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.