# Long‐term risk of acute pancreatitis in patients with celiac disease: A nationwide population‐based cohort study

## TL;DR

People with celiac disease have a higher long-term risk of developing acute pancreatitis, but not of having recurring episodes after the first one.

## Contribution

This study provides the first nationwide population-based evidence of a moderate long-term increased risk of incident acute pancreatitis in celiac disease patients.

## Key findings

- Celiac disease patients had a 42% higher risk of incident acute pancreatitis compared to the general population.
- The increased risk was observed for gallstone-related, non-gallstone-related, and severe acute pancreatitis, but not alcohol-related cases.
- Celiac disease was not associated with a higher risk of recurrent acute pancreatitis after the first episode.

## Abstract

Large‐scale studies on the association between celiac disease (CeD) and acute pancreatitis (AP) are scarce.

To investigate the long‐term risks of incident and recurrent AP in patients with CeD.

Through the Swedish nationwide histopathology cohort Epidemiology Strengthened by Histopathology Reports in Sweden, we collected data on biopsy‐confirmed CeD diagnosed between 1969 and 2023 (n = 57,221) and matched them with general population reference individuals (n = 279,126) by birth year, sex, calendar year, and county. Cox regression estimated average adjusted hazard ratios (aHRs) for incident and recurrent AP over time, whereas flexible parametric survival models assessed time‐varying incident risks.

During a median follow‐up of 15.5 years, incident AP occurred in 549 patients with CeD (incidence rate [IR]: 58.7/100,000 person‐years), and 1732 reference individuals (IR: 37.8). The multivariable‐adjusted hazard for incident AP was consistently increased in patients with CeD compared with reference individuals (aHR = 1.42 [95% confidence intervals {CI}: 1.28–1.58]), resulting in one extra incident AP event per 185 CeD patients during the first 25 years after diagnosis. Increased incident risks were observed for gallstone‐ and non‐gallstone‐related AP, and severe AP, but not alcohol‐related AP. Conversely, in study participants who had survived a first AP episode, CeD was not associated with an increased risk for recurrent AP (aHR = 0.85 [0.67–1.08]). Sensitivity analyses, including a sibling comparison, confirmed the main findings.

CeD is linked to a moderately increased long‐term risk of incident AP, but not to recurrent AP after the first episode. Clinicians should be aware of this increased risk and counsel patients with CeD on AP risk factors.