Gastroenterology, April 2006
Gastroenterology, April 2006
Journal Scan is the clinician's guide to the latest clinical research findings in Gastroenterology, Hepatology, The American Journal of Gastroenterology, Gastrointestinal Endoscopy, and other specialty journals of interest to gastroenterologists and hepatologists. Each installment of the Gastroenterology Journal Scan includes short summaries and clinical commentary for select feature articles from the just-published literature as well as the original article abstracts when available.
Carroccio A, Di Prima L, Scalici C, et al
Clinical Gastroenterology and Hepatology. 2006:4;455-459
Summary: The small intestine is the primary target organ for gluten-sensitive enteropathy (celiac disease). Recently, however, there has been focus on the nonintestinal involvements associated with celiac disease. For example, on the basis of reported deficiency in duodenal output of pancreatic enzymes in some patients, pancreatic insufficiency has been suggested in this setting. To date, there have been no studies assessing the prevalence of abnormal pancreatic enzyme levels in patients with celiac disease.
This current study involved 202 patients with confirmed celiac disease (90 adult, 112 pediatric). For all subjects, serum amylase, pancreatic isoamylase, and lipase were assayed at baseline and after 12 months of a gluten-free diet. Additionally, in 42 of the patients, serum trypsin and elastase levels were determined. All patients underwent abdominal ultrasonography. None of the adults had a history of alcohol abuse (defined as daily consumption > 40 mL). For comparison of the prevalence data on the pancreatic assays, the values were compared with a matched control population of 50 adults and 40 children. All control subjects were negative for celiac disease serology and had no reported history of alcohol abuse.
At the time of diagnosis, 55 of the 202 (27.2%) patients had elevated amylase and/or lipase levels (26/55 had both elevated amylase and lipase, 15/55 had elevated amylase alone, and 14/55 had elevated lipase alone).The frequency of increased enzyme levels was marginally but not statistically higher in the adults compared with the pediatric patients. Most of the increases were less than 2-fold above the threshold normal values. In the 42 adults tested, serum trypsin and elastase levels were elevated in 69% and 19% of cases, respectively. No abnormalities were evident on pancreatic ultrasound evaluation. The elevations in the amylase and lipase values were persistent on reevaluation after 12 months of a gluten-free diet.
Commentary: This study shows a surprisingly high frequency of increased pancreatic enzyme levels in both adult and pediatric patients at the time of diagnosis of celiac disease. There were no clinical correlates with a diagnosis of pancreatitis in any of these patients. These data suggest that elevation in serum pancreatic enzyme levels without evidence of pancreatic disease should be considered within the laboratory spectrum of celiac disease. Although this condition is one of the most frequent genetic disorders in the United States and Europe (prevalence range of 1/130-1300), it is still relatively rare to diagnose in clinical practice. The latter is largely due to the lack of recognition by physicians of the protean, and in this case extraintestinal, manifestations of this disorder. As clinicians are now conducting more evaluations for celiac disease in patients with otherwise unexplained elevations in serum liver enzyme levels, we should likely be taking this same approach in patients with unexplained elevations in pancreatic enzyme levels as well.
Abstract
http://www.medscape.com/medline/abstract/16616350
Clinical Gastroenterology and Hepatology
Journal Scan is the clinician's guide to the latest clinical research findings in Gastroenterology, Hepatology, The American Journal of Gastroenterology, Gastrointestinal Endoscopy, and other specialty journals of interest to gastroenterologists and hepatologists. Each installment of the Gastroenterology Journal Scan includes short summaries and clinical commentary for select feature articles from the just-published literature as well as the original article abstracts when available.
Unexplained Elevated Serum Pancreatic Enzymes: A Reason to Suspect Celiac Disease
Carroccio A, Di Prima L, Scalici C, et al
Clinical Gastroenterology and Hepatology. 2006:4;455-459
Summary: The small intestine is the primary target organ for gluten-sensitive enteropathy (celiac disease). Recently, however, there has been focus on the nonintestinal involvements associated with celiac disease. For example, on the basis of reported deficiency in duodenal output of pancreatic enzymes in some patients, pancreatic insufficiency has been suggested in this setting. To date, there have been no studies assessing the prevalence of abnormal pancreatic enzyme levels in patients with celiac disease.
This current study involved 202 patients with confirmed celiac disease (90 adult, 112 pediatric). For all subjects, serum amylase, pancreatic isoamylase, and lipase were assayed at baseline and after 12 months of a gluten-free diet. Additionally, in 42 of the patients, serum trypsin and elastase levels were determined. All patients underwent abdominal ultrasonography. None of the adults had a history of alcohol abuse (defined as daily consumption > 40 mL). For comparison of the prevalence data on the pancreatic assays, the values were compared with a matched control population of 50 adults and 40 children. All control subjects were negative for celiac disease serology and had no reported history of alcohol abuse.
At the time of diagnosis, 55 of the 202 (27.2%) patients had elevated amylase and/or lipase levels (26/55 had both elevated amylase and lipase, 15/55 had elevated amylase alone, and 14/55 had elevated lipase alone).The frequency of increased enzyme levels was marginally but not statistically higher in the adults compared with the pediatric patients. Most of the increases were less than 2-fold above the threshold normal values. In the 42 adults tested, serum trypsin and elastase levels were elevated in 69% and 19% of cases, respectively. No abnormalities were evident on pancreatic ultrasound evaluation. The elevations in the amylase and lipase values were persistent on reevaluation after 12 months of a gluten-free diet.
Commentary: This study shows a surprisingly high frequency of increased pancreatic enzyme levels in both adult and pediatric patients at the time of diagnosis of celiac disease. There were no clinical correlates with a diagnosis of pancreatitis in any of these patients. These data suggest that elevation in serum pancreatic enzyme levels without evidence of pancreatic disease should be considered within the laboratory spectrum of celiac disease. Although this condition is one of the most frequent genetic disorders in the United States and Europe (prevalence range of 1/130-1300), it is still relatively rare to diagnose in clinical practice. The latter is largely due to the lack of recognition by physicians of the protean, and in this case extraintestinal, manifestations of this disorder. As clinicians are now conducting more evaluations for celiac disease in patients with otherwise unexplained elevations in serum liver enzyme levels, we should likely be taking this same approach in patients with unexplained elevations in pancreatic enzyme levels as well.
References
Carroccio A, Iacono G, Montalto G, et al. Exocrine pancreatic function in children with coeliac disease before and after a gluten free diet. Gut. 1991;32:796-799.
Not T, Horvath K, Hill ID. Celiac disease risk in the USA: high prevalence of antiendomysium antibodies in healthy blood donors. Scand J Gastroenterol. 1998;33:494-498.
Abstract
http://www.medscape.com/medline/abstract/16616350
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