Acute Pancreatitis in Inflammatory Bowel Disease: Results from the European Pandora Study

<i>Background and aims</i>: An increased risk of acute pancreatitis (AP) has been reported in patients with inflammatory bowel disease (IBD), but data on its prevalence, etiology, and outcomes are limited. <i>Materials and Methods:</i> A two-step retrospective analysis spanning 10 years (2011-2020) was conducted across 34 European centers. The first step surveyed the prevalence of AP in patients with IBD, while the second gathered data on disease characteristics, etiology, and outcomes. <i>Results:</i> The survey found an expected AP prevalence of 1.13% (780/68,989), though only 0.58% (n = 398) met the inclusion criteria. The mean age was 33.6 ± 14.3; 52% were female, and 56.5% had Crohn's disease (CD). AP was clinically mild in most cases (86.9%). Among 347 patients with available imaging, no alterations were observed in 81 (23.3%), whereas edematous AP was observed in 218 (62.8%). Drugs (mainly azathioprine) were the leading cause (55.3%), followed by biliary (14.8%) and autoimmune (7.8%) causes. In 13.5% of patients, AP was considered idiopathic. During a median follow-up of 67 months [IQR 34-96] from the index episode, recurrence was observed in 13% of patients, and 1.5% developed chronic pancreatitis. CD patients exhibited distinct risk profiles, including ileal involvement and smoking, whereas ulcerative colitis (UC) patients showed more frequent autoimmune and idiopathic etiologies. <i>Conclusions:</i> The PANDORA study established a 0.58% prevalence of AP in IBD patients, which was lower than expected. AP is usually mild both clinically and radiologically. An ileal location in CD and extensive colitis in UC are usually reported, and azathioprine seems to be the most common cause of AP in this setting, especially a few weeks after its introduction.

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Journal
Medicina
Published
2025-08-26
DOI
https://doi.org/10.3390/medicina61091532
Primary Topic
Pancreatitis Pathology and Treatment
Type
article
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article

Acute Pancreatitis in Inflammatory Bowel Disease: Results from the European Pandora Study

Chiara Viganò, Antonietta Gerarda Gravina, Aikaterini Μantaka, Antonio Rispo et al.
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Medicina
Pancreatitis Pathology and Treatment
article

Acute Pancreatitis in Inflammatory Bowel Disease: Results from the European Pandora Study

Chiara Viganò, Antonietta Gerarda Gravina, Aikaterini Μantaka, Antonio Rispo, Stefano Francesco Crinò, Raquel Oliveira, Javier P. Gisbert, Angela Variola, Stefano Festa, Andrea Michielan, Michele Campigotto, Luca Frulloni, Mathieu Uzzan, Maria Cristina Conti Bellocchi, Lieven Pouillon, Maria Fragaki, Anneline Cremer, Marie Truyens, Piotr Eder, Sophie Vieujean, Laura Loy, Andreas Blesl, Clara Yzet, Tiago Cúrdia Gonçalves, Martina Cattani Mottes, Aldis Puķītis, Rachele Ciccocioppo, Laura Ramos, Daniela Pugliese, Edoardo Vincenzo Savarino, Davide Giuseppe Ribaldone, Ioannis E. Κoutroubakis, Konstantinos Argyriou, Spyridon Vrakas, Pierre Ellul, Anna Viola, Massimo Claudio Fantini, Alessia Dalila Guarino
article en

Abstract

<i>Background and aims</i>: An increased risk of acute pancreatitis (AP) has been reported in patients with inflammatory bowel disease (IBD), but data on its prevalence, etiology, and outcomes are limited. <i>Materials and Methods:</i> A two-step retrospective analysis spanning 10 years (2011-2020) was conducted across 34 European centers. The first step surveyed the prevalence of AP in patients with IBD, while the second gathered data on disease characteristics, etiology, and outcomes. <i>Results:</i> The survey found an expected AP prevalence of 1.13% (780/68,989), though only 0.58% (n = 398) met the inclusion criteria. The mean age was 33.6 ± 14.3; 52% were female, and 56.5% had Crohn's disease (CD). AP was clinically mild in most cases (86.9%). Among 347 patients with available imaging, no alterations were observed in 81 (23.3%), whereas edematous AP was observed in 218 (62.8%). Drugs (mainly azathioprine) were the leading cause (55.3%), followed by biliary (14.8%) and autoimmune (7.8%) causes. In 13.5% of patients, AP was considered idiopathic. During a median follow-up of 67 months [IQR 34-96] from the index episode, recurrence was observed in 13% of patients, and 1.5% developed chronic pancreatitis. CD patients exhibited distinct risk profiles, including ileal involvement and smoking, whereas ulcerative colitis (UC) patients showed more frequent autoimmune and idiopathic etiologies. <i>Conclusions:</i> The PANDORA study established a 0.58% prevalence of AP in IBD patients, which was lower than expected. AP is usually mild both clinically and radiologically. An ileal location in CD and extensive colitis in UC are usually reported, and azathioprine seems to be the most common cause of AP in this setting, especially a few weeks after its introduction.

MedicinaVol. 61(9)
University of Messina (IT), University of Verona (IT), Poznan University of Medical Sciences (PL), Université Libre de Bruxelles (BE), University of Padua (IT), University of Trieste (IT), University of Campania "Luigi Vanvitelli" (IT), Medical University of Graz (AT), Hôpital Beaujon (FR), Hospital Universitario de Canarias (ES), Mater Dei Hospital (MT), Ghent University Hospital (BE), Agostino Gemelli University Polyclinic (IT), Ospedale Santa Chiara (IT), Centre Hospitalier Universitaire Amiens-Picardie (FR), Ospedale San Filippo Neri (IT), Pauls Stradiņš Clinical University Hospital (LV), Ospedale Sacro Cuore Don Calabria (IT), University Hospital of Larissa (GR), Provincia Autonoma di Trento (IT), Administração Regional de Saúde de Lisboa e Vale do Tejo (PT), Federico II University Hospital (IT), Algarve Biomedical Center (PT), Azienda Ospedaliero-Universitaria Cagliari (IT), Tzaneion General Hospital (GR), Hospital Universitario de La Princesa (ES), The General Hospital of Heraklion "Venizeleio-Pananio" (GR), Chania General Hospital ”St. George” (GR), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (ES), Centre Hospitalier Universitaire de Liège (BE), Imelda Hospital (BE), University Hospital of Heraklion (GR), ERN GUARD-Heart (NL), Istituti di Ricovero e Cura a Carattere Scientifico (IT), 404 General Military Hospital (GR), IRCCS Humanitas Research Hospital (IT), University of Turin (IT), Universidad Autónoma de Madrid (ES), University of Naples Federico II (IT), University of Minho (PT)
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Pancreatitis Pathology and Treatment
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