Prognosis, Severity Similar for Patients With Acute Pancreatitis and IBD

Specialized management of acute pancreatitis in patients with IBD may not be necessary.

Patients with acute pancreatitis (AP) have no significant differences in prognosis and disease severity compared with those who have AP and inflammatory bowel disease (IBD), according to a study in Pancreatology.

Researchers assessed differences in prognostic factors, severity indicators, and drug use between patients with AP and those with comorbid AP and IBD using data from the Hungarian Acute Pancreatitis Registry.

Patients aged over 18 years with AP were enrolled from 2012 to 2020. Exact-matched cohort analyses were conducted with 2459 patients in a 1:3 match ratio.

Of the enrolled participants, further analysis was performed in 2170 patients. Final medical AP records confirmed 27 cases of IBD (median age, 42 years; men, 55.6%). The non-IBD population included 81 patients (median age, 42 years; men, 55.6%). All patients were followed until discharge. The patients with IBD and AP had 29 AP episodes, including 14 patients with Crohn disease and 13 with ulcerative colitis.

Overuse of antibiotics in the treatment of AP should be avoided as there is no benefit.

A total of 8 prognostic parameters (on-admission C-reactive protein [CRP], white blood cells [WBC], and serum creatinine, bedside index of severity in acute pancreatitis [BISAP], smoking and drinking habits, imaging results of the pancreas, presence of ascites) were evaluated.

No significant differences were observed in any of the laboratory parameters of prognostic factors between the IBD and non-IBD cases (CRP: P =.297; WBC: P =.538; serum creatinine: P =.794). Also, no differences were found between the 2 groups in BISAP scores, pancreatic structure, or presence of ascites (BISAP: P =.832; pancreas structure: P =1.000; ascites: P =.203).

The investigators also evaluated 6 parameters of severity indicators (length of hospitalization [LOH], peak level of CRP and WBC, severity, and local and systemic complications) in the 2 groups. LOH (P =.677) and peak CRP levels (P =.239) and WBC levels (P =.432) were not significantly different between the IBD and non-IBD groups. No significant change occurred in AP severity (P =.384), and the local or systemic complications of AP were not significantly different between the 2 groups (P =.790 and P =.328, respectively).

No significant difference was found regarding antibiotic treatment in the 2 patient groups (46.2% vs 40.0%; P =.642), but the non-IBD group had significantly more patients who required analgesics vs those in the IBD group (55.6% vs 80.6%, respectively; P =.020). Antibiotic use was significantly increased in the immunosuppressed group vs the nonimmunosuppressed group (P =.017), but a clear indication was not evident.

Study limitations include using a posthoc analysis, so not all aspects of AP and IBD were evaluated, and using a small sample of patients with IBD.

“Our results did not confirm any differences in the prognosis and severity of AP between patients with IBD and the general AP population, regardless of disease type and activity,” the study authors wrote. “Overuse of antibiotics was observed in patients on immunosuppressive therapy, probably due to elevated levels of on-admission WBC, platelet, and peak WBC counts. Based on our previous cohort analysis, in agreement with the F17-18 recommendations in the IAP/APA guidelines, overuse of antibiotics in the treatment of AP should be avoided as there is no benefit.”

This article originally appeared on Gastroenterology Advisor

References:

Dohos D, Farkas N, Váradi A, et al. Inflammatory bowel disease does not alter the clinical features and the management of acute pancreatitis: a prospective, multicentre, exact-matched cohort analysis. Pancreatology. Published online September 29, 2022. doi: 10.1016/j.pan.2022.09.241