Poddighe Dimitri
College of Health Sciences, Vin University, Gia Lam District, Hanoi 10000, Vietnam.
Diagnostics (Basel). 2025 May 14;15(10):1243. doi: 10.3390/diagnostics15101243.
Celiac disease (CD) is a chronic and immune-mediated disorder triggered by the ingestion of gluten in some genetically predisposed individuals. CD can be associated with extra-gastrointestinal manifestations and diseases affecting several organs. In this review, the aim is to analyze and discuss the pancreatic alterations and/or comorbidities that could arise in the context of pediatric CD. Exocrine pancreatic insufficiency (EPI) can be observed in a variable fraction (up to 30%) of children diagnosed with CD at the diagnosis; indeed, it usually resolves after the implementation of a gluten-free diet (GFD). The main pathophysiological mechanisms of EPI could be represented by the impaired pattern of gastrointestinal hormones in CD patients. Conversely, pancreatitis seems to be a very rare comorbidity in CD children, since very few cases have been described in children. Therefore, there is no evidence that pancreatitis (including autoimmune forms) represents a relevant comorbidity in pediatric CD. Type 1 diabetes mellitus (T1DM) is a well-known and frequent comorbidity in CD children. The main determinant of this epidemiological association is the common HLA-related predisposing background, even if other (non-HLA-related) genetic and environmental factors (viruses, gut microbiome, and others) are likely to be also implicated in the development of both these autoimmune diseases. T1DM children with concomitant CD may experience specific challenges in the adherence to GFD, which has no negative impact on the glycemic and, in general, metabolic control of diabetes, if it is properly implemented and followed up.
乳糜泻（CD）是一种慢性免疫介导性疾病，在一些具有遗传易感性的个体中，因摄入麸质而引发。CD可能与胃肠道外表现以及影响多个器官的疾病相关。在本综述中，目的是分析和讨论小儿CD背景下可能出现的胰腺改变和/或合并症。在诊断时，高达30%被诊断为CD的儿童中可观察到外分泌性胰腺功能不全（EPI）；实际上，在实施无麸质饮食（GFD）后，它通常会缓解。EPI的主要病理生理机制可能表现为CD患者胃肠道激素模式受损。相反，胰腺炎在CD儿童中似乎是一种非常罕见的合并症，因为儿童中描述的病例很少。因此，没有证据表明胰腺炎（包括自身免疫性形式）是小儿CD中的一种相关合并症。1型糖尿病（T1DM）是CD儿童中一种众所周知且常见的合并症。这种流行病学关联的主要决定因素是常见的HLA相关易感背景，即使其他（非HLA相关）遗传和环境因素（病毒、肠道微生物群等）可能也与这两种自身免疫性疾病的发生有关。患有CD的T1DM儿童在坚持GFD方面可能会面临特殊挑战，如果正确实施并进行随访，GFD对糖尿病的血糖以及总体代谢控制没有负面影响。
