Pancreatic involvement in celiac disease

Table 1 Summary of studies looking at acute pancreatitis and chronic pancreatitis prevalence among individuals with celiac disease

Ref.	CD, n	Pancreatitis prevalence	OR of AP	Outcome
Alkhayyat et al[21], 2021	133400	AP 1.06%; CP 0.52%	OR for AP = 2.66; OR for CP = 2.18	Worse outcomes compared to non-CD
Osagiede et al[24], 2020	337201	AP 2.2%	OR = 1.92	Lower morbidity and mortality, attributed to less severe forms of AP or lower baseline comorbidities
Sadr-Azodi et al[22], 2012	28908	Pancreatitis 1.4%	HR for gallstone-related AP = 1.59; HR for non-gallstone-related AP = 1.86; HR for CP = 3.33	Increased risk of severe AP (gallstone-related: HR = 3.18; non-gallstone related: HR = 2.00)
Ludvigsson et al[23], 2007	14239	Pancreatitis any type 0.66%	HR for pancreatitis of any type = 3.3; HR for CP = 19.8	Patient population was represented by hospital inpatients, leaving out those managed as outpatients

AP: Acute pancreatitis; CD: Celiac disease; CP: Chronic pancreatitis; HR: Hazard ratio; OR: Odds ratio.

Table 2 Mechanisms of pancreatic exocrine insufficiency in celiac disease

No.
1	Impaired secretion of cholecystokinin and secretin from the diseased small bowel mucosa
2	Reduced amino acid uptake in the small bowel, which subsequently leads to reduction in precursors for synthesis of pancreatic enzymes
3	Morphologic alterations in pancreatic parenchyma secondary to protein malnutrition