title: Pancreatic insufficiency in adult celiac disease: do patients require long-term enzyme supplementation?
abstract: BACKGROUND
  Celiac disease is associated with exocrine pancreatic insufficiency. We previously reported that in 30% (20/66) of adult celiac patients with current or persistent diarrhea the underlying cause was exocrine pancreatic insufficiency. Of these 20 patients, 19 initially improved on pancreatic supplementation. To date, there are no published longitudinal studies.
  
  
  METHODS
  The 20 patients who had initially received therapy for exocrine pancreatic insufficiency were prospectively followed-up for 4 years. Gastrointestinal symptoms, dietary adherence, celiac antibody status, and dose of enzyme supplementation were recorded. Fecal elastase-1 (Fel-1) was repeated to reassess exocrine pancreatic function.
  
  
  RESULTS
  In the study, 19/20 patients were reviewed, as one had died (mean age 59.7 years, 7 males). The mean duration of celiac disease was 13.2 years. Eleven out of nineteen were still taking enzyme supplementation at a mean dose of 45,000 units of lipase per day. Only 1/11 reported no symptomatic benefit and 8/19 patients had discontinued supplementation because their diarrhea had improved. In the whole group there was a significant increase in Fel-1 levels over time, with median values of 90 μg/g at 0 months, 212 μg/g at 6 months, and 365 μg/g at follow-up (45-66 months)(p < 0.0001).
  
  
  CONCLUSIONS
  Fecal elastase-1 is useful in identifying exocrine pancreatic insufficiency in adult celiac patients with diarrhea. Our longitudinal data suggests that pancreatic enzyme supplementation could be discontinued in a substantial proportion of patients as symptoms improve.
authors.affiliation: Department of Gastroenterology, Sheffield Teaching Hospitals Trust, Sheffield, UK. kate.evans@sth.nhs.uk
authors.forename: Kate E
authors.initials: KE
authors.lastname: Evans
authors.forename: John S
authors.initials: JS
authors.lastname: Leeds
authors.forename: Stephen
authors.initials: S
authors.lastname: Morley
authors.forename: David S
authors.initials: DS
authors.lastname: Sanders
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002446:Celiac Disease / Q000150:complications* / Q000188:drug therapy*; D003967:Diarrhea / Q000188:drug therapy / Q000209:etiology; D016903:Drug Monitoring; D056947:Enzyme Replacement Therapy; D010188:Exocrine Pancreatic Insufficiency / Q000188:drug therapy* / Q000209:etiology*; D005243:Feces / Q000201:enzymology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010196:Pancreatic Elastase / Q000378:metabolism; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D010196:Pancreatic Elastase
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