Prevalence of Exocrine Pancreatic Dysfunction Based on Direct Function Testing in Pediatric Inflammatory Bowel Disease

Author:

Fernandez Jenelle12,Hopson Puanani13,Patel Samit B.14,Horvath Karoly1,Pandey Akash1

Affiliation:

1. Center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, Orlando, FL

2. Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of South Florida, Morsani College of Medicine, Tampa, FL

3. Department of Pediatric and Adolescent Medicine, Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN

4. Pediatric Gastroenterology and Nutrition of Tampa Bay, Tampa, FL.

Abstract

Objectives: Patients with inflammatory bowel disease (IBD) frequently have extraintestinal manifestations. The goal of this pilot study was to assess exocrine pancreatic function in cases with suspicion for or an established diagnosis of IBD. Methods: Direct stimulated endoscopic pancreatic function test (ePFT) was performed in 74 children with IBD, in both newly diagnosed and established cases. Demographic, clinical, and laboratory parameters were entered into a database and analyzed. Results: Among the 74 children, 49 were newly diagnosed and 25 had an established diagnosis of IBD. A majority had the diagnosis of Crohn disease (CD) (n = 48; 32 new and 16 established cases) with male predominance (64.6%). Altogether, 42 (56.7%) children had either generalized or partial exocrine pancreatic insufficiency (EPI). Twenty-four of the 48 CD children (50%) had abnormal ePFT. In those with ulcerative colitis (UC), 18 of the 26 (62.9%) had abnormal ePFT. The highest abnormality rate was in lipase enzyme activity. Weight z scores were significantly lower in those with abnormal ePFT (Crohn cases: P = 0.008; UC cases: P = 0.046). Peak protein concentration in collected pancreatic fluid was significantly lower in children with CD who had abnormal ePFT (P = 0.013). Conclusions: This pilot study revealed a relatively high prevalence of EPI in children with IBD through use of ePFT. EPI can result in maldigestion, with decreased capacity to digest fat. Further prospective studies are needed to assess need and efficacy of pancreatic enzyme replacement therapy in children with IBD and abnormal ePFT.

Publisher

Wiley

Subject

Gastroenterology,Pediatrics, Perinatology and Child Health

Reference19 articles.

1. Prevalence of inflammatory bowel disease in pediatric and adult populations: recent estimates from large national databases in the United States, 2007–2016.;Ye;Inflamm Bowel Dis,2020

2. Extraintestinal manifestations of inflammatory bowel disease: current concepts, treatment, and implications for disease management.;Rogler;Gastroenterology,2021

3. Extra-intestinal manifestations of inflammatory bowel disease.;Sange;Cureus,2021

4. Extraintestinal manifestations of inflammatory bowel disease.;Vavricka;Inflamm Bowel Dis,2015

5. Inflammatory bowel disease and pancreatitis: a review.;Ramos;J Crohns Colitis,2016

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