Systematic Review

Pancreatic Involvement in Inflammatory Bowel Disease

Sara Massironi; Ilaria Fanetti; Chiara Viganò; Lorena Pirola; Maria Fichera; Laura Cristoferi; Gabriele Capurso; Pietro Invernizzi; Silvio Danese

Disclosures

Aliment Pharmacol Ther. 2022;55(12):1478-1491. 

In This Article

Abstract and Introduction

Abstract

Background: Inflammatory bowel disease (IBD) is a chronic inflammatory immune-mediated disorder of the gut with frequent extra-intestinal complications. Pancreatic involvement in IBD is not uncommon and comprises a heterogeneous group of conditions, including acute pancreatitis (AP), chronic pancreatitis (CP), autoimmune pancreatitis (AIP) and pancreatic exocrine insufficiency (PEI); however, data on such an association remain sparse and heterogeneous.

Method: PubMed/MEDLINE and EMBASE databases were searched for studies investigating pancreatic involvement in patients with IBD.

Results: Four thousand one hundred and twenty-one records were identified and 547 screened; finally, 124 studies were included in the review. AP is the most frequent pancreatic manifestation in IBD; the majority of AP cases in IBD are due to gallstones and drugs but cases of idiopathic AP are increasingly reported. AIP is a rare disease, but a strong association with IBD has been demonstrated, especially for type 2 and ulcerative colitis. The pathogenetic link between IBD and AIP remains unclear, but an immune-mediated pathway seems plausible. An association between CP and PEI with IBD has also been suggested, but data are to date scarce and conflicting.

Conclusion: This is the first systematic review of the association between IBD and pancreatic diseases. Gallstones and drugs should be considered the most probable causes of AP in IBD, with type 2 AIP also being possible.

Introduction

Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), is a chronic inflammatory immune-mediated disorder of the gut. It is considered a multisystemic disorder since up to 50% of patients experience at least one extra-intestinal manifestation.[1] Extra-intestinal presentations may virtually involve any organ and system with a potentially detrimental impact on the patient's functional status and quality of life.

Pancreatic involvement is not uncommon but is often underestimated and neglected.

Several pancreatic conditions have been reported with increased prevalence in CD and UC compared to the general population.[2] Pancreatic abnormalities in IBD include acute pancreatitis (AP), chronic pancreatitis (CP), autoimmune pancreatitis (AIP), pancreatic exocrine insufficiency (PEI) and asymptomatic abnormalities, comprising both imaging and laboratory findings.[3] As for causality, the involvement of the pancreas in IBD may be framed in the autoimmune process itself or be iatrogenic.

We, therefore, aimed to investigate pancreatic involvement in patients with IBD by performing a systematic review with the objective to evaluate the aetiology, prevalence and impact of pancreatic diseases in patients with IBD.

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