Celiac Disease and Pancreatic Insufficiency

Diagnostic Approach and Management

• Pancreatic insufficiency is common in celiac disease and can be treated with gluten-free pancreatic enzyme supplements 1
• A quantitative serum IgA level should be obtained at the time of celiac disease screening to rule out IgA deficiency, which could lead to false-negative results 2
• For patients with elevated tTG levels, referral to a gastroenterologist for small-bowel biopsy is recommended, even in the absence of gastrointestinal symptoms 2
• For patients with chronic pancreatitis related to celiac disease, celiac plexus block should not be routinely performed but may be considered on a case-by-case basis for those with debilitating pain when other therapeutic measures have failed 3, 4
• Pancreatic enzyme supplementation may be necessary for patients with pancreatic insufficiency 1