Risk of Pancreatitis in Patients With Celiac Disease: Is Autoimmune Pancreatitis a Biologically Plausible Mechanism?

We read with interest the study by Ludvigsson et al.1 By using an epidemiologic database the authors described that patients with celiac disease (CD) had an increased risk of both acute pancreatitis (hazard ratio, 3.3; 95% confidence interval, 2.6–4.4) and chronic pancreatitis (hazard ratio, 19.8; 95% confidence interval, 9.2–42.8). In our center, despite active follow-up evaluation of more than 700 adult CD patients, we have not documented any episodes of acute pancreatitis. We previously identified that exocrine pancreatic insufficiency (EPI) is associated with persisting diarrhea in patients with adult CD and changes of chronic pancreatitis on radiologic imaging.2