Krishnan A, Teran D, Mukherjee D. Risk of incident pancreatitis in patients with celiac disease: A population-based matched retrospective cohort study. World J Clin Cases 2025; 13(35): 112965 [DOI: 10.12998/wjcc.v13.i35.112965]
Corresponding Author of This Article
Arunkumar Krishnan, Department of Supportive Oncology, Atrium Health Levine Cancer, 1021 Morehead Medical Drive, Suite 70100, Charlotte, NC 28204, United States. dr.arunkumar.krishnan@gmail.com
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Gastroenterology & Hepatology
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Retrospective Cohort Study
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Dec 16, 2025 (publication date) through Dec 16, 2025
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World Journal of Clinical Cases
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Krishnan A, Teran D, Mukherjee D. Risk of incident pancreatitis in patients with celiac disease: A population-based matched retrospective cohort study. World J Clin Cases 2025; 13(35): 112965 [DOI: 10.12998/wjcc.v13.i35.112965]
World J Clin Cases. Dec 16, 2025; 13(35): 112965 Published online Dec 16, 2025. doi: 10.12998/wjcc.v13.i35.112965
Risk of incident pancreatitis in patients with celiac disease: A population-based matched retrospective cohort study
Arunkumar Krishnan, Daniel Teran, Diptasree Mukherjee
Arunkumar Krishnan, Diptasree Mukherjee, Department of Supportive Oncology, Atrium Health Levine Cancer, Charlotte, NC 28204, United States
Arunkumar Krishnan, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, United States
Daniel Teran, Department of Medicine, West Virginia University School of Medicine, Morgantown, WV 26506, United States
Author contributions: Krishnan A contributed to the concept of the study and study design and was responsible for data acquisition and statistical analysis; Krishnan A drafted the manuscript; Krishnan A, Teran D, and Mukherjee D participated in the review and editing. All authors were involved with interpreting the data and critically revising the manuscript for important intellectual content. All authors reviewed and approved the final version of the manuscript.
Institutional review board statement: TriNetX data have been granted a waiver from the Western Institutional Review Board as a federated network, as only aggregated counts and statistical summaries of de-identified information are used.
Informed consent statement: Not applicable for de-identified data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Arunkumar Krishnan, Department of Supportive Oncology, Atrium Health Levine Cancer, 1021 Morehead Medical Drive, Suite 70100, Charlotte, NC 28204, United States. dr.arunkumar.krishnan@gmail.com
Received: August 11, 2025 Revised: September 16, 2025 Accepted: December 10, 2025 Published online: December 16, 2025 Processing time: 127 Days and 7.6 Hours
Abstract
BACKGROUND
Celiac disease (CD) is an autoimmune disorder associated with an increased risk of pancreatitis, yet large-scale studies examining long-term risk and specific etiologies in CD patients are scarce.
AIM
To assess the long-term risk of pancreatitis in CD patients.
METHODS
We conducted a population-based cohort study with consecutive patients diagnosed with CD using the TriNeTx research network. Each patient was matched to a patient in the control group using a 1:1 propensity score matching to minimize confounding effects. The primary outcomes were the incidence of acute pancreatitis and chronic pancreatitis, and the secondary outcome was to assess the etiologies of pancreatitis. The incidence was estimated using a Cox proportional hazards model with a hazard ratio (HR) and 95% confidence interval (CI).
RESULTS
A total of 160228 patients were identified to have CD, and the remaining 250725 individuals without CD were considered as controls. At 7-year follow-up, CD patients exhibited a significantly higher risk of acute pancreatitis (HR = 2.05; 95%CI: 1.93-2.17) and chronic pancreatitis (HR = 1.42; 95%CI: 1.31-1.54) compared to controls. Elevated risks for alcohol-induced (HR = 1.35), biliary (HR = 1.37), and idiopathic pancreatitis (HR = 1.49) were also observed. Findings remained robust across all follow-up intervals and sensitivity analyses.
CONCLUSION
Patients with CD have a substantially increased long-term risk of acute and chronic pancreatitis, including alcohol-related, biliary, and idiopathic subtypes. These findings support the routine surveillance of pancreatitis in CD management and highlight the need for further research into disease-specific risk factors and mitigation approaches.
Core Tip: Celiac disease (CD) is an immune-mediated disorder with well-recognized gastrointestinal and extraintestinal manifestations. However, limited large-scale studies have evaluated its association with pancreatic disease. We investigated the long-term risk of acute and chronic pancreatitis in a large, propensity score-matched cohort of patients with CD. CD was associated with a significantly higher risk of pancreatitis, including alcohol-related, biliary, and idiopathic subtypes, compared with matched non-CD controls. This risk persisted for at least seven years. Our findings highlight the importance of pancreatitis surveillance and preventive strategies as an integral part of CD management.
