Gastroenterology and Hepatology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Biosanitaria (IRYCIS), Madrid, Spain.
Gastroenterology and Hepatology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Biosanitaria (IRYCIS), Madrid, Spain.
Pancreatology. 2020 Apr;20(3):331-337. doi: 10.1016/j.pan.2020.02.007. Epub 2020 Feb 19.
Idiopathic acute pancreatitis (IAP) in patients with inflammatory bowel disease (IBD) is not well characterized. Our purpose was to better understand this condition and its natural history.
Retrospective cohort study conducted at nine Spanish IBD referral centers. Patients with IBD and a first episode of acute pancreatitis (AP) between 1998 and 2018 were included. Patients with a previous episode of AP or a diagnosis of chronic pancreatitis were excluded. IAP and non-IAP were compared by multivariate logistic regression and survival analysis.
We identified 185 patients with IBD (68.7% Crohn's disease) and a first episode of AP. Thirty-eight of those 185 (20.6%) fulfilled criteria for IAP. There were no severe cases of IAP. On multivariate analysis, AP before IBD diagnosis (21.1% vs. 3.4%, p = 0.04) and ulcerative colitis (52.6% vs. 23.1%, p = 0.002) were significantly more common in IAP. Further work-up was performed in 16/38 (42%) IAP patients, and a cause was identified in 6/16 (37.5%). Median time from AP to the end of follow-up was 6.3 years (3.1-10). Five-year risk of AP recurrence was significantly higher in IAP group (28% vs. 5.1%, log-rank p = 0.001), with a median time to first recurrence of 4.4 months (2.9-12.2).
IAP represents the second cause of AP in patients with IBD. It is more frequent in ulcerative colitis, and presents a high risk of recurrence. Additional imaging work-up after a first episode of IAP in IBD patients is highly advisable, as it identifies a cause in more than one-third of cases.
特发性急性胰腺炎（IAP）在炎症性肠病（IBD）患者中并不常见。我们的目的是更好地了解这种情况及其自然史。
在西班牙的九个 IBD 转诊中心进行回顾性队列研究。纳入 1998 年至 2018 年间首次发生急性胰腺炎（AP）的 IBD 患者。排除有先前发作的 AP 或慢性胰腺炎诊断的患者。通过多变量逻辑回归和生存分析比较 IAP 和非 IAP。
我们共纳入了 185 例 IBD（68.7%为克罗恩病）和首次发作的 AP 患者。其中 38 例（20.6%）符合 IAP 的标准。没有严重的 IAP 病例。多变量分析显示，在 IBD 诊断前出现 AP（21.1%比 3.4%，p=0.04）和溃疡性结肠炎（52.6%比 23.1%，p=0.002）在 IAP 中更为常见。在 16/38 例（42%）IAP 患者中进行了进一步的检查，在 6/16 例（37.5%）患者中确定了病因。从 AP 到随访结束的中位时间为 6.3 年（3.1-10）。IAP 组的 AP 复发风险明显更高（28%比 5.1%，对数秩 p=0.001），首次复发的中位时间为 4.4 个月（2.9-12.2）。
IAP 是 IBD 患者发生 AP 的第二大原因。它在溃疡性结肠炎中更为常见，且复发风险较高。在 IBD 患者首次发生 IAP 后进行额外的影像学检查非常重要，因为这可以在超过三分之一的病例中确定病因。
