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P674. Pancreatitis associated to inflammatory bowel disease (IBD): clinical and genetic patterns in children

S. Cardile1, I. Loddo2, R. Mallamace1, F. Sancetta1, T. Alterio1, R. Centorrino1, C. Romano1, 1AOU G. Martino, Pediatric Department, Messina, Italy, 2AOU G. Martino, Genetic and Pediatric Immunology, Messina, Italy

Background

Pancreas involvement is considered an extraintestinal manifestation in the setting of IBD. Acute pancreatitis (AP) is most prevalent in Crohn's Disease (CD) and seems to be related to the course of disease. It can be considered related to the activity of the disease, secondary to medications (mesalamine, azathioprine) or idiopathic. Although recent study have identified an idiopathic form (IAP) that precedes IBD, just few studies have been conducted about the presence of potential susceptibility genes and outcome of pancreatic disease. Mutations correlated to PRSS1, SPINK1 and CFTR genes are considered to increase risk of pancreatitis.

Methods

We performed a retrospective survey in children with IBD to evaluate the prevalence of IAP, describing clinical pattern, natural history and genetic background. Data was collected from January 2001 to October 2012 in 107 children (age 3–18 years) with IBD (70 UC, 37 CD). The diagnosis of IBD was done on the basis of the endoscopic and histological criteria, while the diagnosis of IAP was made for the presence of at least two of the following characteristics: (1) abdominal pain, (2) elevated serum amylase and/or lipase >3 times the upper level of normal, and (3) characteristic radiological changes.

Results

Pancreatitis was diagnosed in 8 cases (7.5%), 5 CD (62.5%) and 3 UC (37.5%). The epigastric pain and vomiting were the most frequent presenting symptoms. In one patient diagnosis of pancreatitis preceded the onset of IBD, in the other it was later (1–3 years). Molecular analysis of PRSS1, SPINK1 and CFTR gene was performed. The presence of IVS-8 polyT polymorphism 5T/5T of CFTR gene was found in 2 patients (25%) with most severe pancreatic disease.

Conclusion

Our data confirm that IAP is more frequent in IBD than in general population. 5T/5T polymorphism of CFTR gene, mapped on chromosome 7q31.2, is considered as susceptibility gene associated. This mutation in our study is correlated with most severe clinical presentation. Further studies can be useful to confirm these data.