Endoscopy controls with biopsies for histology, immunohistochemistry, and flow cytometry are essential. The purpose of this article was to review the risk and diagnostics of malignancy in celiac disease. A proposal for the individualized surveillance of premalignant gastrointestinal lesions in adult celiac disease was drafted.