Pancreatitis aguda recidivante con enteropatía por gluten asociada: Características clínico-analíticas y evolutivas en 34 pacientes Relapsing acute pancreatitis associated with gluten enteropathy: Clinical, laboratory, and evolutive characteristics in thirty-four patients

Abstract

Objetivos: describir la frecuencia y características clínico-analíticas de la pancreatitis aguda (PA) recidivante con enteropatía por gluten (EG) asociada. Pacientes y métodos: estudiamos de forma prospectiva los casos de pancreatitis agudas ingresados en nuestro Servicio durante el año 2006. Registramos un total de 185 pacientes. A las formas recurrentes que fueron 40 en total (22%), les aplicamos un protocolo clínico-analítico consistente en la determinación de marcadores serológicos, genéticos y biopsias duodenales, para descartar una EG asociada. Resultados: un total de 34 pacientes (18%) cumplían criterios clínico-biológicos de EG asociada (grupo 1) y se compararon con el resto de las PA no-EG (n = 161) (grupo 2). La edad media en la EG fue de 54 ± 25 años, ligeramente inferior al grupo 2, (61 ± 14) (NS). Existía un ligero predominio de mujeres (50%) en el grupo 1, respecto al grupo 2 (38,5%) (NS). Siete pacientes del grupo 1 (20%) presentaron una PA grave, frente a 27 (17%) en el grupo 2 (NS). La presencia de colelitiasis en el grupo 1, fue de 6 casos (18%), significativamente inferior a la del grupo 2, de 72 casos (45%) (p Objectives: to describe the frequency and the clinical and laboratory characteristics of relapsing acute pancreatitis (AP) associated with gluten enteropathy (GE). Patients and methods: we prospectively examined all acute pancreatitis cases admitted to our Department in 2006. We recorded a total of 185 patients. With recurring forms, 40 (22%) in all, we used a clinical-lab protocol including serologic and genetic markers, and duodenal biopsy to rule out GE. Results: a total of 34 patients (18%) met clinical-biological criteria for GE (group 1), and were compared to the remaining non-GE AP cases (n = 161) (group 2). Mean age in the GE group was 54 ± 25 years, slightly younger than group 2 (61 ± 14) (NS). There was a mild predominance of women (50%) in group 1 versus group 2 (38.5%) (NS). Seven patients in group 1 (20%) had severe AP, as compared to 27 (17%) in group 2 (NS). The presence of cholelithiasis in group 1 involved 6 cases (18%), which was significantly lower than in group 2 - 72 cases (45%) (p < 0.05). Four patients with GE developed pseudocysts (12%) versus 13 (8%) in group 2 (NS). Tissue transglutaminase (tTG) was elevated only in 3 patients (9%). Nine patients (34%) were DQ2 (+) and 4 (12%) DQ8 (+); the rest (54%) were all negative for both markers. From an endoscopic perspective there was diffuse duodenitis in 32 patients (95%). Duodenal biopsies revealed villous atrophy (Marsh 3) in 2 patients (6%); submucosal inflammatory infiltration (Marsh 2) in 10 (29.4%); increased intraepithelial lymphocytes (Marsh 1) in 8 cases (23.5%), and normal mucosa (Marsh 0) in 14 patients (41.2%). Response to GFD after 1 year was excellent in 30 patients (88%). Conclusions: relapsing AP with GE represents a relatively common association that is indistinguishable from other APs from a clinical-evolutive standpoint, except for a lower presence of cholelithiasis (p < 0.05). A specific diagnostic protocol is much needed in the identification of these patients since GFD is the only effective therapy to prevent new AP events from developing.

Keywords

• Enfermedad celiaca
• Pancreatitis aguda
• Celiac disease
• Acute pancreatitis