Abstract
OBJECTIVES:We aimed to evaluate the incidence of pancreatic alterations in Crohn's disease using endoscopic ultrasound (EUS) and to correlate the number of alterations with current clinical data.METHODS:Patients diagnosed with Crohn's disease (n=51) were examined using EUS, and 11 variables were analyzed. A control group consisted of patients with no history of pancreatic disease or Crohn's disease. Patients presenting with three or more alterations underwent magnetic resonance imaging (MRI). Pancreatic function was determined using a fecal elastase assay.RESULTS:Two of the 51 patients (3.9%) presented with four EUS alterations, 3 (5.9%) presented with three, 11 (21.5%) presented with two, and 13 (25.5%) presented with one; in the control group, only 16% presented with one EUS alteration (p<0.001). Parenchymal abnormalities accounted for 39 of the EUS findings, and ductal abnormalities accounted for 11. Pancreatic lesions were not detected by MRI. Low fecal elastase levels were observed in 4 patients, none of whom presented with significant pancreatic alterations after undergoing EUS. Ileal involvement was predictive of the number of EUS alterations.CONCLUSION:A higher incidence of pancreatic abnormalities was found in patients with Crohn's disease than in individuals in the control group. The majority of these abnormalities are related to parenchymal alterations. In this group of patients, future studies should be conducted to determine whether such morphological abnormalities could evolve to induce exocrine or endocrine pancreatic insufficiency and, if so, identify the risk factors and determine which patients should undergo EUS.
Highlights
Chronic pancreatic involvement in patients diagnosed with Crohn’s disease (CD) has been the focus of studies in recent years [1,2,3,4,5,6,7]
The present study shows that 9.8% of the patients with CD presented with pancreatic involvement in morphological evaluations using Endoscopic ultrasound (EUS), predominantly in patients with ileal involvement
This protein is present on the apical surface of microfold (M) intestinal cells located in the ileum but not in colonic cells, which explains the close relation between higher positive rates in CD versus fewer than 8% in UC
Summary
Chronic pancreatic involvement in patients diagnosed with Crohn’s disease (CD) has been the focus of studies in recent years [1,2,3,4,5,6,7]. Medications, primary sclerosing cholangitis, inflammatory involvement of the duodenum and autoimmune pancreatitis (AIP) are all well-established causes of pancreatitis in this population [812]. Studies on this topic are limited and extremely heterogeneous, mainly because there is no established consensus method to study the pancreas. The prevalence of this combination (CD and pancreatitis) ranges from 1.2% to 58% depending on the population studied and the method of pancreatic evaluation employed [5,6,13,14,15,16,17,18]. Received for publication on July 1, 2018. Accepted for publication on January 17, 2019
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