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Northeast Florida Medicine
Vol. 66, No. 4 2015
71
Inflammatory Bowel Disease
Pancreatic Diseases in Patients with
Inflammatory Bowel Disease
Introduction
Inflammatory Bowel Disease (IBD) includes major
entities such as Crohn’s disease, and ulcerative colitis, but
microscopic colitis (MC), a minor member, is a surging
form of this disease group. Although their etiology is
unknown, and they all have distinct clinic and patho-
logical characteristics, the relationship between IBD and
pancreatic idiosyncrasies has definitely been established
throughout the years.
IBD Classification
Crohn’s Disease
Crohn’s disease is a chronic disorder characterized by
transmural inflammatory skip lesions that involve the en-
tire gastrointestinal tract. Its symptoms are unpredictable
and may include abdominal pain, cramping, diarrhea,
fever, fatigue, anemia, reduced appetite, and weight loss.
1
Ulcerative Colitis
Ulcerative colitis is the chronic inflammation of the
mucosal layer of the colon. Its most common symptoms
Abstract:
Patients with inflammatory bowel disease (IBD)
show an increased risk of pancreatic diseases compared to the
general population, usually taking place in the course of the
malady or sometimes even preceding the diagnosis. This particular
kind of complication is mainly due to therapeutic agents used
in the management of Crohn’s disease (CD), ulcerative colitis
(UC), and microscopic colitis (MC). IBD also displays other
extraintestinal manifestations involving joints, skin, eyes, kidneys,
liver, gallbladder, and lungs. Despite IBD’s unknown etiology,
it is believed to be the result of the interaction of genetics, the
immune system, and environmental factors. Health care providers
and the general population need to identify premature clinical
manifestations of pancreatic affliction to delay progression and/or
sustain a better management of patients with IBD.
include diarrhea, abdominal pain, hematochezia, fatigue,
weight loss, reduced appetite, tenesmus, and fever.
1,2
Microscopic Colitis
Microscopic colitis is an inflammatory condition of
the colon, usually of insidious onset, characterized by
non-bloody, watery, chronic diarrhea.
3-6
Based on the
exhibited histological features, MC is subclassified in
lymphocytic and collagenous colitis. Lymphocytic colitis
is branded as an intraepithelial lymphocytic infiltrate of
>20 cells per high power field, while collagenous colitis
shows a subepithelial collagen band >10 micrometers in
thickness.
3,7-10
Most commonly associated symptoms include fecal
urgency/incontinence, abdominal pain, and nocturnal
episodes.
11,12
Weight loss can be perceived due to fluid
loss, mostly in patients with active disease (≥3 stools or
≥1 watery stool daily); some extreme cases may lose up
to two liters per day.
4,13
Pancreatic Involvement in IBD
The etiology of pancreatic anomalies in IBD appears to
be multifactorial. Contributing factors include medication
used to treat IBD (6-mercaptopurine, azathioprine, corti-
costeroids or 5-ASA agents), duodenal fistulas, anatomic
abnormalities, such as ampullary and duodenal Crohn’s
disease, gallstones, primary sclerosing cholangitis, pancre-
By Martha Arévalo, MD and Jose M. Nieto, DO, FACP, FACG, AGAF
Address correspondence to:
Martha Arévalo, MD
Universidad de Especialidades Espíritu Santo
Km. 2.5 Vía a La Puntilla
Samborondón - Ecuador
Jose M. Nieto, DO
Borland Groover Clinic
4800 Belfort Road
Jacksonville, FL 32256
Email:
drjnieto@yahoo.com