Document Detail

Silent celiac disease activated by pancreaticoduodenectomy.
MedLine Citation:
PMID:  17373587     Owner:  NLM     Status:  MEDLINE    
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 under-recognized. The underlying mechanism may relate to an increased antigenic load secondary to postsurgical changes in intestinal physiology.
John T Maple; Randall K Pearson; Joseph A Murray; Darlene G Kelly; Luis F Lara; Andy C Fan
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Publication Detail:
Type:  Journal Article     Date:  2007-03-21
Journal Detail:
Title:  Digestive diseases and sciences     Volume:  52     ISSN:  0163-2116     ISO Abbreviation:  Dig. Dis. Sci.     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-08-09     Completed Date:  2007-09-27     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  7902782     Medline TA:  Dig Dis Sci     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2140-4     Citation Subset:  AIM; IM    
Department of Gastroenterology, Washington University, 660 South Euclid Avenue, Campus Box 8124, St. Louis, Missouri 63110, USA.
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MeSH Terms
Celiac Disease / diet therapy,  etiology*,  pathology
Diagnosis, Differential
Diet, Protein-Restricted
Disease Progression
Duodenum / pathology
Follow-Up Studies
Glutens / contraindications
Middle Aged
Pancreatic Neoplasms / surgery*
Pancreaticoduodenectomy / adverse effects*
Postoperative Complications
Retrospective Studies
Risk Factors
Reg. No./Substance:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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