Natural history of pancreatic involvement in paediatric inflammatory bowel disease

Martinelli, Massimo; Strisciuglio, Caterina; Illiceto, M.T.; Cardile, Sabrina; Guariso, Graziella; Vignola, Silvia; Aloi, Marina; D’Altilia, Mario; Alvisi, Patrizia; Salvatore, Silvia; Staiano, Annamaria; Cucchiara, Salvatore; Miele, Erasmo

doi:10.1016/j.dld.2015.01.155

Cited by 15 publications

(54 citation statements)

References 34 publications

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“…Pancreatic involvement in IBD may also be a part of a common immune disorder whereby the target cells of gut epithelium and pancreas share a similar molecular structure lending themselves to antigenic mimicry [1, 8]. There have been reports of the rarer variant, autoimmune pancreatitis, occurring more often in IBD patients [2].…”

Section: Discussionmentioning

confidence: 99%

“…Studies have reported the presence of periductal lymphocytic inflammatory infiltrates and perilobular fibrosis [8]. Martinelli et al [1] reported correlation between pancreatic inflammation and IBD disease activity, with 91% of their patients eliciting acute pancreatitis during active disease. They also reported that patients with recurrent pancreatitis had higher disease activity indices (PCDAI and PUCAI) for pediatric CD and ulcerative colitis, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…It is especially known that pediatric IBD represents more extensive inflammation with a predilection for colitis [1]. It is an immune-mediated inflammation of the gastrointestinal tract arising out of a host immune dysregulation with genetic and environmental influences.…”

Section: Introductionmentioning

confidence: 99%

“…There have been very limited and no recent published data on the incidence of elevated lipase in pediatric IBD [1, 2]. Stawarski and Iwańczak [2] conducted a 4-year study in over 100 children with ulcerative colitis or Crohn's disease (CD) and found the incidence of acute pancreatitis to be 4.5% in children with CD and 5.1% in children with ulcerative colitis.…”

Section: Introductionmentioning

confidence: 99%

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Elevated Lipase during Initial Presentation of Ulcerative Colitis in a Pediatric Patient: Do We Check for It

Ray

Arsdall²

2016

Case Rep Gastroenterol

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There are very few reports of elevated lipase in pediatric inflammatory bowel disease (IBD). Symptoms of pancreatitis may be masked by abdominal pain in pediatric IBD. During the initial presentation of IBD in our patient, lipase was elevated to more than 3 times the upper limit of normal. Normalization of values coincided with remission of IBD. This may be due to extraintestinal involvement of the pancreas as part of the inflammatory process or due to leakage of pancreatic enzymes from an inflamed gut or mediated by inflammatory cytokines. Checking pancreatic enzymes during initial presentation of IBD may, therefore, be important to determine if pancreatic involvement has resulted from the inflammation in IBD or as an adverse effect of therapy. If unchecked, recurrent subclinical pancreatitis may be masked by IBD symptoms and missed prior to starting IBD therapy. This may result in chronic pancreatic insufficiency as reported in 50% of adults with IBD. Early detection of elevated pancreatic enzymes in IBD may help direct the management strategy, as treatment of the underlying inflammation in IBD may be the most important management for resolution of pancreatitis instead of cessation of therapy for fear of iatrogenic medication-induced pancreatitis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Elevated Lipase during Initial Presentation of Ulcerative Colitis in a Pediatric Patient: Do We Check for It

Ray

Arsdall²

2016

Case Rep Gastroenterol

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“…Drug-induced pancreatitis (e.g., from azathioprine) and autoimmune pancreatitis are frequent causes (Fig. 5) [27][28][29]. All of these hepatic and pancreatic abnormalities can be clinically unexpected or unknown at the time of MRE.…”

Section: Detection Of Unexpected Pancreatobiliary Abnormalitiesmentioning

confidence: 99%

MR enterography: how to deliver added value

2016

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MR enterography (MRE) is increasingly vital to the diagnosis and follow-up of children with Crohn disease. This diagnostic test, which can provide valuable information regarding the presence of intestinal inflammation, intestinal and intra-abdominal complications, and extra-intestinal disease-related manifestations, has the potential to directly impact both medical and surgical decision-making. Consequently, it is imperative that the interpretation and reporting of these examinations provide as much clinical information as possible. This article reviews specific ways radiologists can provide added value when interpreting MRE examinations in the setting of pediatric Crohn disease by (1) establishing the true extent of disease involvement, (2) subjectively and objectively assessing response to medical treatment and (3) accurately characterizing disease-related complications.

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Acute pancreatitis in children with inflammatory bowel disease: Risk factors, clinical course, and prognosis

Anafy,

Mirkin,

Galai

et al. 2024

J. pediatr. gastroenterol. nutr.

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ObjectivesTo characterize the clinical course of acute pancreatitis (AP) in pediatric inflammatory bowel disease (IBD) patients compared to children with AP without IBD and to identify risk factors associated with AP among IBD patients.MethodsThis retrospective, single‐center study compared clinical characteristics of children (<19 years) with AP with and without concomitant IBD who were hospitalized 2005–2019. We also conducted a risk factor analysis of AP development in pediatric IBD.ResultsSixty‐eight (54% males) patients with 120 episodes of AP were admitted at a median age of 15.3 years. Thirteen patients (14 episodes) had a co‐diagnosis of IBD, representing 4% of our IBD patient population. The AP‐IBD patients presented with lower amylase levels compared to the non‐IBD patients (160 [interquartile range, IQR: 83–231] vs. 418 [IQR: 176–874] U/L, p > 0.01), all had a mild pancreatitis, and none required invasive intervention. The presumed etiology for AP in all IBD patients was IBD‐related: IBD flare‐up in five, side effects of medications in two, and undetermined in seven. The only risk factor for AP development among IBD patients was IBD‐associated arthritis (23% vs. 3% for IBD‐non‐AP, p = 0.04), while extracolonic Crohn's disease and induction therapy with nutrition were negative risk factors (15% vs. 51%, p = 0.05, and 8% vs. 44%, p = 0.04, respectively). Other parameters, including disease type and medications, were nonsignificant.ConclusionThe clinical course of AP in pediatric IBD patients is mild. Only IBD‐associated arthritis emerged as a risk factor for the development of AP, while, unexpectedly, IBD medication did not.

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Natural history of pancreatic involvement in paediatric inflammatory bowel disease

Cited by 15 publications

References 34 publications

Elevated Lipase during Initial Presentation of Ulcerative Colitis in a Pediatric Patient: Do We Check for It

Elevated Lipase during Initial Presentation of Ulcerative Colitis in a Pediatric Patient: Do We Check for It

MR enterography: how to deliver added value

Acute pancreatitis in children with inflammatory bowel disease: Risk factors, clinical course, and prognosis

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