Is Pancreatic Exocrine Insufficiency in Celiac Disease Tied to Changes in Pancreatic Parenchyma?

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By Jefferson Adams

November 9, 2016
By Jefferson Adams • November 9, 2016

Is Pancreatic Exocrine Insufficiency in Celiac Disease Tied to Changes in Pancreatic Parenchyma?

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What's the connection between pancreatic exocrine insufficiency in celiac disease and changes in pancreatic parenchyma?
Celiac.com 11/09/2016 - Although exocrine pancreatic insufficiency (EPI) has been reported in a number of patients with celiac disease (celiac disease), 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 celiac disease patients with EPI.

A team of researchers recently set out to prospectively assess pancreatic exocrine function in recently diagnosed celiac patients. The research team included Surinder S. Rana, Arvind Dambalkar, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Satyavati Rana, Deepak K. Bhasin and Ritambhra Nada. They are variously affiliated with the Department of Gastroenterology, and the Department of Histopathology at the Post Graduate Institute of Medical Education and Research (PGIMER) in Chandigarh, India.

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For their study, the team measured fecal elastase to prospectively assess pancreatic exocrine function in 36 recently diagnosed celiac patients. They relied on EPI by EUS and elastography to assess pancreatic structural changes in celiac patients. The team then reassessed exocrine functions in these patients after 3 months of gluten-free diet.

Of the 36 celiac patients the team studied, 30 patients had anemia, 21 had diarrhea, and 7 had hypothyroidism. Ten patients had EPI with mean elastase levels of 141.6 μg/g of stool, only one of whom had a history of recurrent acute pancreatitis, while the other 9 patients had no history of either acute or chronic pancreatitis. Of these 10 patients, 8 (80%) had diarrhea, 8 (80%) anemia, and 2 (20%) had hypothyroidism.

The team performed EUS in 8 patients. Five showed normal pancreas, 3 showed hyperechoic strands, and 2 patients showed hyperechoic foci without shadowing. None showed lobularity or parenchymal calcification. All patients, except the patient with recurrent pancreatitis, showed normal strain ratio. In 6 of the remaining 7 patients, follow-up fecal elastase fell within normal range.

EPI, as measured by fecal elastase levels in adult celiac patients, possibly does not relate to structural alterations in the pancreatic parenchyma, and may be reversible by following a gluten-free diet.

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Guest Sharon

Posted November 9, 2016

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I was diagnosed celiac 6 years ago. I am always careful to avoid cross contamination. But I still can't eat a meal without pancreatic enzymes.

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Guest Laura Burt-Thorpe

Posted November 14, 2017

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These are all very helpful since I seem to be having several issues going on. I am getting so confused. After many violent attacks of vomiting, diarrhea, nausea, stomach pain, fever, chills, fainting, over a 12 hour period, at first, I never attributed them to celiac, we settled on the pancreas. Went 6 months on enzymes, no attacks. Then had 2-3, out of the blue, figured it was Pancreatic Exocrine Insufficiency, so kept track of my fats, every day, for 13 months and no attacks. During that time had bread, pasta, with no problems. Then had 4 attacks within 3 weeks? They did not even happen around when I ate. Now I am really mystified. Had an upper GI, biopsy showed celiac. I am struggling with that because of the 13 months of eating it with no problems. An upper GI done 3 years ago, shows the biopsy was negative for celiac. My blood test was negative, yet lipase high, glucose high, and lactic acid critical. I also have thyroid trouble so these articles have been very insightful to help me realize that the 3 are/can be connected. I am still struggling with cutting out gluten but I do not want anymore attacks, my husband is beside himself over this. I knocked my 2 front teeth out during one of them when I fainted. I struggle too because it seems everyone has such different symptoms with different degrees of difficulty. Do most of you out there have instant reactions or can you go long periods without any?

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About Me

Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University. His articles, essays, poems, stories and book reviews have appeared in numerous magazines, journals, and websites, including North American Project, Antioch Review, Caliban, Mississippi Review, Slate, and more. He is the author of more than 2,500 articles on celiac disease. His university coursework includes studies in science, scientific methodology, biology, anatomy, physiology, medicine, logic, and advanced research. He previously devised health and medical content for Colgate, Dove, Pfizer, Sharecare, Walgreens, and more. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of numerous books, including "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

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