Pancreatic Duct Abnormalities and Pancreatic Function in Patients with Chronic Inflammatory Bowel Disease

Abstract

Our results show the presence of pancreatic duct abnormalities and exocrine pancreatic insufficiency in some patients with IBD.

Frequency and characteristics of pancreatitis in patients with inflammatory bowel disease

“…By using the secretin-cerulein test, Angelini et al [11] found a decrease in bicarbonate and enzyme output in 11 among 27 patients and an isolated decrease of lipase output in 18/27 patients in a series of 27 patients with IBD. Heykius et al [6] , in a series of patients with UC or CD, found abnormal PABA test results in 21.8 and 26% of the cases. In IBD patients, Hegnhoj et al [12] confirmed a significant decrease of amylase and lipase output with Lundh meal test.…”

“…None of them had previous clinical evidence for pancreatic disease, suggesting subclinical or silent alteration of the pancreas. The relationships between pancreatitis and the extent and severity of [2,6,20] . Such data and the recent evaluation of standardized incidence ratios of pancreatitis, 4.3 for CD and 2.1 for UC [21] , led to the conclusion that many cases of IBD-associated pancreatitis are extraintestinal manifestations of the intestinal disease [2,22] but with an unknown or controversial frequency when considering clinical, biological or radiological data.…”

“…The low prevalence of increased values of amylase or lipase (2-4%) in patients of group C points out the fact that anomalies of the amylasemia or lipasemia in asymptomatic patients with IBD are uncommon. In the literature, abnormal serum levels of amylase were shown in 5.8-15.8% of patients with UC or CD [6][7][8] . The results of our series are similar to those of the literature but cannot predict alone the existence of pancreatic involvement in IBD because of the lack of specificity.…”

“…Clinical symptoms of IBD-associated pancreatitis are found in ϳ 2% of patients but the actual frequency of the disease could be much higher since, according to several studies, hyperamylasemia and exocrine pancreatic insufficiency are found in 6-16 and 21-80% of patients, respectively, whereas histological changes are observed in 38-53% of postmortem pathological examinations [6][7][8][9][10][11][12] . Therefore, it appears that IBD-associated pancreatitis could be mainly a silent disease.…”

Mechanisms of gastric emptying disturbances in chronic and acute inflammation of the distal gastrointestinal tract

“…Octanoic acid is absorbed without further requirements as soon as it enters the duodenum. As a consequence, potentially decreased pancreatic exocrine function as observed in IBD (22,25) is irrelevant. Because we did not have evidence for involvement of the proximal gastrointestinal tract apart from small ulcers and/or histological lesions in two patients with CD (Table 1), we conclude that the 13 C-OABT reliably reflected gastric emptying of solids in our patients.…”