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Pancreatic involvement in pediatric IBD: Data from the IBD registry of the Italian society for pediatric gastroenterology, hepatology and nutrition

Digestive and Liver Disease, September 30, 2013Volume 45, Supplement 4, Pages e266–e267

Aims:There are only few case reports, mainly in adults, describing the frequency and the clinical features of pancreatic involvement (PI) in IBD. We aimed to estimate the prevalence and to characterize demographic, clinical, laboratory and imaging data of pediatric patients with IBD, presenting with elevated pancreatic enzymes.

Methods:We retrospectively reviewed data collected between January 2009 and November 2012 in the recently developed IBD web-registry of the Italian Society for Pediatric Gastroenterology, Hepatology and Nutrition. All children presenting with hyperamylasemia and/or hyperlipasemia were identified. Demographic and clinical data, IBD type, disease extension activity, laboratory data, IBD therapy, imaging findings and therapeutic interventions were evaluated. Episodes of acute pancreatitis (AP) were defined by the occurrence of at least two of the following findings: acute onset epigastric abdominal pain, elevated serum amylase and/or lipase = 3 times the upper level of normal, and characteristic radiological changes.

Results:We found 27 children out of 649 (4.1%) with an increased value of amylase and/or lipase [Median Age: 148, range 65–191, months; F/M: 14/13; Ulcerative colitis (UC): 12; Crohn's disease (CD): 13; Unclassified Colitis (IBDU): 2)]. Eleven patients (1.6%) fulfilled diagnostic criteria for AP (6 CD, 4 UC, 1 IBDU). Mean serum amylase level was 205.3 ± 91.5 (median 196, range 61–413 IU/L) and mean serum lipase level was 526.8 ± 598.8 (median 299, range 37–2565 IU/L). Ten (37%) patients underwent imaging ultrasound scan, 8 (29.6%) patients had magnetic resonance cholangiopancreatography and 2 (7.4%) patients had a computed tomography scan. Pancreatic pathological findings were found in all subjects with AP; in one patient primary sclerosing cholangitis was diagnosed. The mean lag time period between the diagnosis of IBD and the PI was 12.1 months (median 7, range 0–65). Five patients out of 27 (18.5%) showed PI at diagnosis of IBD. Twenty-four out of 27 (88.8%) had colonic disease [10 CD, 12 UC (8 pancolitis) and 2 IBDU]. Comparing with the patients with an exclusive hyperamylasemia and/or hyperlipasemia, the onset of AP was significantly associated with female gender (p = 0.018), whereas type of IBD, ongoing treatments, activity and extension of disease did not result significant risk factors. Seven out of 11 (63.6%) patients with AP needed therapeutic measures including AZT and/or ASA withdrawal, compared to only 4 (25%) patients out of 16 with serum hyperamylasemia and/or hyperlipasemia (p = 0.06).

Conclusions:To the best of our knowledge this is the first pediatric registry-based study evaluating the prevalence of pancreatic involvement in IBD. Our study suggests that prevalence of AP in children was similar to that reported in adults. Female gender appears to be a risk factor for developing AP in pediatric IBD. In contrast to previous study, PI was not associated with any type of IBD.

Footnotes

1 Translational Medical Sciences, Section Pediatrics, University of Naples Federico II, Naples, Italy

2 Paediatric Gastroenterology Unit, Spirito Santo Hospital, Pescara, Italy

3 Pediatrics, University of Messina, Messina, Italy

4 Pediatrics, University Hospital of Padua, Padua, Italy

5 Gastroenterology and Endoscopy Unit, G. Gaslini Institute for Children, Genoa, Italy

6 Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy

7 Pediatrics, General Hospital I.R.C.C.S., S. G. Rotondo, Italy

8 Pediatric Unit, Maggiore Hospital, Bologna, Italy

9 Pediatrics, University of Insubria, Varese, Italy

lowast Corresponding author.