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The Risk of Acute and Chronic Pancreatitis in Celiac Disease

Abstract

Background and Aims

Celiac disease (CD) is a chronic immune-mediated enteropathy that is precipitated by dietary gluten in genetically predisposed individuals. A few studies reported a higher incidence of pancreatitis in the CD population. Using a large US database, we sought to describe the epidemiology, risk, and outcomes of acute pancreatitis (AP) and chronic pancreatitis (CP) in CD patients.

Methods

We queried a multiple health system data analytics and research platform (Explorys Inc, Cleveland, OH, USA). A cohort of patients with a diagnosis of CD was identified. Subsequently, individuals who developed a new diagnosis of AP and CP after at least 30 days of being diagnosed with CD were identified. A multivariate regression model was performed to adjust for multiple confounding factors.

Results

Of the 72,965,940 individuals in the database, 133,400 (0.18%), 362,050 (0.50%), and 95,190 (0.13%) had CD, AP, and CP, respectively. New diagnosis of AP and CP after at least 30 days of CD diagnosis was 1.06%, 0.52%, respectively, compared to non-CD patients with 0.49% for AP and 0.13% for CP, P < .0001. In multivariate regression analysis, patients with CD were at higher risk of developing AP [OR 2.66; 95% CI 2.55–2.77] and CP [OR 2.18; 95% CI 2.04–2.34]. Idiopathic AP was the most common etiology among CD patients [OR 1.54; 95% CI 1.34–1.77].

Conclusions

In this largest US population database and after adjusting for several confounders, patients with CD were at increased risk of developing AP and CP. Celiac disease patients had worse outcomes and higher medical burden compared to non-CD patients. Recurrent abdominal pain that suggests pancreatic etiology, idiopathic pancreatitis, or elevation of pancreatic enzymes should warrant investigation for CD as a potential cause of pancreatic disease.

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Abbreviations

AP:

Acute pancreatitis

ARDS:

Acute respiratory distress syndrome

CD:

Celiac disease

CI:

Confidence interval

CP:

Chronic pancreatitis

HIPAA:

Health Insurance Portability and Accountability Act

ICD:

International Classification of Diseases

IRB:

Institutional Review Board

OR:

Odds ratio

SNOMED-CT:

Systematized Nomenclature of Medicine-Clinical Terms

US:

United States

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Funding

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Authors

Contributions

Study conception and design were contributed by Alkhayyat, MAS, EM and PC. Acquisition of data was contributed by Alkhayyat, MAS, Abureesh, EM and CRS-L. Analysis and interpretation of data were contributed by Alkhayyat, MAS, Abureesh, GK and PC. Drafting of manuscript was contributed by Alkhayyat, MAS, GK and TQ. Critical revision was contributed by JV, TS, AR-T and PC. Statistical analysis was contributed by Alkhayyat, MAS, Abureesh and PC. Study supervision was contributed by PC.

Corresponding author

Correspondence to Prabhleen Chahal.

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There are no potential conflicts (financial, professional, or personal) to disclose by all the authors.

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Alkhayyat, M., Saleh, M.A., Abureesh, M. et al. The Risk of Acute and Chronic Pancreatitis in Celiac Disease. Dig Dis Sci 66, 2691–2699 (2021). https://doi.org/10.1007/s10620-020-06546-2

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Keywords

  • Risk factors
  • Pancreatitis
  • Celiac disease
  • Epidemiology