Dig Dis Sci. 2021 Aug;66(8):2691-2699. doi: 10.1007/s10620-020-06546-2. Epub 2020 Aug 18.

Motasem Alkhayyat ^1 2, Mohannad Abou Saleh ^1 3, Mohammad Abureesh ⁴, George Khoudari ¹, Thabet Qapaja ¹, Emad Mansoor ⁵, C Roberto Simons-Linares ¹, John Vargo ¹, Tyler Stevens ¹, Alberto Rubio-Tapia ¹, Prabhleen Chahal ^6 7

Author information

¹Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.

²Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.

³Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/A30, Cleveland, OH, 44195, USA.

⁴Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY, 10305, USA.

⁵University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.

⁶Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. chahalp@ccf.org.

⁷Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. chahalp@ccf.org.

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.