P1218 Pancreatic Involvement in Patients with Inflammatory Bowel Disease: A Cohort Study of 474 IBD Patients

Abstract Background Inflammatory bowel disease (IBD) is a systemic condition that extends beyond the gastrointestinal tract, affecting multiple organ systems, including the skin, musculoskeletal system, and eyes... . The pancreas is one such organ that can be affected, exhibiting diverse manifestations through various pathophysiological mechanisms. These manifestations range from asymptomatic elevations of pancreatic enzymes to severe conditions such as acute pancreatitis (AP), autoimmune pancreatitis (AIP), chronic pancreatitis (CP), and pancreatic cancer. This study evaluates the prevalence and characteristics of pancreatic involvement in patients with IBD. Methods This retrospective, descriptive, analytical study spanned nine years (January 2016–December 2023) and included regular follow-up of patients with a confirmed diagnosis of IBD. We specifically investigated different pancreatic involvements in IBD patients, excluding asymptomatic elevations of pancreatic enzymes. Results A total of 474 IBD patients were analyzed: 291 with Crohn's disease (CD), 178 with ulcerative colitis (UC), and 5 with indeterminate colitis. Pancreatic involvement was observed in 6 patients (4 women and 2 men), comprising 3 with Crohn's disease and 3 with ulcerative colitis, resulting in an overall prevalence of 1.26%. The mean age of presentation for pancreatic manifestations was 42.5 years (range 23–59 years), with a male-to-female ratio of 0.5. The prevalence among CD patients was 1.03%, compared to 1.68% in UC patients. Five cases of acute pancreatitis were documented:Medication-related AP: Two patients developed acute pancreatitis related to 6-mercaptopurine and azathioprine. Biliary and medication-related AP: One patient treated with 5-ASA presented with a bile duct stone, suggesting a biliary or drug-related cause. Morphological anomaly Another case was linked to mesalazine or pancreas divisum. Autoimmune pancreatitis (type 2): One case was identified, associated with exocrine pancreatic insufficiency. Diffuse abdominal pain with elevated lipase: One patient exhibited elevated lipase levels and acute renal failure without imaging abnormalities. Conclusion Pancreatic abnormalities in patients with IBD encompass diverse clinical manifestations and etiologies. Our findings indicate that acute pancreatitis is the most common presentation, primarily linked to medications such as azathioprine, 6-mercaptopurine, and mesalazine, as well as biliary causes and autoimmune disorders. The identification of type 2 autoimmune pancreatitis underscores the importance of further research into the pathophysiology of pancreatic involvement in IBD.