Pancreatic Involvement in Patients with Inflammatory Bowel Disease

In this paper we review the existing data concerning the incidence, pathogenesis, clinical picture, management and longterm outcome of patients with IBD who developed acute or chronic pancreatitis before or during the course of their underlying bowel disease. It seems certain that patients with IBD are considered to be at increased risk for developing acute pancreatitis, although large epidemiological studies are scattered. They have also an elevated risk for developing chronic pancreatitis and/or pancreatic insufficiency. Increased levels of amylase and lipase can occur in up to 11% of asymptomatic IBD patients. Drugs could be a definite cause of acute pancreatitis in patients with IBD, immunosuppressives and mesalamine being the most frequently encountered. Some of the factors possibly involved are related to the secretory acinar cells, the protease-activated receptor-2, the pro-inflammatory cytokines IL-1 and TNF-alpha, the pancreatitis-associated protein, the pancreatic autoantibodies and prolonged stress. In most cases chronic pancreatitis is clinically unapparent, although it may be accompanied by clinically relevant exocrine insufficiency. The course of pancreatitis after cessation of the acute flare is quite benign. The management does not differ from ordinary patients with acute pancreatitis.