Department of Pediatrics, Gastroenterology, Hepatology, Nutrition and Allergology, Medical University of Bialystok, 15-274 Bialystok, Poland.
Medicina (Kaunas). 2021 May 11;57(5):473. doi: 10.3390/medicina57050473.
Inflammatory bowel disease (IBD) is a chronic condition and mainly affects the intestines, however, the involvement of the other organs of the gastrointestinal tract (upper part, pancreas, and liver) have been observed. The coexistence of IBD with pancreatic pathology is rare, however, it has been diagnosed more frequently during recent years in the pediatric population. This article reviews the current literature on the most common pancreatic diseases associated with IBD in the pediatric population and their relationship with IBD activity and treatment. We performed a systematic review of data from published studies on pancreatic disorders, also reported as extraintestinal manifestations (EIMs), among children with IBD. We searched PubMed and Web of Science to identify eligible studies published prior to 25 April 2020. Forty-four papers were chosen for analysis after a detailed inspection, which aimed to keep only the research studies (case control studies and cohort studies) or case reports on children and only those which were written in English. The manifestations of IBD-associated pancreatic disorders range from asymptomatic increase in pancreatic enzymes activity to severe disease such as acute pancreatitis. Acute pancreatitis (AP) induced by drugs, mainly thiopurine, seems to be the most- often-reported pancreatic disease associated with IBD in children. AP associated with other than drug etiologies, and chronic pancreatitis (CP), are rarely observed in the course of pediatric IBD. The pancreatic involvement can be strictly related to the activity of IBD and can also precede the diagnosis of IBD in some pediatric patients. The course of AP is mild in most cases and may occasionally lead to the development of CP, mainly in cases with a genetic predisposition. The involvement of the pancreas in the course of IBD may be considered as an EIM or a separate co-morbid disease, but it can also be a side effect of IBD therapy, therefore a differential diagnosis should always be performed. As the number of IBD incidences with concomitant pancreatic diseases is constantly increasing in the pediatric population, it is important to include pancreatic enzymes level measurement in the workup of IBD.
炎症性肠病（IBD）是一种慢性疾病，主要影响肠道，但也观察到胃肠道的其他器官（上消化道、胰腺和肝脏）受累。IBD 合并胰腺病变较为罕见，但近年来在儿科人群中的诊断频率有所增加。本文综述了儿科人群中与 IBD 相关的最常见胰腺疾病及其与 IBD 活动和治疗的关系。
我们对发表的关于儿童 IBD 患者胰腺疾病的研究数据进行了系统评价，这些胰腺疾病也被报道为肠外表现（EIM）。我们在 PubMed 和 Web of Science 上搜索了截至 2020 年 4 月 25 日发表的合格研究。经过详细检查，选择了 44 篇论文进行分析，目的是仅保留针对儿童的研究研究（病例对照研究和队列研究）或病例报告，并且仅保留用英语撰写的研究报告。IBD 相关胰腺疾病的表现从无症状的胰腺酶活性升高到严重疾病如急性胰腺炎不等。由药物引起的急性胰腺炎（AP），主要是硫唑嘌呤，似乎是儿童 IBD 中最常报道的与 IBD 相关的胰腺疾病。与药物以外的病因相关的 AP 和慢性胰腺炎（CP）在儿科 IBD 中很少观察到。胰腺受累可能与 IBD 的活动密切相关，在某些儿科患者中也可能先于 IBD 的诊断。大多数情况下，AP 的病程较轻，偶尔可能导致 CP 发展，主要发生在有遗传易感性的情况下。IBD 病程中胰腺的受累可被视为 EIM 或单独的合并疾病，但也可能是 IBD 治疗的副作用，因此应始终进行鉴别诊断。由于儿科人群中同时伴有胰腺疾病的 IBD 发病率不断增加，因此在 IBD 的检查中测量胰腺酶水平很重要。
