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, 10 (10), 1136-1142.e3

Patients With Celiac Disease Have an Increased Risk for Pancreatitis

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Patients With Celiac Disease Have an Increased Risk for Pancreatitis

Omid Sadr-Azodi et al. Clin Gastroenterol Hepatol.

Abstract

Background & aims: Patients with celiac disease have been reported to be at increased risk for pancreatitis and pancreatic insufficiency, but the risk might have been overestimated because of patient selection and limited numbers of patients for analysis. Furthermore, no distinction has been made between patients with gallstone-related and non-gallstone-related pancreatitis. We performed a nationwide study to determine the risk for any pancreatitis or subtype of pancreatitis among patients with biopsy-verified celiac disease.

Methods: We analyzed data from patients in Sweden with celiac disease (n = 28,908) who were identified on the basis of small intestinal biopsy records from 28 pathology departments (those with villous atrophy, Marsh 3). Biopsies were performed from 1969 to 2008, and biopsy report data were collected from 2006 to 2008. Patients with pancreatitis were identified on the basis of diagnostic codes in the Swedish Patient Register and records of pancreatic enzyme use in the Swedish Prescribed Drug Register. Data were matched with those from 143,746 individuals in the general population; Cox regression was used to estimate hazard ratios (HRs) for pancreatitis.

Results: We identified 406 patients with celiac disease who were later diagnosed with pancreatitis (and 143 with expected pancreatitis) (HR, 2.85; 95% confidence interval [CI], 2.53-3.21). The absolute risk of any pancreatitis among patients with celiac disease was 126/100,000 person-years, with an excess risk of 81/100,000 person-years. The HR for gallstone-related acute pancreatitis was 1.59 (95% CI, 1.06-2.40), for non-gallstone-related acute pancreatitis HR was 1.86 (95% CI, 1.52-2.26), for chronic pancreatitis HR was 3.33 (95% CI, 2.33-4.76), and for supplementation with pancreatic enzymes HR was 5.34 (95% CI, 2.99-9.53). The risk of any pancreatitis within 5 years of diagnosis was 2.76 (95% CI, 2.36-3.22).

Conclusions: Based on an analysis of medical records from Sweden, patients with celiac disease have an almost 3-fold increase in risk of developing pancreatitis, compared with the general population.

Conflict of interest statement

Conflicts of interest/Disclosure summary

DS has received an educational and research grant from Solvay (formerly involved with Creon).

JAM: Grant support: Alba Therapeutics (>$50,000); Advisory board: Alvine Pharmaceuticals, Inc. (<$10,000), Nexpep (<$10,000), Consultant (none above 10,000 USD): Ironwood, Inc., Flamentera, Actogenix, Ferring Research Institute inc., Bayer Healthcare Pharmaceuticals, Vysera Biomedical, 2G Pharma, Inc, ImmunosanT, Inc and Shire US Inc.

The other authors (OSA and JFL) declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1. Flow chart of study participants
CD, Celiac disease * Inflammation (intraepithelial lymphocytosis) equals Marsh 1–2 # Normal mucosa with positive IgA/IgG endomysium, transglutaminase or gliadin antibodies. § Because all calculations were performed stratum-wise, reference individuals whose index individual with celiac disease had been excluded were also excluded.

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