Pancreatic function in Crohn's disease.

Hegnhøj, J; Hansen, Carsten P.; Rannem, T.; Søbirk, H; Andersen, L. B.; Andersen, Jesper Rye

doi:10.1136/gut.31.9.1076

Cited by 58 publications

(38 citation statements)

References 13 publications

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“…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. This exocrine pancreatic insufficiency appeared to correlate with the extension of the lesions of CD, especially with ileal location and with disease activity in case of predominant lesions to the ileum [12] .…”

Section: Discussionmentioning

confidence: 95%

“…In IBD patients, Hegnhoj et al [12] confirmed a significant decrease of amylase and lipase output with Lundh meal test. This exocrine pancreatic insufficiency appeared to correlate with the extension of the lesions of CD, especially with ileal location and with disease activity in case of predominant lesions to the ileum [12] . In this series, we did not demonstrate any relationship between pancreatic insufficiency and an inflammatory pattern (PAP, CRP) or immune response (pancreatic autoantibodies) ( table 4 ).…”

Section: Discussionmentioning

confidence: 95%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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Frequency and characteristics of pancreatitis in patients with inflammatory bowel disease

Barthet

Lesavre

Desplats³

et al. 2006

Pancreatology

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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Frequency and characteristics of pancreatitis in patients with inflammatory bowel disease

Barthet

Lesavre

Desplats³

et al. 2006

Pancreatology

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“…It is often associated with anatomical changes or the use of medication. There is also a number of case reports where acute pancreatitis was associated with Crohn's disease alone and several studies have reported pancreatic insufficiency in Crohn's disease [23][24][25][26][27] In addition, one study showed that in an animal model of acute pancreatitis in rats, the use of azathioprine worsened the inflammation. 28 These findings taken together might suggest that azathioprine exacerbates an already inflamed pancreas in Crohn's disease.…”

Section: Discussionmentioning

confidence: 99%

Increased incidence of azathioprine‐induced pancreatitis in Crohn's disease compared with other diseases

Weersma¹,

Peters²,

Oostenbrug³

et al. 2004

Aliment Pharmacol Ther

108

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Summary Background : Azathioprine is widely used in Crohn's disease. A major drawback is the occurrence of side‐effects, especially acute pancreatitis. Acute pancreatitis is rarely seen when azathioprine is used for other diseases than Crohn's disease. Aim : To survey side‐effects of azathioprine after liver or renal transplantation, for systemic lupus erythematosis, Wegener's granulomatosis, autoimmune hepatitis, rheumatoid arthritis, ulcerative colitis or Crohn's disease. Methods : A computerized search using the term ‘azathioprine’ or ‘imuran’ was performed on the Hospital Information System of the university hospital Groningen, resulting in 1564 patients matching our criteria. Results : Eleven of 224 patients with Crohn's disease experienced acute pancreatitis (4.9%) compared with two of 129 (1.5%) with autoimmune hepatitis, two of 388 (0.5%) after renal transplantation, one of 254 (0.4%) after liver transplantation. Acute pancreatitis was more prevalent in Crohn's disease compared with any other disease. Azathioprine‐toxicity necessitating withdrawal occurred significantly (P < 0,05) more in rheumatoid arthritis(78 of 317), ulcerative colitis (20 of 94) and Crohn's disease (52 of 224) compared with systemic lupus erythematosis (five of 73), Wegener's granulomatosis (six of 85), autoimmune hepatitis (eight of 129), after liver transplantation (17 of 254) and after renal transplantation (22 of 388). Conclusions : Acute pancreatitis is strongly associated with Crohn's disease and rarely occurs with other underlying conditions. Overall azathioprine‐induced toxicity and the necessity of withdrawal is more common in inflammatory bowel disease and rheumatoid arthritis compared with other diseases.

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“…While IBD-associated clinical pancreatitis was found in only 2% of patients, autopsy series showed histologic pancreatitis in 38%-53% of patients with CD or UC, and laboratory tests demonstrated exocrine pancreatic insufficiency in 21%-80% of these patients. [132][133][134][135][138][139][140] An autopsy study of 39 IBD patients showed the presence of pancreatic fibrosis in 15 (38%), but none of them had previous clinical, radiographic, or laboratory evidence for pancreatic diseases. 140 Exocrine deficiency was seen in 4% of patients, while pancreatic duct abnormalities were seen in 8.4% in a study of unselected IBD patients.…”

Section: Chronic Pancreatitismentioning

confidence: 99%

Hepatopancreatobiliary manifestations and complications associated with inflammatory bowel disease

Navaneethan¹,

Shen²

2010

Inflammatory Bowel Diseases

182

127

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Diseases involving the hepatopancreatobiliary (HPB) system are frequently encountered in patients with inflammatory bowel disease (IBD). Hepatobiliary manifestations constitute some of the most common extraintestinal manifestations of IBD. They appear to occur with similar frequency in patients with Crohn's disease or ulcerative colitis. HPB manifestations may occur in following settings: 1) disease possibly associated with a shared pathogenetic mechanism with IBD including primary sclerosing cholangitis (PSC), small-duct PSC/pericholangitis and PSC/autoimmune hepatitis overlap, acute and chronic pancreatitis related to IBD; 2) diseases which parallel structural and physiological changes seen with IBD, including cholelithiasis, portal vein thrombosis, and hepatic abscess; and 3) diseases related to adverse effects associated with treatment of IBD, including drug-induced hepatitis, pancreatitis (purine-based agents), or liver cirrhosis (methotrexate), and reactivation of hepatitis B, and biologic agent-associated hepatosplenic lymphoma. Less common HPB manifestations that have been described in association with IBD include autoimmune pancreatitis (AIP), IgG4-associated cholangitis (IAC), primary biliary cirrhosis (PBC), fatty liver, granulomatous hepatitis, and amyloidosis. PSC is the most significant hepatobiliary manifestation associated with IBD and poses substantial challenges in management requiring a multidisciplinary approach. The natural disease course of PSC may progress to cirrhosis and ultimately require liver transplantation in spite of total proctocolectomy with ileal-pouch anal anastomosis. The association between AIP, IAC, and elevated serum IgG4 in patients with PSC is intriguing. The recently reported association between IAC and IBD may open the door to investigate these complex disorders. Further studies are warranted to help understand the pathogenesis of HPB manifestations associated with IBD, which would help clinicians better manage these patients. An interdisciplinary approach, involving gastroenterologists, hepatologists, and, in advanced cases, general, colorectal, and transplant surgeons is advocated.

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Pancreatic function in Crohn's disease.

Abstract: We investigated exocrine pancreatic function in a population of patients with Crohn's disease in order to correlate the pancreatic function with clinical and laboratory variables.

Cited by 58 publications

References 13 publications

Frequency and characteristics of pancreatitis in patients with inflammatory bowel disease

Frequency and characteristics of pancreatitis in patients with inflammatory bowel disease

Increased incidence of azathioprine‐induced pancreatitis in Crohn's disease compared with other diseases

Hepatopancreatobiliary manifestations and complications associated with inflammatory bowel disease

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