Laboratorio de Gastroenterologia Clinica e Experimental, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
Departamento de Gastroenterologia, Instituto do Cancer do Estado de Sao Paulo, Sao Paulo, SP, BR.
Clinics (Sao Paulo). 2019 May 30;74:e853. doi: 10.6061/clinics/2019/e853.
We aimed to evaluate the incidence of pancreatic alterations in Crohn's disease using endoscopic ultrasound (EUS) and to correlate the number of alterations with current clinical data.
Patients diagnosed with Crohn's disease (n=51) were examined using EUS, and 11 variables were analyzed. A control group consisted of patients with no history of pancreatic disease or Crohn's disease. Patients presenting with three or more alterations underwent magnetic resonance imaging (MRI). Pancreatic function was determined using a fecal elastase assay.
Two of the 51 patients (3.9%) presented with four EUS alterations, 3 (5.9%) presented with three, 11 (21.5%) presented with two, and 13 (25.5%) presented with one; in the control group, only 16% presented with one EUS alteration (p<0.001). Parenchymal abnormalities accounted for 39 of the EUS findings, and ductal abnormalities accounted for 11. Pancreatic lesions were not detected by MRI. Low fecal elastase levels were observed in 4 patients, none of whom presented with significant pancreatic alterations after undergoing EUS. Ileal involvement was predictive of the number of EUS alterations.
A higher incidence of pancreatic abnormalities was found in patients with Crohn's disease than in individuals in the control group. The majority of these abnormalities are related to parenchymal alterations. In this group of patients, future studies should be conducted to determine whether such morphological abnormalities could evolve to induce exocrine or endocrine pancreatic insufficiency and, if so, identify the risk factors and determine which patients should undergo EUS.
我们旨在使用内镜超声（EUS）评估克罗恩病患者胰腺改变的发生率，并将改变数量与当前临床数据相关联。
对诊断为克罗恩病的 51 例患者进行 EUS 检查，并分析了 11 个变量。对照组由无胰腺疾病或克罗恩病病史的患者组成。有 3 个或更多改变的患者行磁共振成像（MRI）检查。使用粪便弹性蛋白酶测定法测定胰腺功能。
51 例患者中有 2 例（3.9%）有 4 个 EUS 改变，3 例（5.9%）有 3 个，11 例（21.5%）有 2 个，13 例（25.5%）有 1 个；对照组仅有 16%的患者有 1 个 EUS 改变（p<0.001）。EUS 发现中 39 个为实质异常，11 个为胰管异常。MRI 未发现胰腺病变。4 例患者粪便弹性蛋白酶水平较低，EUS 后均无明显胰腺改变。回肠受累可预测 EUS 改变的数量。
与对照组相比，克罗恩病患者胰腺异常的发生率更高。这些异常大多数与实质改变有关。在这组患者中，应进行未来的研究以确定这些形态学异常是否会发展为诱导外分泌或内分泌性胰腺功能不全，如果是这样，则确定危险因素并确定哪些患者需要进行 EUS。
