title: Is pancreatic exocrine insufficiency in celiac disease related to structural alterations in pancreatic parenchyma?
abstract: BACKGROUND
  Although exocrine pancreatic insufficiency (EPI) has been reported in a number of patients with celiac disease (CD), 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 CD patients with EPI.
  
  
  METHODS
  Pancreatic exocrine function was prospectively assessed in 36 recently diagnosed CD patients (mean age: 29.8 years) by measuring fecal elastase. Pancreatic structural changes were assessed in CD patients with EPI by EUS and elastography. Exocrine functions were reassessed after 3 months of gluten-free diet.
  
  
  RESULTS
  Of the 36 CD patients included, 30 (83%) had anemia, 21 (58%) diarrhea, and 7 (19%) hypothyroidism. Ten (28%) patients had EPI with mean elastase levels of 141.6 μg/g of stool, of whom only one had a history of recurrent acute pancreatitis while the rest 9 patients had no history of acute or chronic pancreatitis. Of these 10 patients, 8 (80%) had diarrhea, 8 (80%) anemia, and 2 (20%) hypothyroidism. EUS was done in 8 patients which showed: normal pancreas in 5 (50%), hyperechoic strands in 3 (30%), and hyperechoic foci without shadowing in 2 (20%) patients. None had lobularity or parenchymal calcification. All patients except the patient with recurrent pancreatitis had normal strain ratio. Follow-up fecal elastase was within normal range in 6 of 7 (86%) patients.
  
  
  CONCLUSIONS
  EPI, assessed by fecal elastase levels in adult CD patients, possibly does not relate to structural alterations in the pancreatic parenchyma and may be reversible by following a gluten-free diet.
authors.affiliation: Department of Gastroenterology (Surinder S. Rana, Arvind Dambalkar, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Satyavati Rana, Deepak K. Bhasin), Chandigarh, India.
authors.forename: Surinder S
authors.initials: SS
authors.lastname: Rana
authors.affiliation: Department of Gastroenterology (Surinder S. Rana, Arvind Dambalkar, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Satyavati Rana, Deepak K. Bhasin), Chandigarh, India.
authors.forename: Arvind
authors.initials: A
authors.lastname: Dambalkar
authors.affiliation: Department of Gastroenterology (Surinder S. Rana, Arvind Dambalkar, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Satyavati Rana, Deepak K. Bhasin), Chandigarh, India.
authors.forename: Puneet
authors.initials: P
authors.lastname: Chhabra
authors.affiliation: Department of Gastroenterology (Surinder S. Rana, Arvind Dambalkar, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Satyavati Rana, Deepak K. Bhasin), Chandigarh, India.
authors.forename: Ravi
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Department of Histopathology (Ritambhra Nada), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Ritambhra
authors.initials: R
authors.lastname: Nada
authors.affiliation: Department of Gastroenterology (Surinder S. Rana, Arvind Dambalkar, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Satyavati Rana, Deepak K. Bhasin), Chandigarh, India.
authors.forename: Vishal
authors.initials: V
authors.lastname: Sharma
authors.affiliation: Department of Gastroenterology (Surinder S. Rana, Arvind Dambalkar, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Satyavati Rana, Deepak K. Bhasin), Chandigarh, India.
authors.forename: Satyavati
authors.initials: S
authors.lastname: Rana
authors.affiliation: Department of Gastroenterology (Surinder S. Rana, Arvind Dambalkar, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Satyavati Rana, Deepak K. Bhasin), Chandigarh, India.
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Bhasin
keywords: Celiac disease; diarrhea; endosonography; fecal elastase; pancreatitis