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Exocrine Pancreatic Insufficiency Is Common in Celiac Disease: A Systematic Review and Meta-Analysis

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Abstract

The prevalence of celiac disease (CD) is approximately 1% in the US. Studies have shown possible association between exocrine pancreatic insufficiency (EPI) and CD, with numerous hypothesized biological mechanisms including small bowel mucosal damage causing disruption of enteric-mediated hormonal secretion such as cholecystokinin and loss of enterokinase. The overall prevalence of EPI in CD remains unknown. We performed systematic review and metanalysis and examined the prevalence of EPI in patients who were first diagnosed with CD versus those who had been on treatment with gluten-free diet (GFD). Results  Six studies were included in the analysis totaling 446 CD patients (Avg age 44.1 years; 34% Males). One hundred and forty-four patients had newly diagnosed CD, and 302 patients had known CD with at least 9 months treatment with GFD. Four studies examined newly diagnosed CD patients. The individual rates of EPI in new CD patients ranged from 10.5 to 46.5%. The pooled prevalence of EPI in newly diagnosed CD patients was 26.2% (95% CI 8.43–43.92%, Q = 2.24, I2 = 0%). Five studies examined CD patients on GFD. The rate of EPI ranged from 1.9% to 18.2%. The prevalence of EPI in patients treated with GFD is 8% (95% CI 1.52–14.8%, Q = 4.42, I2 = 9.59%). Patients with newly diagnosed CD are significantly more likely to have EPI compared to those patients treated with GFD (p = 0.031). CD patients on GFD with persistent symptoms have a significantly higher rate of EPI (28.4%) compared to CD patients on GFD who are asymptomatic (3%) (p < 0.001).

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Acknowledgments

We thank Pranusha Atuluru for her contribution to the editing of citations to DDS guidelines.

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  1. Division of Gastroenterology, University of Miami/Jackson Memorial Hospital, Miami, USA

    Chunsu Jiang, Jodie A. Barkin & Jamie S. Barkin

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  1. Chunsu Jiang
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Contributions

CJ contributed to study concept and design, acquisition of data, analysis and interpretation of the data, drafting of the manuscript, and statistical analysis. JAB contributed to drafting of the manuscript and critical revision of the manuscript for important intellectual content. JB contributed to study concept and design, acquisition of the data, drafting of the manuscript, and critical revision of the manuscript for important intellectual content.

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Correspondence to Chunsu Jiang.

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Jiang, C., Barkin, J.A. & Barkin, J.S. Exocrine Pancreatic Insufficiency Is Common in Celiac Disease: A Systematic Review and Meta-Analysis. Dig Dis Sci 68, 3421–3427 (2023). https://doi.org/10.1007/s10620-023-07965-7

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