Tu1952 Title: Increased Epithelial Gap Density in the Small Bowel Is Mediated by Caspase-1 Activation of Intestinal Epithelial Cells: A Quantitative Analysis of Confocal Laser Endomicroscopy Images and Mucosal Biopsy Samples

Abstract

BACKGROUND AND AIMS: There are only few case reports describing the frequency and the clinical features of pancreatic involvement (PI) in inflammatory bowel disease (IBD). We aimed to estimate the prevalence and to characterize IBD pediatric patients with PI. METHODS: We retrospectively reviewed data collected in the IBD web-registry of the Italian Society for Pediatric Gastroenterology, Hepatology and Nutrition. All children presenting with hyperamylasemia and/or hyperlipasemia were identified. Demographic and clinical data, IBD type, disease exstension and activity, laboratory data, IBD therapy, imaging findings and therapeutic interventions were evaluated. Acute pancreatitis (AP) was defined by the occurrence of at least two of the following findings: acute epigastric abdominal pain, elevated serum amylase and/or lipase ≥ 3 times the upper level of normal, and characteristic radiological changes. RESULTS: We found 27 children out of 649 (4.1%) with an increased value of amylase and/or lipase [Median Age: 148, range 65-191, mths; F/M: 14/13; Ulcerative colitis (UC): 12; Crohn's disease (CD): 13; Unclassified Colitis (IBDU): 2)]. Mean serum amylase level was 205.3 ± 91.5 (range 61-413 IU/L) and mean serum lipase level was 526.8 ± 598.8 (range 37-2565 IU/L). Eleven patients (1.6%) fulfilled diagnostic criteria for AP (6 CD, 4 UC, 1 IBDU). Ten (37%) patients underwent imaging ultrasound scan, 8 (29.6%) patients had magnetic resonance cholangiopancreatography and 2 (7.4%) patients had a computed tomography scan. Pancreatic pathological findings were found in all subjects with AP. The mean lag time period between the diagnosis of IBD and the PI was 12.1 mths (range 0-65). Five patients out of 27 (18.5%) showed PI at diagnosis of IBD. Twenty-four out of 27 (88.8%) had colonic disease [10 CD, 12 UC (8 pancolitis) and 2 IBDU]. Ten patients were receiving mesalamine (ASA) and 16 patients were under immunosuppressive therapy [3 streoids, 6 azathioprine (AZT), 5 AZT + ASA, 1 methotrexate, 1 infliximab (IFX), and 1 IFX+ASA+AZT], while 1 patient was not treated. Comparing with the patients with an exclusive hyperamylasemia and/or hyperlipasemia, AP was significantly associated with female gender (p=0.018), whereas type of IBD, ongoing treatments, activity and extension of disease did not result significant risk factors. Seven out of 11 (63.6%) patients with AP needed therapeutic measures including AZT and/or ASA withdrawal, compared to only 4 (25%) patients out of 16 with serum hyperamylasemia and/or hyperlipasemia (p=0.06). CONCLUSIONS: Our study suggests that prevalence of AP in children is similar to that reported in adults. PI was more common in colonic disease. Female gender seems to be a risk factor for developing AP in children. In contrast to previous study, PI was not associated with any type of IBD.