Celiac disease and autoimmune pancreatitis: an uncommon association. A case report.

We present the clinical scenario of acute abdominal pain in a 27-year-old man with recent-onset type 1 diabetes mellitus. Evaluation of the patient revealed elevated levels of serum amylase, lipase, and transaminase without any biliary obstruction. He had elevated serum IgG4 levels, and his computed tomography scan showed features consistent with autoimmune pancreatitis. Further evaluation revealed celiac disease. He was treated as a patient with autoimmune pancreatitis and was started on steroids in addition to a gluten-free diet. His liver function improved in 6 weeks. He gained weight and his glycemic control also improved. Magnetic resonance cholangiopancreatography after 3 months revealed complete resolution of pancreatic enlargement. The patient is being followed up in our clinic since the past 3 years. To the best of our knowledge and according to the Medline search, this is the first case report of celiac disease as an association of autoimmune pancreatitis.

Biomarkers in the management of ulcerative colitis: a brief review.

Several attempts have been made in the last two decades to investigate ulcerative colitis (UC) patients during the natural course of the disease so as to identify appropriate surrogate markers of disease activity. Most patients with quiescent inflammatory bowel disease have low grade inflammation and it is possible that relapse occurs only once the inflammatory process crosses a critical intensity. Since inflammation is a continuous process, its direct assessment may provide us a quantitative pre-symptomatic measure of imminent relapse. If substantial, it may allow targeted treatment early, to avert relapse or formulate newer therapeutic strategies to maintain symptomatic remission. It is clinically very important to identify these patients at a subclinical stage, noninvasively, by various biomarkers. Biomarkers help to gain an objective measurement of disease activity as symptoms are often subjective. Biomarkers also help to avoid invasive procedures which are often a burden to the patient and the health care system. If an ideal biomarker existed for UC, it would greatly facilitate the work of the gastroenterologist treating these patients. Both "classical" and "emerging" biomarkers of relevance for UC have been studied, but the quest for an ideal biomarker still continues. In this brief review we describe various biomarkers of clinical importance.