Systematic review—pancreatic involvement in inflammatory bowel disease

• Published in: Alimentary pharmacology & therapeutics Vol. 55; no. 12; pp. 1478 - 1491
• Main Authors: Massironi, Sara, Fanetti, Ilaria, Viganò, Chiara, Pirola, Lorena, Fichera, Maria, Cristoferi, Laura, Capurso, Gabriele, Invernizzi, Pietro, Danese, Silvio
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.06.2022; John Wiley and Sons Inc
• Subjects: Acute Disease; Autoimmune Diseases - complications; Autoimmune Diseases - pathology; Calculi; Chronic Disease; Colitis, Ulcerative - complications; Exocrine Pancreatic Insufficiency; Gallstones; Gallstones - complications; Humans; Immunosuppressive agents; Inflammatory bowel disease; Inflammatory bowel diseases; Inflammatory Bowel Diseases - complications; Inflammatory diseases; Intestine; Pancreas; Pancreatic diseases; Pancreatitis; Pancreatitis, Chronic; Systematic Review; Ulcerative colitis
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.16949

Summary Background Inflammatory bowel disease (IBD) is a chronic inflammatory immune‐mediated disorder of the gut with frequent extra‐intestinal complications. Pancreatic involvement in IBD is not uncommon and comprises a heterogeneous group of conditions, including acute pancreatitis (AP), chronic pancreatitis (CP), autoimmune pancreatitis (AIP) and pancreatic exocrine insufficiency (PEI); however, data on such an association remain sparse and heterogeneous. Method PubMed/MEDLINE and EMBASE databases were searched for studies investigating pancreatic involvement in patients with IBD. Results Four thousand one hundred and twenty‐one records were identified and 547 screened; finally, 124 studies were included in the review. AP is the most frequent pancreatic manifestation in IBD; the majority of AP cases in IBD are due to gallstones and drugs but cases of idiopathic AP are increasingly reported. AIP is a rare disease, but a strong association with IBD has been demonstrated, especially for type 2 and ulcerative colitis. The pathogenetic link between IBD and AIP remains unclear, but an immune‐mediated pathway seems plausible. An association between CP and PEI with IBD has also been suggested, but data are to date scarce and conflicting. Conclusion This is the first systematic review of the association between IBD and pancreatic diseases. Gallstones and drugs should be considered the most probable causes of AP in IBD, with type 2 AIP also being possible. Systematic review. Pancreatic involvement in inflammatory bowel disease (IBD). The wide spectrum of pancreatic involvement in patients with IBD may represent a challenge. From the 124 studies analyzed, acute pancreatitis (AP) is the most frequent pancreatic manifestation in IBD; the majority of AP cases in IBD are due to gallstones and drugs, but cases of idiopathic AP are increasingly reported. Autoimmune pancreatisis is a rare disease, but a strong association with IBD has been demonstrated, especially for type 2 and ulcerative colitis.