Risk of pancreatitis in 14,000 individuals with celiac disease.
ABSTRACT The aim of this study was to examine the risk of pancreatitis in patients with celiac disease (CD) from a general population cohort.
By using Swedish national registers, we identified 14,239 individuals with a diagnosis of CD (1964-2003) and 69,381 reference individuals matched for age, sex, calendar year, and county of residence at the time of diagnosis. Cox regression estimated the hazard ratios (HRs) for a subsequent diagnosis of pancreatitis. We restricted analyses to individuals with more than 1 year of follow-up and no diagnosis of pancreatitis before or within 1 year after study entry. Conditional logistic regression estimated the association of pancreatitis with subsequent CD.
CD was associated with an increased risk of subsequent pancreatitis of any type (HR, 3.3; 95% confidence interval [CI], 2.6-4.4; P < .001; on the basis of 95 positive events in individuals with CD vs 163 positive events in reference individuals) and chronic pancreatitis (HR, 19.8; 95% CI, 9.2-42.8; P < .001; on the basis of 37 and 13 positive events, respectively). Adjustment for socioeconomic index, diabetes mellitus, alcohol-related disorders, or gallstone disease had no notable effect on the risk estimates. The risk increase for pancreatitis was only found among individuals with CD diagnosed in adulthood. Pancreatitis of any type (odds ratio, 3.2; 95% CI, 2.5-4.3; P < .001) and chronic pancreatitis (odds ratio, 7.3; 95% CI, 4.0-13.5; P < .001) were associated with subsequent CD.
This study suggests that individuals with CD are at increased risk of pancreatitis.
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ABSTRACT: A 42-year-old man with a history of coronary artery disease and dyslipidemia presented to the emergency department with abdominal and chest discomfort. Two days earlier, he had had a sudden onset of abdominal pain in the left upper quadrant, which radiated to his back and in a bandlike pattern across the subcostal margin. The abdominal pain was associated with nausea and early satiety and worsened with movement. During the next 2 days, the abdominal discomfort increased from an intensity of 3 to 6 on a 10-point scale. In addition, he reported substernal chest pressure, which had developed the day before presentation and was consistent with his usual angina but was unresponsive to self-administration of one sublingual nitroglycerin tablet. The pain diminished with three sublingual nitroglycerin tablets administered in the emergency department but resolved only after he had been given intravenous morphine, ketorolac, and a chewable aspirin. The patient reported no abdominal trauma, emesis, rectal bleeding, or black stools. He had not consumed any meals outside his home recently. He reported having had chronic diarrhea since undergoing coronary-artery bypass surgery more than 10 years before presentation, but with increasing volume and frequency (four loose stools a day) after the dose of his cholesterol-lowering medication was increased 6 months earlier. He noted that the diarrhea would worsen with food intake. Over this period of time, he had a 16-kg (35-lb) unintentional weight loss with intermittent early satiety. He also noted daily headaches and frequent nocturia, and he reported feeling warm at night, without night sweats or fevers. A colonoscopy performed 4 months before the current presentation was unremarkable.New England Journal of Medicine 10/2014; 371(14):1333-1338. DOI:10.1056/NEJMcps1301321 · 54.42 Impact Factor
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ABSTRACT: Pediatric pancreatitis is a rare disease with variable etiology. In the past 10-15 years the incidence of pediatric pancreatitis has been increased. The management of pediatric pancreatitis requires up-to-date and evidence based management guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines and evidences. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and complemented and/or modified the international guidelines if it was necessary. In 8 topics (diagnosis; etiology; prognosis; imaging; therapy; biliary tract management; complications; chronic pancreatitis) 50 relevant clinical questions were defined. (Evidence was classified according to the UpToDate® grading system. The draft of the guidelines was presented and discussed at the consensus meeting on September 12, 2014. All clinical questions were accepted with total (more than 95%) agreement. The present Hungarian Pancreatic Study Group guideline is the first evidence based pediatric pancreatitis guideline in Hungary. This guideline provides very important and helpful data for tuition of pediatric pancreatitis in everyday practice and establishing proper finance and, therefore, the authors believe that these guidelines will widely serve as a basic reference in Hungary. Orv. Hetil., 2015, 156(8), 308-325.Orvosi Hetilap 02/2015; 156(8):308-25. DOI:10.1556/OH.2015.30062