Unexplained Elevated Serum Pancreatic Enzymes: A Reason to Suspect Celiac Disease

Carroccio, Antonio; Prima, Lidia Di; Scalici, C.; Soresi, Maurizio; Cefalù, Angelo B.; Noto, Davide; Averna, Maurizio; Montalto, Giuseppe; Iacono, Giuseppe

doi:10.1016/j.cgh.2005.12.027

Cited by 32 publications

(22 citation statements)

References 32 publications

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“…This patient had no clinical or imaging features of pancreatitis . Coeliac disease and inflammatory bowel disease (IBD) were associated with lipase elevations that came close to but did not reach three or more times the ULN (Table ).…”

Section: Resultsmentioning

confidence: 99%

Significant elevations of serum lipase not caused by pancreatitis: a systematic review

Hameed

Lam

Pleass

2015

HPB

100

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A series of differential diagnoses for significant serum lipase elevations (i.e. exceeding three times the ULN) has been provided by this study. Clinicians should utilize this knowledge in the interpretation and management of patients who have lipase levels over three times as high as the ULN, remaining vigilant for an alternative diagnosis to pancreatitis. The medical officer should be aware of the possibility of incorrect diagnosis in the asymptomatic patient.

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Section: Resultsmentioning

confidence: 99%

Significant elevations of serum lipase not caused by pancreatitis: a systematic review

Hameed

Lam

Pleass

2015

HPB

100

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“…However, the clinical presentation of CD seems to differ from the typical form observed in past years, as almost 50% of the patients with newly diagnosed CD do not present with gastrointestinal symptoms [35,36]. Thus, in order to identify the greatest number of "atypical" or "silent" CD patients and prevent long-term complications, it has been suggested that the clinicians should investigate those subjects who present "indirect" signs of CD, such as chronic anaemia [37], hyper-transaminasemia or hyperamylasemia of unknown origin [38,39], osteoporosis [40], autoimmune thyroid disorders [41]. …”

Section: Discussionmentioning

confidence: 99%

Lack of association between celiac disease and dental enamel hypoplasia in a case-control study from an Italian central region

et al. 2007

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“…It seems likely that the method of diagnosing acute pancreatitis and characteristics of the celiac population may have contributed to an even higher misdiagnosis rate. Diagnosis was based on a ‘combination of elevated serum amylase or lipase and clinical symptoms, including abdominal pain’, which would under-diagnose acute pancreatitis in patients with lower serum amylase values but imaging evidence of acute pancreatitis and would overdiagnose acute pancreatitis due to hyperamylasemia without acute pancreatitis, which the authors note may occur in a variety of conditions [1 ■ ], including celiac disease [5,6]. More importantly, there is no apparent validation for the methods to diagnose chronic pancreatitis, which was based on either ICD-CM codes in the registry and/or documentation of PERT prescriptions from the Swedish Prescribed Drug Register.…”

Section: Celiac Disease and Pancreatitismentioning

confidence: 99%

Chronic pancreatitis

DiMagno

2013

Current Opinion in Gastroenterology

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Purpose of review We review selected important clinical observations reported in 2012. Recent findings Celiac disease is a risk factor for pancreatitis. Patients with recurrent acute pancreatitis likely have chronic pancreatitis, do not benefit from pancreatic sphincterotomy, and may not benefit from biliary sphincterotomy. Analysis of endoscopic ultrasonography (EUS) images with an artificial neural network (ANN) program may improve chronic pancreatitis diagnosis compared with clinical interpretation of images. In a multicenter, randomized controlled trial of chronic pancreatitis patients, 90 000 USP U of pancreatin with meals decreased fat malabsorption compared with placebo. Detection of visceral pain in chronic pancreatitis predicts pain relief from various treatments, but nonvisceral pain due to altered central pain processing may respond to agents such as pregabalin. Predictors of surgical pain relief include onset of symptoms less than 3 years and preoperatively no opioid use and less than five endoscopic procedures. Total pancreatectomy for presumed painful chronic pancreatitis remains controversial. Summary Celiacs are at risk for pancreatitis. The diagnosis of chronic pancreatitis may be enhanced by ANN analysis of EUS imaging. Treatment of fat malabsorption requires 90 000 USP U of lipase with meals. Relief of pain from organ directed treatment of chronic pancreatitis may depend upon timing of interventions and whether pain is visceral or nonvisceral.

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Unexplained Elevated Serum Pancreatic Enzymes: A Reason to Suspect Celiac Disease

Cited by 32 publications

References 32 publications

Significant elevations of serum lipase not caused by pancreatitis: a systematic review

Significant elevations of serum lipase not caused by pancreatitis: a systematic review

Lack of association between celiac disease and dental enamel hypoplasia in a case-control study from an Italian central region

Chronic pancreatitis

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