Is exocrine pancreatic insufficiency in adult coeliac disease a cause of persisting symptoms?
BACKGROUND
Patients with coeliac disease may have diarrhoea despite being on a gluten-free diet.


OBJECTIVE
To assess whether exocrine pancreatic insufficiency causes persisting symptoms compared with controls, we determined whether pancreatic enzyme supplementation provided symptomatic benefit in coeliac patients with chronic diarrhoea.


METHODS
Patients (n = 259) were subdivided into four groups: (a) new coeliac disease (n = 57), (b) coeliac disease patients on a gluten-free diet without gastrointestinal symptoms (n = 86), (c) coeliac disease patients on a gluten-free diet with chronic diarrhoea (n = 66) and (d) patients with chronic diarrhoea without coeliac disease (n = 50). Stool frequency and weight, before and after treatment with pancreatic enzyme supplementation were recorded.


RESULTS
The prevalence of a low faecal elastase-1 within the groups was: group (A) six of 57 (11%), group (B) five of 86 (6%), group (C) 20 of 66 (30%) and group (D) two of 50 (4%). Low faecal elastase-1 was more frequent in coeliac disease patients with chronic diarrhoea vs. other subgroups of coeliac disease (P < or = 0.0001) and controls (P < or = 0.0003). In 18 of 20 stool frequency reduced following pancreatic enzyme supplementation from four per day to one (P < or = 0.001). No weight increase (P = 0.3) was observed.


CONCLUSIONS
Low faecal elastase is common in patients with coeliac disease and chronic diarrhoea, suggesting exocrine pancreatic insufficiency. In this group of patients, pancreatic enzyme supplementation may provide symptomatic benefit.
Leeds
J S
JS
Department of Gastroenterology, Sheffield Teaching Hospitals Trust, Sheffield, UK. jsleeds@hotmail.com
Hopper
A D
AD
Hurlstone
D P
DP
Edwards
S J
SJ
McAlindon
M E
ME
Lobo
A J
AJ
Donnelly
M T
MT
Morley
S
S
Sanders
D S
DS
D000328:Adult; D002446:Celiac Disease / Q000150:complications / Q000503:physiopathology*; D003967:Diarrhea / Q000209:etiology*; D010188:Exocrine Pancreatic Insufficiency / Q000150:complications / Q000503:physiopathology*; D005260:Female; D005983:Glutens / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010186:Pancreatic Function Tests
D005983:Glutens