S0755 Inflammatory Bowel Disease Increases the Risk of Acute Pancreatitis: A National Population-Based Study

Abstract

INTRODUCTION: Acute pancreatitis (AP) can occur in patients with inflammatory bowel disease (IBD) and can be either due to the underlying inflammatory disease itself or as a side effect of treatment. We aimed to is to estimate the risk of AP in patients with IBD using a national population-based cohort compared to a control population without IBD and to estimate the impact of anti-inflammatory and biologic agents on this risk. METHODS: Patients with crohn’s disease (CD), ulcerative colitis (UC) and a control cohort without CD or UC were identified using a national population-based database, Explorys from 2015 to 2020. After excluding tobacco users, patients with alcohol abuse, and those with cholelithiasis from all three cohorts (to minimize the risk of confounders) the rates and odds ratios (OR) of CD and UC patients with de-novo AP were calculated with 95% confidence intervals (CI). The rates of AP diagnosed within 6 months, 1 year, 2 years, and 3 years of a CD or UC diagnosis were also recorded ORs of CD or UC patients with de-novo AP after exposure to different classes of medications were noted. RESULTS: A total of 168,950 cases of CD were identified and 1.8% of them subsequently diagnosed with AP. While, 133,980 patients with UC were identified and 1.6% of them subsequently developed AP. Patients with CD were 6.03 times more likely to develop AP than the general population (OR 6.03; 95% CI 5.81–6.26; P < 0.05) and those with UC were 4.09 times more likely to develop AP than the general population (OR 4.09; 95% CI 3.92–4.27; P < 0.05). Only the use of glucocorticosteroids [CD: (OR: 1.38; 95% CI 1.30–1.48; P < 0.05), UC: (OR: 1.34; 95% CI 1.23–1.44; P < 0.05)] decreased the risk of AP when compared to the overall CD and UC cohorts. Interestingly, treatment with 5-aminosalicylic acid medications (OR: 1.23, 95% CI 1.14–1.32; P < 0.05) and immunomodulators [CD: (OR: 1.21; 95% CI 1.11–1.31; P < 0.05) decreased the risk of AP only in the CD group. CONCLUSION: Patients with CD or UC are at a greater risk of developing AP than the general population. The majority are likely to be diagnosed with AP within the first 6 months of their inflammatory disease diagnosis. 5-aminosalicylic acid drugs, and immunomodulators decreased only CD patients’ AP risk, while glucocorticosteroids significantly decreased both CD and UC patients’ risk of developing AP.Figure 1.: Flow chart of the 3 study population.Table 1.: Demographics of crohn's disease and ulcerative colitis patientsTable 2.: Odds ratios for crohn's disease and ulcerative colitis patients developing denovo acute pancreatitis