title: Idiopathic pancreatitis preceding the diagnosis of inflammatory bowel disease is more frequent in pediatric patients.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Institute of Gastroenterology, Liver Diseases and Nutrition, Assaf Harofeh Medical Center, Zerifin (affiliated with the Sackler Faculty of Medicine, Tel Aviv University), Tel Aviv, Israel. efibroide@yahoo.com
authors.forename: Efrat
authors.initials: E
authors.lastname: Broide
authors.forename: Iris
authors.initials: I
authors.lastname: Dotan
authors.forename: Batia
authors.initials: B
authors.lastname: Weiss
authors.forename: Michael
authors.initials: M
authors.lastname: Wilschanski
authors.forename: Baruch
authors.initials: B
authors.lastname: Yerushalmi
authors.forename: Aharon
authors.initials: A
authors.lastname: Klar
authors.forename: Arie
authors.initials: A
authors.lastname: Levine
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000681:Amylases / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000097:blood / Q000150:complications; D003424:Crohn Disease / Q000097:blood / Q000150:complications; D005260:Female; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000097:blood / Q000150:complications*; D008297:Male; D010195:Pancreatitis / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D012189:Retrospective Studies; D000637:Transaminases / Q000097:blood; D055815:Young Adult
chemical_list: D000637:Transaminases; D000681:Amylases