Pancreatic Exocrine Insufficiency Is Not Uncommon in Celiac Disease: A Systematic Review and Meta-Analysis

Abstract

Introduction: Pancreatic exocrine insufficiency (PEI) is seen in primary pancreatic disease but has also been seen in extrapancreatic conditions including celiac disease (CeD). The symptoms of PEI and CeD often overlap, which makes diagnostics challenging. In this systematic review and meta-analysis, we aimed to investigate the prevalence of PEI in CeD.

Methods: With the assistance of a professional librarian, we searched five databases: PubMed, Embase, Cochrane, Web of Science Core Collection, and Google Scholar, up until October 21, 2024. The pooled prevalence of PEI in biopsy-confirmed CeD was estimated, and the quality of studies appraised.

Results: We identified and screened the titles and abstracts of 1432 publications, of which 60 were reviewed in full text and 12 were included in the analyses. The overall pooled weighted prevalence of PEI in CeD was 13.5% (95% CI 7.2-21.0). The prevalence was similar among children (14.2%; 95% CI 2.0-32.8) and adults (12.8%; 95% CI 7.8-18.7) with CeD. The prevalence in studies that used secretory testing to define PEI was 13.1% (95% CI 6.4-21.3) and in those requiring digestive tests 17.1% (95% CI 5.8-32.1). The weighted prevalence of PEI was significantly higher among untreated CeD patients (18.2%) than patients on a gluten-free diet (6.9%) (p = 0.03), in both adults and children.

Conclusion: One in eight individuals with CeD may suffer from PEI. The prevalence was particularly high in untreated CeD. PEI should be considered in patients who do not respond to a gluten-free diet.

Keywords: celiac disease; enzyme replacement therapy; gluten‐free diet; malabsorption; meta‐analysis; pancreatic exocrine insufficiency; prevalence.