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Pancreatic and hepatobiliary disorders in inflammatory

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Pancreatic and hepatobiliary disorders in inflammatory bowel diseaseBENGT HEIKIUS
OULU 2000
BENGT HEIKIUS
PANCREATIC AND HEPATOBILIARY DISORDERS IN INFLAMMATORY BOWEL DISEASE
Academic Dissertation to be presented with the assent of the Faculty of Medicine, University of Oulu, for public discussion in Auditorium 10 of the University Hospital of Oulu, on October 6th, 2000, at 12 noon.
OULUN YLIOPISTO, OULU 2000
Manuscript received: 23 August 2000 Manuscript accepted: 28 August 2000
Communicated by Docent Risto Julkunen Docent Isto Nordback
ISBN 951-42-5756-1 (URL: http://herkules.oulu.fi/isbn9514257561/)
ALSO AVAILABLE IN PRINTED FORMAT ISBN 951-42-5755-3 ISSN 0355-3221 (URL: http://herkules.oulu.fi/issn03553221/)
OULU UNIVERSITY PRESS OULU 2000
Heikius, Bengt, Pancreatic and hepatobiliary disorders in inflammatory bowel disease Department of internal Medicine, Vaasa Central Hospital, , FIN 65130 Vaasa, Finland, Department of Internal Medicine, University of Oulu, P.O.Box 5000, FIN-90014 University of Oulu, Finland 2000 Oulu, Finland (Manuscript received: 23 August 2000)
Abstract
Extraintestinal manifestations in inflammatory bowel disease (IBD) have been described with vary- ing frequencies. The aim of this study was to estimate the prevalence of pancreatic duct abnormalities, exocrine and endocrine dysfunction, elevated pancreatic enzymes, hepato-biliary disease, coexisting cholangiographic and pancreatographic duct changes, and elevated serum levels of fibrosis markers in IBD, and to correlate the findings with clinical, endoscopic and histologic variables.
From a local patient register, 237 patients were randomly selected and studied. Of these, 170 had ulcerative colitis (UC), 46 had Crohn’s disease (CD), and 21 had indeterminate colitis (IC). A detailed history was obtained from medical records and in a face-to-face interview. The patients were screened with a para-aminobenzoic acid (PABA) test and, for pancreatic enzymes, liver function tests, serum aminoterminal propeptide of type III procollagen (PIIINP), and laminin. Further pancreatic evalua- tion included endoscopic retrograde cholangiopancreato-graphy (ERCP), ultrasound (US), secretin test, and glucagon C-peptide test. Further hepatobiliary evaluation consisted of ERCP, US, and liver biopsy.
In IBD, the prevalence rates of pancreatic duct abnormalities and exocrine dysfunction were 8% and 4%, respectively. Parallel impairment of exocrine and endocrine functions was shown. Acute id- iopathic pancreatitis may complicate IBD. About 7-17% presented with elevated pancreatic enzymes. Enzyme elevation was associated with extensive and histologically active disease and, in some cases, with primary sclerosing cholangitis (PSC). Abnormal liver test results were commoner in patients with CD than in patients with UC (30% versus 11%). The prevalence of PSC in IBD was 11%, which is higher than previously reported (3.7-7.5%). PSC was commoner in patients with CD than in pa- tients with UC (17.4% versus 7.6%). About half of the PSC patients had concomitant pancreatic duct changes, and the prevalence of concurrent cholangiographic and pancreatographic duct changes in IBD was 4.6%. Both serum PIIINP and laminin were increased in IBD patients. This was not only seen in patients with hepatobiliary disease and PSC, but also in patients with pancreatic disease.
In conclusion, pancreatic and hepatobiliary complications in IBD occur with high and similar fre- quencies in all IBD categories and are associated with each other. They are not clearly associated with the clinical course of IBD.
Keywords: collagen markers, pancreatic enzymes, primary sclerosing cholangitis.