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Idiopathic Pancreatitis Preceding the Diagnosis of Inflammatory Bowel Disease Is More Frequent in Pediatric Patients

Broide, Efrat*; Dotan, Iris; Weiss, Batia; Wilschanski, Michael§; Yerushalmi, Baruch||; Klar, Aharon; Levine, Arie#

Journal of Pediatric Gastroenterology and Nutrition: June 2011 - Volume 52 - Issue 6 - p 714–717
doi: 10.1097/MPG.0b013e3182065cad
Original Articles: Gastroenterology

Background and Objectives: Acute pancreatitis (AP) can be a rare extraintestinal manifestation of inflammatory bowel disease (IBD). There are only a few reports of AP presenting before the diagnosis of IBD. We aimed to characterize the demographic, clinical, and laboratory data of patients with IBD in whom AP preceded disease onset and compare the presentation of AP between children and adults.

Patients and Methods: Pediatric and adult patients presenting with AP as the first symptom of IBD were retrospectively identified (10 years, 7 university hospitals). Demographic and clinical data, IBD type, disease extension, and laboratory data were extracted from the charts. Imaging methods, number of AP episodes, and lag time between onset of first pancreatitis episode and onset of IBD were recorded.

Results: AP preceding the diagnosis of IBD was found in 10 in 460 pediatric patients with IBD (2.17%), compared with only 2 in 3500 adults (0.06%). Eight children had colonic disease (4 Crohn disease, 4 ulcerative colitis [3 pancolitis]). Mean amylase level was 1419 and range 100 to 1370. Three children (30%) had mildly elevated transaminases. Median time between onset of first episode of AP in relation to onset of IBD was 24 (range 1–156) weeks. AP most commonly presented with abdominal pain.

Conclusions: IBD presenting as AP was more frequent among the pediatric population with IBD in comparison to adults. It was more common in patients with colitis than in those with ileal disease, suggesting that patients with idiopathic AP should be observed carefully for a possible diagnosis of IBD.

*Institute of Gastroenterology, Liver Diseases and Nutrition, Assaf Harofeh Medical Center, Zerifin (affiliated with the Sackler Faculty of Medicine, Tel Aviv University), Israel

Institute of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

Division of Pediatric Gastroenterology and Nutrition, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel

§Pediatric Gastroenterology Unit, Department of Pediatrics, Hadassah Medical Center, Jerusalem, Israel

||Pediatric Gastroenterology and Nutrition Unit, Department of Pediatric Surgery and Pediatrics, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Negev, Israel

Pediatric Gastroenterology Unit, Department of Pediatrics, Bikur Cholim General Hospital, Jerusalem, Israel

#Pediatric Gastroenterology Unit, the Edith Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Received 29 June, 2010

Accepted 10 November, 2010

Address correspondence and reprint requests to Dr Efrat Broide, Institute of Gastroenterology, Liver Diseases and Nutrition, Assaf Harofeh Medical Center, Zerifin 70300, Israel (e-mail:

The authors report no conflicts of interest.

Copyright 2011 by ESPGHAN and NASPGHAN