Clin Transl Gastroenterol. 2023 Aug 9. doi: 10.14309/ctg.0000000000000628.Online ahead of print.

Ke-You Zhang ¹, Ismaeel Siddiqi ², Michelle Saad ³, Tatiana Balabanis ¹, Melody S Dehghan ¹, Alexander Nasr ³, Vania Tolj ⁴, Aida Habtezion ⁵, K T Park ¹, Maisam Abu-El-Haija ³, Zachary M Sellers ¹

Author information

¹Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, CA.

²Department of Medicine, Division of Digestive Diseases, University of Cincinnati, Cincinnati, OH.

³Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Medical Center, Cincinnati, OH.

⁴Department of Medicine, University of Cincinnati, Cincinnati, OH.

⁵Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA.

Abstract

Introduction: Pancreatitis in inflammatory bowel disease has been attributed to peripancreatic intestinal disease and/or drug-induced pancreatic toxicity. We used large cohort analyses to define inflammatory bowel disease and pancreatitis temporal co-occurrence with a detailed descriptive analysis to gain greater insight into the pathophysiological relationship between these two diseases.

Methods: Truven Health MarketScan private insurance claims from 141,017,841 patients (<65 years-old) and 7,457,709 patients from four academic hospitals were analyzed. We calculated prevalence of Crohn's disease or ulcerative colitis with acute or chronic pancreatitis and performed temporal and descriptive analyses.

Results: Of 516,724 inflammatory bowel disease patients, 12,109 individuals (2.3%) had pancreatitis. Acute pancreatitis was 2-6x more prevalent than chronic pancreatitis. In adults, acute pancreatitis occurred equally among Crohn's disease and ulcerative colitis (1.8-2.2% vs. 1.6-2.1%, respectively), whereas in children, acute pancreatitis was more frequent in ulcerative colitis (2.3-3.4% vs. 1.5-1.8%, respectively). The highest proportion of pancreatitis (21.7-44.7%) was at/near the time of inflammatory bowel disease diagnosis. Of these, 22.1-39.3% were on steroids at the time of pancreatitis. Individuals with chronic pancreatitis or recurrent pancreatitis hospitalizations had increased risk of a future inflammatory bowel disease diagnosis (odds ratio=1.52 or 1.72, respectively).

Conclusions: Pancreatitis in inflammatory bowel disease may not simply be a drug adverse event but may also involve local and/or systemic processes that negatively impact the pancreas. Our analysis of pancreatitis before, during, and after inflammatory bowel disease diagnosis suggests a bi-directional pathophysiologic relationship between inflammatory bowel disease and pancreatitis, with potentially more complexity than previously appreciated.