Barthet Marc, Lesavre Nathalie, Desplats Sophie, Panuel Michel, Gasmi Mohamed, Bernard Jean-Paul, Dagorn Jean-Charles, Grimaud Jean-Charles
Department of Gastroenterology and Hepatology, Hôpital Nord, Chemin des Bourrely, Marseille, France.
Pancreatology. 2006;6(5):464-71. doi: 10.1159/000094564. Epub 2006 Jul 13.
Clinical symptoms of inflammatory bowel disease (IBD)-associated pancreatitis are found in approximately 2% of patients, but the frequency of the disease could be much higher since IBD-associated pancreatitis could be mainly a silent disease. The aim of this study was to describe the radiological and biological features of IBD-associated pancreatitis and assess its frequency by comparing data from IBD patients with or without a history of pancreatitis.
79 patients were prospectively enrolled (median age 36 years). Symptoms of pancreatitis had been previously recorded in 30 of them (group P; the other 49 patients (group C) had no history of pancreatitis. Pancreatic ductal changes were investigated by pancreato-MRI. Exocrine function was assessed by the fecal elastase test and by assaying serum amylase, lipase, C-reactive protein, PAP, IgG4 and pancreatic autoantibodies.
Increased levels of amylase and lipase occurred in 11% of IBD patients, that frequency being significantly higher in group P (23%) than in group C (4%) (p = 0.01). Low fecal elastase reflecting impaired exocrine function was observed in 30% of patients and again significantly more in group P (50%) than in group C (17%) (p = 0.04). The frequency of elevated values varied from 12% for amylase and lipase to 18% for PAP, 20% for pancreatic autoantibodies and 45% for CRP, without a difference between groups P and C. Silent exocrinopathy was observed in both groups, pancreatic autoantibodies and pancreatic duct alterations being found in 20 and 11% of patients, respectively.
Finding pancreatic insufficiency in about 30% of the included patients and in 50% of those with a previous history of pancreatitis suggests that IBD might be associated with chronic pancreatic alteration. Episodes of mild acute pancreatitis observed in some patients are not always due to adverse effects of treatments and can be acute manifestations of the chronic disease.
炎症性肠病（IBD）相关胰腺炎的临床症状在约2%的患者中出现，但由于IBD相关胰腺炎可能主要是一种无症状疾病，该病的实际发病率可能更高。本研究旨在描述IBD相关胰腺炎的影像学和生物学特征，并通过比较有或无胰腺炎病史的IBD患者的数据来评估其发病率。
前瞻性纳入79例患者（中位年龄36岁）。其中30例患者先前有胰腺炎症状（P组）；其他49例患者（C组）无胰腺炎病史。通过胰腺磁共振成像（pancreato-MRI）研究胰管变化。通过粪便弹性蛋白酶试验以及检测血清淀粉酶、脂肪酶、C反应蛋白、胰蛋白酶原激活肽（PAP）、IgG4和胰腺自身抗体来评估外分泌功能。
11%的IBD患者淀粉酶和脂肪酶水平升高，P组（23%）的这一发生率显著高于C组（4%）（p = 0.01）。30%的患者粪便弹性蛋白酶水平低，反映外分泌功能受损，P组（50%）同样显著高于C组（17%）（p = 0.04）。各项指标升高的发生率从淀粉酶和脂肪酶的12%到PAP的18%、胰腺自身抗体的20%以及CRP的45%不等，P组和C组之间无差异。两组均观察到无症状性外分泌病，分别有20%和11%的患者发现胰腺自身抗体和胰管改变。
约30%的纳入患者以及50%有胰腺炎病史的患者存在胰腺功能不全，这表明IBD可能与慢性胰腺改变有关。部分患者中观察到的轻度急性胰腺炎发作并非总是由治疗的不良反应所致，可能是慢性疾病的急性表现。
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