Division of Gastroenterology, University of Miami/Jackson Memorial Hospital, Miami, USA.
Dig Dis Sci. 2023 Aug;68(8):3421-3427. doi: 10.1007/s10620-023-07965-7. Epub 2023 Jun 9.
The prevalence of celiac disease (CD) is approximately 1% in the US. Studies have shown possible association between exocrine pancreatic insufficiency (EPI) and CD, with numerous hypothesized biological mechanisms including small bowel mucosal damage causing disruption of enteric-mediated hormonal secretion such as cholecystokinin and loss of enterokinase. The overall prevalence of EPI in CD remains unknown. We performed systematic review and metanalysis and examined the prevalence of EPI in patients who were first diagnosed with CD versus those who had been on treatment with gluten-free diet (GFD). Results Six studies were included in the analysis totaling 446 CD patients (Avg age 44.1 years; 34% Males). One hundred and forty-four patients had newly diagnosed CD, and 302 patients had known CD with at least 9 months treatment with GFD. Four studies examined newly diagnosed CD patients. The individual rates of EPI in new CD patients ranged from 10.5 to 46.5%. The pooled prevalence of EPI in newly diagnosed CD patients was 26.2% (95% CI 8.43-43.92%, Q = 2.24, I = 0%). Five studies examined CD patients on GFD. The rate of EPI ranged from 1.9% to 18.2%. The prevalence of EPI in patients treated with GFD is 8% (95% CI 1.52-14.8%, Q = 4.42, I = 9.59%). Patients with newly diagnosed CD are significantly more likely to have EPI compared to those patients treated with GFD (p = 0.031). CD patients on GFD with persistent symptoms have a significantly higher rate of EPI (28.4%) compared to CD patients on GFD who are asymptomatic (3%) (p < 0.001).
乳糜泻（CD）的患病率在美国约为 1%。研究表明，外分泌胰腺功能不全（EPI）与 CD 之间可能存在关联，有许多假设的生物学机制，包括小肠黏膜损伤导致肠源性激素分泌中断，如胆囊收缩素和肠激酶丢失。CD 中 EPI 的总体患病率尚不清楚。我们进行了系统评价和荟萃分析，检查了首次诊断为 CD 的患者与接受无麸质饮食（GFD）治疗的患者中 EPI 的患病率。结果 纳入的分析共包括 6 项研究，总计 446 例 CD 患者（平均年龄 44.1 岁；34%为男性）。144 例患者为新诊断的 CD，302 例患者为已知的 CD，接受 GFD 治疗至少 9 个月。4 项研究检查了新诊断的 CD 患者。新 CD 患者的 EPI 个体发生率为 10.5%至 46.5%。新诊断 CD 患者的 EPI 总患病率为 26.2%（95%CI 8.43-43.92%，Q=2.24，I=0%）。5 项研究检查了接受 GFD 治疗的 CD 患者。EPI 发生率为 1.9%至 18.2%。接受 GFD 治疗的患者中 EPI 的患病率为 8%（95%CI 1.52-14.8%，Q=4.42，I=9.59%）。与接受 GFD 治疗的患者相比，新诊断的 CD 患者发生 EPI 的可能性显著更高（p=0.031）。持续存在症状的接受 GFD 治疗的 CD 患者的 EPI 发生率明显高于无症状的接受 GFD 治疗的 CD 患者（28.4%比 3%）（p<0.001）。
