Association between Inflammatory Bowel Disease and Pancreatitis: A PRISMA-Compliant Systematic Review

Abstract

Background/Objectives. This systematic review was conducted to investigate the association between pancreatitis and IBD. Methods. MEDLINE, Embase, and CENTRAL were systematically searched for correlative studies till 2 November 2019. RevMan5.3 was used to estimate relevance. Results. Three studies with 166008 participants were included. The risk of pancreatitis significantly increased in the patients with CD (OR, 3.40; 95% CI, 2.70-4.28; P<0.00001) and UC (OR, 2.49; 95% CI, 1.91-3.26; P<0.00001). Increased risks of CD (OR, 12.90; 95% CI, 5.15-32.50; P<0.00001) and UC (OR, 2.80; 95% CI, 1.00-7.86; P=0.05) were found in patients with chronic pancreatitis. As for patients with acute pancreatitis, there were significant association of CD (OR, 3.70; 95% CI, 1.90-7.60; P=0.0002), but were not UC. Conclusions. The evidence confirmed an association between pancreatitis and IBD. When pancreatitis patients have chronic diarrhea and mucus blood stool or IBD patients have repeated abdominal pain and weight loss, they should consult pancreatic and gastrointestinal specialists.

Severity of acute pancreatitis in patients with inflammatory bowel disease in the era of biologics: A propensity‐score‐matched analysis using a nationwide database in Japan

“…The reason for the lower severity of AP in patients remains unclear. Several studies have reported that the risk of AP increases in IBD patients 7,23,24 . The pathogenesis of AP in patients with IBD varies, including gallstones, autoimmune mechanisms, drug‐induced types including azathioprine and 5ASA, duodenal stenosis due to intestinal inflammation, and anatomical abnormalities 10,25–29 .…”

“…Several studies have reported that the risk of AP increases in IBD patients. 7 , 23 , 24 The pathogenesis of AP in patients with IBD varies, including gallstones, autoimmune mechanisms, drug‐induced types including azathioprine and 5ASA, duodenal stenosis due to intestinal inflammation, and anatomical abnormalities. 10 , 25 , 26 , 27 , 28 , 29 A multicenter cohort study reported that drug‐induced AP was the most common form of AP, followed by idiopathic AP.…”

Pancreatic Associated Manifestations in Pediatric Inflammatory Bowel Diseases

“…A combination of genetic susceptibility, immunological disturbances and environmental factors variably participate in the pathogenesis of pancreatic disease associated with IBD [ 1 ]. Nevertheless, while the contribution of genetics to the onset and progression of pancreatitis has been widely assessed, poor are the data about its role in pancreatitis associated with IBD [ 23 ].…”

“…It is known that changes in microflora composition may result in a reduced microbial diversity, leading to immune disorders and susceptibility to disease, including pancreatitis and IBD [ 1 , 23 , 30 ]. IBD has been associated consistently with gut dysbiosis, low concentration of Firmicutes, such as Bifidobacterium, Clostridia and especially Faecalibacterium prausnitzii, and increased concentrations of Escherichia Coli [ 46 ].…”

“…Similarly, in AP and CP levels of Bifidobacterium or Lactobacillus have been shown to be lower, along with a higher concentration of Enterobacteriaceae. Such a close interaction between changes of microbiota, intestinal inflammation and pancreatic disease has been considered as the gut-pancreas axis [ 23 ]. Its pivotal role as a first line of defense against adhesive and invasive commensal bacteria has been confirmed by recently published results on glycoprotein 2 (GP2) [ 47 ].…”