S1705 Celiac Disease and Chronic Pancreatitis

Abstract

Introduction: Celiac disease involves a T-cell-mediated immune response to dietary gluten. Celiac disease has 3-fold increased risk for developing chronic pancreatitis but only has a reported incidence of 0.52%. We present a case of a 61-year-old male with newly diagnosed celiac disease who was incidentally found to have associated chronic pancreatitis. Case Description/Methods: A 61-year-old male with a past medical history of diabetes, hypertension, coronary artery disease, and a remote history of hepatitis presented to our clinic for his first screening colonoscopy and recent anemia. Prior to colonoscopy, the patient noted a 45-pound unintentional weight loss over the past few years, and with recent lab studies revealing a hemoglobin level of 11.7 g/dL. The patient then underwent colonoscopy, esophagogastroduodenoscopy (EGD), and an extensive laboratory work-up that was significant for iron deficiency anemia, anti-gliadin (AGA) IgA >150 U/mL, AGA-IgG 134 U/mL, endomysial (EMA)-IgA positive, tissue transglutaminase (tTG)-IgA >100 U/mL, total IgA 280 mg/dL, fecal elastase 31 mcg/g and was positive for anti-smooth muscle antibodies (1:160). Subsequent results were negative for viral hepatitis panel, antinuclear antibodies, anti-mitochondrial antibodies, alpha-1 antitrypsin levels, and normal ceruloplasmin levels. Colonoscopy was unrevealing except for a diminutive tubular adenoma. EGD later revealed blunted villi with flat mucosa in the first and second portion of the duodenum. Biopsy results later confirmed pathology results compatible with celiac disease. During this course of workup, the patient developed nephrolithiasis and with incidental findings of pancreatic atrophy and pancreatic head calcifications detected on CT urogram. Chronic pancreatitis was later confirmed on endoscopic ultrasound with evidence of multiple intraductal stones. Patient did not have a history of alcohol use or pancreatic problems in the family. After being diagnosed with Celiac disease and secondary chronic pancreatitis with exocrine pancreatic insufficiency, he was started on a gluten-free diet and pancrelipase. Patient was noted to have 9-pound weight gain during a 4 month follow-up appointment. Discussion: Chronic pancreatitis is a rare extraintestinal manifestation of celiac disease, reported to have a threefold increased risk but only with a reported incidence of 0.52% at least 30 days after diagnosis of celiac disease compared to 0.13% in non-celiac disease patients.