Silent celiac disease activated by pancreaticoduodenectomy

John T. Maple, Randall K. Pearson, Joseph A Murray, Darlene G. Kelly, Luis F. Lara, Andy C. Fan

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Diarrhea and weight loss are common after pancreaticoduodenectomy, and arise from varying etiologies. An uncommon but important cause for these symptoms is the postoperative activation of silent celiac disease. We sought to describe the clinical presentation, diagnosis, treatment, and follow-up of a series of patients with silent celiac disease unmasked after pancreaticoduodenectomy, and to summarize the existing case reports on this association. A search of the electronic medical record at our institution was performed cross-referencing terms associated with celiac disease and pancreaticoduodenectomy for the years 1976-2004. Cases were then reviewed to ensure that no signs or symptoms attributable to celiac disease were present preoperatively. Seven patients were identified; five were male, and the median age was 56. All patients underwent surgery for a presumed pancreatic or ampullary malignancy. Six patients developed symptoms ultimately attributable to celiac disease immediately after pancreaticoduodenectomy, most commonly diarrhea and weight loss. A single patient had silent celiac disease incidentally diagnosed at pancreaticoduodenectomy that remained silent postoperatively on an unrestricted diet. Symptoms completely resolved in 4 of 6 patients after initiation of a gluten-free diet, with partial improvement in the remaining 2 patients. The median delay from pancreaticoduodenectomy to diagnosis of celiac disease in the 6 symptomatic patients was 6 months. Clinicians should consider celiac disease as a potential diagnosis in patients with failure to thrive and diarrhea after pancreaticoduodenectomy. This entity is uncommon, but may be underrecognized. The underlying mechanism may relate to an increased antigenic load secondary to postsurgical changes in intestinal physiology.

Original languageEnglish (US)
Pages (from-to)2140-2144
Number of pages5
JournalDigestive Diseases and Sciences
Volume52
Issue number9
DOIs
StatePublished - Sep 2007
Externally publishedYes

Fingerprint

Pancreaticoduodenectomy
Celiac Disease
Diarrhea
Weight Loss
Gluten-Free Diet
Failure to Thrive
Electronic Health Records
Signs and Symptoms
Diet

Keywords

  • Celiac disease
  • Diarrhea
  • Pancreaticoduodenectomy
  • Post-operative complications

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Maple, J. T., Pearson, R. K., Murray, J. A., Kelly, D. G., Lara, L. F., & Fan, A. C. (2007). Silent celiac disease activated by pancreaticoduodenectomy. Digestive Diseases and Sciences, 52(9), 2140-2144. https://doi.org/10.1007/s10620-006-9598-y

Silent celiac disease activated by pancreaticoduodenectomy. / Maple, John T.; Pearson, Randall K.; Murray, Joseph A; Kelly, Darlene G.; Lara, Luis F.; Fan, Andy C.

In: Digestive Diseases and Sciences, Vol. 52, No. 9, 09.2007, p. 2140-2144.

Research output: Contribution to journalArticle

Maple, JT, Pearson, RK, Murray, JA, Kelly, DG, Lara, LF & Fan, AC 2007, 'Silent celiac disease activated by pancreaticoduodenectomy', Digestive Diseases and Sciences, vol. 52, no. 9, pp. 2140-2144. https://doi.org/10.1007/s10620-006-9598-y
Maple, John T. ; Pearson, Randall K. ; Murray, Joseph A ; Kelly, Darlene G. ; Lara, Luis F. ; Fan, Andy C. / Silent celiac disease activated by pancreaticoduodenectomy. In: Digestive Diseases and Sciences. 2007 ; Vol. 52, No. 9. pp. 2140-2144.
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