Is pancreatic exocrine insufficiency in celiac disease related to structural alterations in pancreatic parenchyma?

Abstract

BackgroundAlthough exocrine pancreatic insufficiency (EPI) has been reported in a number of patients with celiac disease (CD), it is not clear if this is primarily a functional or a structural defect. We studied pancreatic structural abnormalities by endoscopic ultrasound (EUS) in adult CD patients with EPI.MethodsPancreatic exocrine function was prospectively assessed in 36 recently diagnosed CD patients (mean age: 29.8 years) by measuring fecal elastase. Pancreatic structural changes were assessed in CD patients with EPI by EUS and elastography. Exocrine functions were reassessed after 3 months of gluten-free diet.ResultsOf the 36 CD patients included, 30 (83%) had anemia, 21 (58%) diarrhea, and 7 (19%) hypothyroidism. Ten (28%) patients had EPI with mean elastase levels of 141.6 μg/g of stool, of whom only one had a history of recurrent acute pancreatitis while the rest 9 patients had no history of acute or chronic pancreatitis. Of these 10 patients, 8 (80%) had diarrhea, 8 (80%) anemia, and 2 (20%) hypothyroidism. EUS was done in 8 patients which showed: normal pancreas in 5 (50%), hyperechoic strands in 3 (30%), and hyperechoic foci without shadowing in 2 (20%) patients. None had lobularity or parenchymal calcification. All patients except the patient with recurrent pancreatitis had normal strain ratio. Follow-up fecal elastase was within normal range in 6 of 7 (86%) patients.ConclusionEPI, assessed by fecal elastase levels in adult CD patients, possibly does not relate to structural alterations in the pancreatic parenchyma and may be reversible by following a gluten-free diet.

Coeliac disease in infants: antibodies to deamidated gliadin peptide come first!

“…In subjects with villous atrophy, the mucosal damage may impair the release of enteric hormones (secretin and cholecystokinin) and cause secondary reduction of exocrine pancreatic secretion, which includes fecal elastase [ 46 – 50 ]. However in children with CD, fecal elastase concentration usually normalizes after a few months from the introduction of a gluten free diet [ 51 ], as in the case presented here.…”

Less common etiologies of exocrine pancreatic insufficiency

“…In a single-center study by Rana et al[ 142 ], 36 patients with celiac disease serologically and histopathologically diagnosed were studied with fecal elastase, endoscopic ultrasound (EUS), and elastography. At study entry, 10 of the patients (28%) were diagnosed with EPI based on abnormal fecal elastase levels; 9 (90%) of these patients had villous atrophy of the duodenum, and 1 patient had a history of several episodes of acute pancreatitis.…”

Pancreatic exocrine dysfunction: common in type 3c diabetes, but don't forget types 1 and 2 diabetes mellitus

“…Other rarer conditions can also cause PEI, including hereditary haemochromatosis due to the iron deposition within the pancreas. Coeliac disease is thought to cause PEI in some patients due to damage to duodenal villi resulting in reduced secretin and CCK release, in addition to the increased incidence of chronic pancreatitis seen in patients with the condition; and Zollinger‐Ellison syndrome, in which the excessive gastric acid production can inactivate the pancreatic enzymes …”