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Pancreatic Involvement in the Course of Inflammatory Bowel Disease in Children-A Multi-Center Study
Urszula Daniluk1, Paulina Krawiec2, Elżbieta Pac-Kożuchowska2
1Department of Pediatrics, Gastroenterology, Hepatology, Nutrition, Allergology and Pulmonology, Medical University of Bialystok, 15-274 Bialystok, Poland.
Insights
Pancreatic involvement occurs in over 11% of pediatric inflammatory bowel disease (IBD) patients, often presenting as acute pancreatitis or elevated pancreatic enzymes. Routine monitoring, especially during azathioprine therapy, is recommended.
Area of Science:
- Pediatric Gastroenterology
- Hepatology and Pancreatology
- Inflammatory Bowel Disease Research
Background:
- Coexistence of inflammatory bowel disease (IBD) and pancreatic pathology is uncommon in pediatric populations.
- Understanding the frequency and etiology of pancreatic involvement in children with IBD is crucial for effective management.
Purpose of the Study:
- To determine the incidence and causes of pancreatitis and asymptomatic hyperlipasemia (HL) or hyperamylasemia (HA) in children diagnosed with IBD.
- To analyze the characteristics of pancreatic involvement (PI) in relation to IBD severity and treatment.
Main Methods:
- Retrospective analysis of data from 1538 children diagnosed with IBD between 2014 and 2021.
- Evaluation of pancreatic involvement, including acute pancreatitis (AP), HA, and HL, in the study cohort.
Main Results:
- Pancreatic involvement (PI) was identified in 11.4% of pediatric IBD patients (176 children).
- Acute pancreatitis (AP) occurred in 43.8% of those with PI, while HA or HL was observed in 50.0%.
- Idiopathic PI was most frequent (57%), followed by drug-induced PI (37%), notably azathioprine (AZA)-induced.
Conclusions:
- Routine monitoring of pancreatic enzymes is advised for pediatric IBD patients, particularly after initiating AZA therapy.
- Transient hyperamylasemia/hyperlipasemia in IBD does not always signify significant pancreatic pathology.
Abstract:
The coexistence of inflammatory bowel disease (IBD) with pancreatic pathology is rare in children. A retrospective analysis of data from 1538 children diagnosed with IBD in 2014-2021 was conducted to determine the frequency and causes of pancreatitis and asymptomatic hyperlipasemia (HL) or hyperamylasemia (HA) in this group of patients. Among the 176 children (11.4%) with pancreatic involvement (PI), acute pancreatitis (AP) was diagnosed in 77 children (43.8%), and HA or HL was observed in 88 children (50.0%). Only a few patients were diagnosed with autoimmune or chronic pancreatitis (6.2%). PI was observed at the time of the IBD diagnosis in 26.1% of the cases. A total of 54.5% of the patients had moderate to severe IBD, and 96% had colonic involvement at the time of diagnosis of PI. Idiopathic PI was the most common (57%), followed by drug-induced PI (37%) and azathioprine (AZA). In patients with AZA-induced AP, the successful introduction of 6-mercaptopurine (6-MP) to therapy was noted in 62.5% of the children. Our results suggest that routine monitoring of pancreatic enzymes in patients with IBD should be performed, especially after the initiation of the AZA treatment. The presence of transient HA/HL in IBD does not necessarily indicate pancreatic pathology.
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