Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2017; 23(19): 3505-3512
Published online May 21, 2017. doi: 10.3748/wjg.v23.i19.3505
Clinical course of ulcerative colitis patients who develop acute pancreatitis
Jong Wook Kim, Sung Wook Hwang, Sang Hyoung Park, Tae Jun Song, Myung-Hwan Kim, Ho-Su Lee, Byong Duk Ye, Dong-Hoon Yang, Kyung-Jo Kim, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang
Jong Wook Kim, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang 10380, South Korea
Sung Wook Hwang, Sang Hyoung Park, Tae Jun Song, Myung-Hwan Kim, Byong Duk Ye, Dong-Hoon Yang, Kyung-Jo Kim, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
Ho-Su Lee, Department of Biochemistry and Molecular Biology, University of Ulsan College of Medicine, Seoul 05505, South Korea
Author contributions: Kim JW and Hwang SW contributed equally to this work and should be regarded as co-first authors; Kim JW wrote the manuscript; Hwang SW acquired and analysed the data; Park SH, Song TJ, Kim MH, Lee HS, Ye BD, Yang DH, Kim KJ, Byeon JS and Myung SJ generated the data; Yang SK had the original idea for the paper, gave critical comments, and revised the manuscript; all authors approved the final version of the manuscript.
Supported by Korean Health Technology R and D Project, Ministry of Health and Welfare, South Korea, No. A120176.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of Asan Medical Center (IRB No. 2016-0688).
Informed consent statement: Patients provided informed verbal consent to participate in this study. All clinical data were obtained anonymously and innocuously.
Conflict-of-interest statement: Suk-Kyun Yang received a research grant from Janssen Korea Ltd., but this grant is not related to the current study topic. The remaining authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Suk-Kyun Yang, MD, PhD, Professor, Chief, Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. sky@amc.seoul.kr
Telephone: +82-2-30103901 Fax: +82-2-4760824
Received: January 16, 2017
Peer-review started: January 16, 2017
First decision: February 9, 2017
Revised: March 17, 2017
Accepted: April 12, 2017
Article in press: April 12, 2017
Published online: May 21, 2017
Abstract
AIM

To investigate the clinical course of ulcerative colitis (UC) patients who develop acute pancreatitis.

METHODS

We analyzed 3307 UC patients from the inflammatory bowel disease registry at Asan Medical Center from June 1989 to May 2015. The clinical course of UC patients who developed acute pancreatitis was compared with that of non-pancreatitis UC patients.

RESULTS

Among 51 patients who developed acute pancreatitis, 13 (0.40%) had autoimmune, 10 (0.30%) had aminosalicylate-induced, and 13 (1.73%) had thiopurine-induced pancreatitis. All 13 patients with autoimmune pancreatitis (AIP) had type 2 AIP. Two (15.4%) patients had pre-existing AIP, and three (23.1%) patients developed AIP and UC simultaneously. Compared to non-pancreatitis patients, AIP patients had UC diagnosed at a significantly younger age (median, 22.9 years vs 36.4 years; P = 0.001). AIP and aminosalicylate-induced pancreatitis patients had more extensive UC compared to non-pancreatitis patients. All patients with pancreatitis recovered uneventfully, and there were no recurrences. Biologics were used more frequently in aminosalicylate- and thiopurine-induced pancreatitis patients compared to non-pancreatitis patients [adjusted OR (95%CI), 5.16 (1.42-18.67) and 6.90 (1.83-25.98), respectively]. Biologic utilization rate was similar among AIP and non-pancreatitis patients [OR (95%CI), 0.84 (0.11-6.66)]. Colectomy rates for autoimmune, aminosalicylate-induced, and thiopurine-induced pancreatitis, and for non-pancreatitis patients were 15.4% (2/13), 20% (2/10), 15.4% (2/13), and 7.3% (239/3256), respectively; the rates were not significantly different after adjusting for baseline disease extent.

CONCLUSION

Pancreatitis patients show a non-significant increase in colectomy, after adjusting for baseline disease extent.

Keywords: Ulcerative colitis, Pancreatitis, Autoimmune, Colectomy, Clinical course

Core tip: Clinical course of ulcerative colitis (UC) patients who develop acute pancreatitis is not well known. In a large prospectively maintained inflammatory bowel disease cohort at Asan Medical Center, we found 51 cases of acute pancreatitis among 3,307 UC patients. Among these, there were 13 (0.4%) patients with autoimmune, 10 (0.3%) with aminosalicyte-induced, and 13 (1.73%) with thiopurine-induced pancreatitis, whose colectomy rates were 15.4% (2/13), 20% (2/10), and 15.4% (2/13), respectively. The colectomy rate for non-pancreatitis patients was 7.3% (239/3256), which was not significantly different from those of acute pancreatitis patients, after adjusting for baseline extent.