Department of Internal Medicine, Lahey Hospital and Medical Center, Tufts Medical School, Burlington, 01805, MA, USA.
Department of Internal Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Clinic, Burlington, 01803, MA, USA.
BMC Gastroenterol. 2023 May 22;23(1):171. doi: 10.1186/s12876-023-02790-8.
Patients with inflammatory bowel disease (IBD), whether Crohn's disease (CD) or ulcerative colitis (UC), have an increased risk of acute pancreatitis. The prognostic value of diagnosing acute idiopathic pancreatitis in patients with IBD is not well understood.
A retrospective review of 56 patients with IBD and acute pancreatitis was conducted in a tertiary center from 2011 to 2020. Aggressive disease course was defined as (i)biologic change, (ii)biologic dose escalation, or (iii)IBD-related surgeries occurring within 1 year of acute pancreatitis diagnosis. Logistic regression modelling identified associations between covariates and an aggressive disease course.
Baseline characteristics between idiopathic pancreatitis and other causes of acute pancreatitis, in both CD and UC cohorts, were similar. Idiopathic pancreatitis was significantly associated with an aggressive disease course in CD (P = 0.04). No confounding factors were associated with an aggressive disease course in CD. Idiopathic pancreatitis, however, was not associated with an aggressive disease course in UC (P = 0.35).
The diagnosis of acute idiopathic pancreatitis may provide a prognostic indicator of a more severe disease course in CD. No such association appears to exist with UC. To the best of our knowledge, this is the first study that identifies an association and possible prognostic value between idiopathic pancreatitis and a more severe disease course in CD. More studies with a larger sample size are needed to validate these findings, further define idiopathic pancreatitis as an extraintestinal manifestation of IBD and elucidate a clinical strategy to optimize care in patients with aggressive CD and idiopathic pancreatitis.
患有炎症性肠病（IBD）的患者，无论是克罗恩病（CD）还是溃疡性结肠炎（UC），都有发生急性胰腺炎的风险增加。在 IBD 患者中诊断特发性急性胰腺炎的预后价值尚未得到很好的理解。
对 2011 年至 2020 年在一家三级中心患有 IBD 和急性胰腺炎的 56 例患者进行了回顾性研究。疾病进程活跃定义为（i）生物变化，（ii）生物剂量升级，或（iii）急性胰腺炎诊断后 1 年内发生的与 IBD 相关的手术。逻辑回归模型确定了协变量与活跃疾病进程之间的关联。
CD 和 UC 队列中，特发性胰腺炎与其他原因引起的急性胰腺炎的基线特征相似。特发性胰腺炎与 CD 中活跃的疾病进程显著相关（P=0.04）。在 CD 中，没有混杂因素与活跃的疾病进程相关。然而，特发性胰腺炎与 UC 中的活跃疾病进程无关（P=0.35）。
急性特发性胰腺炎的诊断可能是 CD 疾病进程更严重的预后指标。UC 中似乎没有这种关联。据我们所知，这是第一项确定特发性胰腺炎与 CD 更严重疾病进程之间存在关联和可能具有预后价值的研究。需要更多具有更大样本量的研究来验证这些发现，进一步将特发性胰腺炎定义为 IBD 的肠外表现，并阐明优化具有活跃性 CD 和特发性胰腺炎患者的治疗策略。
