title: Exocrine pancreatic insufficiency, MRI of the pancreas and serum nutritional markers in patients with coeliac disease.
abstract: OBJECTIVE
  To determine whether exocrine pancreatic function is impaired in patients with coeliac disease (CD) in our population and to evaluate its clinical importance.
  
  
  METHODS
  Pancreatic exocrine function was determined by measuring faecal elastase-1 (FE) concentration. CD was diagnosed by serological testing using IgA anti-tissue transglutaminase antibody (IgAtTg) and small bowel biopsy using the Marsh classification. MRI of the pancreas was performed to evaluate any morphological changes. The study took place from January 2012 to December 2013.
  
  
  RESULTS
  90 patients (73 women and 17 men) of mean age 43.8±17.7 years (range 20-80) were included in the study. Mean time from CD confirmation was 5.8±0.7 years (range 1-25). Exocrine pancreatic insufficiency (EPI) was diagnosed in four (4.4%) patients (one with mild EPI and three with severe EPI). MRI showed no morphological changes in any of the four patients. In all patients with EPI at least one serological nutritional marker was below the lower limit of normal.
  
  
  CONCLUSIONS
  EPI is present in a small number of patients with CD. EPI should be excluded in all patients with CD in the presence of overt malnutrition or in cases of persistent gastrointestinal symptoms despite a gluten-free diet. Measurement of a serum nutritional panel, regardless of the presence of clinical symptoms of EPI, can be of clinical importance. MRI should be performed to exclude any morphological change in the pancreas.
authors.affiliation: Department of Internal Medicine, Slovenj Gradec General Hospital, Slovenj Gradec, Slovenia.
authors.forename: Miroslav
authors.initials: M
authors.lastname: Vujasinovic
authors.affiliation: Abakus Medico Diagnostic Centre, Rogaska Slatina, Slovenia.
authors.forename: Bojan
authors.initials: B
authors.lastname: Tepes
authors.affiliation: Diagnostic Centre Bled, Bled, Slovenia.
authors.forename: Jasna
authors.initials: J
authors.lastname: Volfand
authors.affiliation: Department of Radiology, University Medical Centre Maribor, Maribor, Slovenia.
authors.forename: Sasa
authors.initials: S
authors.lastname: Rudolf
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002446:Celiac Disease / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D010188:Exocrine Pancreatic Insufficiency / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D005243:Feces; D005260:Female; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000097:blood* / Q000503:physiopathology; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D010179:Pancreas / Q000473:pathology*; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers