Pancreatitis aguda recidivante con enteropatía por gluten asociada. Características clínico-analíticas y evolutivas en 34 pacientes / No disponible

ABSTRACT

Objectives: to describe the frequency and the clinical and laboratorycharacteristics of relapsing acute pancreatitis (AP) associatedwith gluten enteropathy (GE).Patients and methods: we prospectively examined all acutepancreatitis cases admitted to our Department in 2006. Werecorded a total of 185 patients. With recurring forms, 40 (22%)in all, we used a clinical-lab protocol including serologic and geneticmarkers, and duodenal biopsy to rule out GE.Results: a total of 34 patients (18%) met clinical-biological criteriafor GE (group 1), and were compared to the remaining non-GE AP cases (n = 161) (group 2). Mean age in the GE group was54 ± 25 years, slightly younger than group 2 (61 ± 14) (NS).There was a mild predominance of women (50%) in group 1 versusgroup 2 (38.5%) (NS). Seven patients in group 1 (20%) hadsevere AP, as compared to 27 (17%) in group 2 (NS). The presenceof cholelithiasis in group 1 involved 6 cases (18%), whichwas significantly lower than in group 2 – 72 cases (45%) (p <0.05). Four patients with GE developed pseudocysts (12%) versus13 (8%) in group 2 (NS).Tissue transglutaminase (tTG) was elevated only in 3 patients(9%). Nine patients (34%) were DQ2 (+) and 4 (12%) DQ8 (+); therest (54%) were all negative for both markers. From an endoscopicperspective 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 relativelycommon association that is indistinguishable from other APs froma clinical-evolutive stand point, except for a lower presence ofcholelithiasis (p < 0.05) (AU)