Daniluk Urszula, Krawiec Paulina, Pac-Kożuchowska Elżbieta, Dembiński Łukasz, Bukowski Jan Stanisław, Banaszkiewicz Aleksandra, Woźniuk-Kaźmierczak Anna, Czkwianianc Elżbieta, Brylak Jan, Walkowiak Jarosław, Borys-Iwanicka Agnieszka, Kofla-Dłubacz Anna, Pytrus Tomasz, Zdanowicz Katarzyna, Lebensztejn Dariusz Marek
Department of Pediatrics, Gastroenterology, Hepatology, Nutrition, Allergology and Pulmonology, Medical University of Bialystok, 15-274 Bialystok, Poland.
Department of Pediatrics and Gastroenterology, Medical University of Lublin, 20-059 Lublin, Poland.
J Clin Med. 2023 Jun 21;12(13):4174. doi: 10.3390/jcm12134174.
The coexistence of inflammatory bowel disease (IBD) with pancreatic pathology is rare in children. A retrospective analysis of data from 1538 children diagnosed with IBD in 2014-2021 was conducted to determine the frequency and causes of pancreatitis and asymptomatic hyperlipasemia (HL) or hyperamylasemia (HA) in this group of patients. Among the 176 children (11.4%) with pancreatic involvement (PI), acute pancreatitis (AP) was diagnosed in 77 children (43.8%), and HA or HL was observed in 88 children (50.0%). Only a few patients were diagnosed with autoimmune or chronic pancreatitis (6.2%). PI was observed at the time of the IBD diagnosis in 26.1% of the cases. A total of 54.5% of the patients had moderate to severe IBD, and 96% had colonic involvement at the time of diagnosis of PI. Idiopathic PI was the most common (57%), followed by drug-induced PI (37%) and azathioprine (AZA). In patients with AZA-induced AP, the successful introduction of 6-mercaptopurine (6-MP) to therapy was noted in 62.5% of the children. Our results suggest that routine monitoring of pancreatic enzymes in patients with IBD should be performed, especially after the initiation of the AZA treatment. The presence of transient HA/HL in IBD does not necessarily indicate pancreatic pathology.
炎症性肠病（IBD）与胰腺病变在儿童中并存的情况较为罕见。对2014年至2021年期间诊断为IBD的1538名儿童的数据进行了回顾性分析，以确定该组患者中胰腺炎以及无症状性高脂肪酶血症（HL）或高淀粉酶血症（HA）的发生率和病因。在176名有胰腺受累（PI）的儿童（11.4%）中，77名儿童（43.8%）被诊断为急性胰腺炎（AP），88名儿童（50.0%）观察到HA或HL。仅有少数患者被诊断为自身免疫性或慢性胰腺炎（6.2%）。26.1%的病例在IBD诊断时观察到PI。共有54.5%的患者患有中度至重度IBD，96%在PI诊断时累及结肠。特发性PI最为常见（57%），其次是药物性PI（37%）和硫唑嘌呤（AZA）。在AZA诱导的AP患者中，62.5%的儿童在治疗中成功引入了6-巯基嘌呤（6-MP）。我们的结果表明，应对IBD患者进行胰腺酶的常规监测，尤其是在开始AZA治疗后。IBD中短暂性HA/HL的存在不一定表明胰腺病变。
