Celiac disease (CD): An etiological factor in papillary stenosis

CD is associated with pancreaticobiliary disease. Postulated mechanisms include reduced gallbladder emptying due to impaired cholecystokinin release, and pancreatitis due to malnutrition. We hypothesize that CD may also be associated with pancreaticobiliary abnormalities due to duodenal inflammation and papillary stenosis. METHODS: Over a 24 month period, 110 consecutive patients with evidence of papillary stenosis (documented during ERCP by delayed drainage and/or manometric criteria) had duodenal and papillary biopsies, and serum anti-endomysial and anti-gliadin antibodies (EG) measured. RESULTS: CD was found in 8 (7.3%) patients (M:F 2:6, mean age 59 yr,. range 56-61 yr.) with papillary stenosis. 3 had previously known CD and 5 were newly diagnosed. All patients were referred for evaluation of recurrent abdominal pain and all had a normal body mass index and serum albumin level. In 2 patients, pain was associated with abnormal serum liver tests and in 6 patients, elevated amylase and lipase levels. None of these patients had evidence of chronic pancreatitis. 2 patients had undergone previous sphincterotomy but developed recurrent symptoms; ERCP at our institution confirmed recurrent stenosis and newly diagnosed active celiac disease. Histologically, all patients had active duodenitis and papillitis, and elevated EG consistent with CD. Patients who maintained a gluten free diet (7) had resolution of the duodenitis and papillitis. All patients had sphincterotomy or revision and have not had recurrent symptoms. CONCLUSION: We describe 8 patients with papillary stenosis associated with active CD. In 5 patients, CD was newly diagnosed following our evaluation of the papillary stenosis. We suggest that pancreaticobiliary disorders in patients with CD may be associated with papillary stenosis, which is related to chronic duodenitis. CD should also be considered as an underlying diagnosis in patients with papillary stenosis.