Celiac disease (CD) is an autoimmune intestinal disorder that affects approximately 1% of the Western population. Patients with CD have been reported to have an increased risk for having coexisting pancreatitis. A Swedish study that used their national database found an almost 3-fold risk of developing pancreatitis in CD patients compared to that of the general population. This relationship has not been verified in the United States population. No studies have been conducted on this association using a national database in the United States. The association of pancreatitis with CD is believed to be related to the exocrine pancreatic insufficiency (EPI) that has been reported in patients with untreated CD. Among patients with newly diagnosed CD, 10% to 20% of individuals are likely to experience EPI. The aim of this study was to determine whether CD is associated with pancreatitis using a large national database.Methods:
We performed a cross-sectional study using the National Inpatient Sample (NIS) database (Healthcare Cost and Utilization Project (HCUP) of the Agency for Healthcare Research and Quality) of hospital admissions from 2013. We included all patients with CD (ICD 9 Code: 579.0) (study group) and those without CD (control group). We analyzed both groups for the presence or absence of acute and chronic pancreatitis (ICD 9 Codes: 577.0 and 577.1) along with patient demographics. Patients who had a diagnosis of both acute and chronic pancreatitis were put into the chronic category to include patients admitted for an acute on chronic episode. Continuous variables were compared using t-tests and categorical variables were compared using Rao-Scott chi-square tests.Results:
Our study included more than 35 million related hospitalizations in 2013 out of which 38,835 had an admission diagnosis of CD, 378,715 patients had acute pancreatitis, and 155,130 patients had chronic pancreatitis with or without acute pancreatitis. There was a higher percentage of females in the CD group (70.6%) than that in the control group (57.4%) (P < 0.001). Of 5 stratified age groups, the older age group (>65 yr) had the most patients with CD, comprising 37.0% of the total CD population, followed by the 51 to 65 age group comprising 23.5% of the total CD population (P < 0.001). Patients with CD are also more likely to be Caucasian (81.6%) than the non-CD control group (61.9%) (P < 0.001). Patients with CD were found to be significantly more likely to have acute pancreatitis (2.3%) than non-CD controls (1.2%) (P < 0.001). Patients with CD were also found to be significantly more likely to have chronic pancreatitis (1.2%) than the control group (0.43%) (P < 0.001).Conclusions:
This study revealed that the prevalence of acute and chronic pancreatitis is higher in patients with CD than controls. Moreover, CD patients appear to have a greater risk of developing chronic pancreatitis as opposed to acute pancreatitis, suggesting a “dose-response” trend. Further prospective studies are needed to further support this claim.