Treatment failure in celiac disease due to coexistent exocrine pancreatic insufficiency

Weizman, Z., Hamilton, J.R., Kopelman, H.R., Cleghorn, G.J., & Durie, P.R. (1987) Treatment failure in celiac disease due to coexistent exocrine pancreatic insufficiency. Pediatrics, 80(6), pp. 924-926.

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A 17-year-old white adolescent had a history of chronic diarrhea, delayed puberty, and growth failure. Investigations excluded cystic fibrosis, Shwachman syndrome, and endocrine causes of growth failure. Severe steatorrhea was diagnosed from fecal fat studies, and a jejunal suction biopsy showed total villus atrophy, consistent with a diagnosis of celiac diseases. Following introduction of a gluten-free diet, his appetite and growth improved, but he continued to have abdominal discomfort and loose offensive bowel motions. One year later, severe steatorrhea was present. A repeat jejunal biopsy showed partial recovery of villus architecture. Serum immunoreactive trypsinogen level was low, which was highly suggestive of exocrine pancreatic failure. Results of quantitative pancreatic stimulation test confirmed the presence of primary pancreatic insufficiency. After introduction of oral pancreatic enzyme supplements with meals, his gastrointestinal symptoms resolved and growth velocity accelerated. Previously, primary pancreatic insufficiency has only been described in elderly patients with long-standing untreated celiac disease. This case, however, emphasizes that pancreatic failure can occur with celiac disease at any age. Determination of a serum immunoreactive trypsinogen level should be considered a useful screening tool for pancreatic insufficiency in patients with celiac disease who have not responded to a gluten-free diet.

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19 citations in Scopus
18 citations in Web of Science®
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ID Code: 90834
Item Type: Journal Article
Refereed: Yes
Keywords: pancreas enzyme, trypsinogen, case report, celiac disease, congenital malformation, gluten free diet, human, pancreas function, pancreas insufficiency, steatorrhea, Adolescent, Gluten, Growth Disorders, Male, Pancreatic Function Tests, Pancreatic Insufficiency
ISSN: 0031-4005
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Deposited On: 30 Nov 2015 02:02
Last Modified: 30 Nov 2015 02:02

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