Temporal Analysis of Inflammatory Bowel Disease and Pancreatitis Co-Occurrence in Children and Adults in the United States

Pancreatitis in inflammatory bowel disease has been attributed to peripancreatic intestinal disease and/or drug-induced pancreatic toxicity. We used large cohort analyses to define inflammatory bowel disease and pancreatitis temporal co-occurrence with a detailed descriptive analysis to gain greater insight into the pathophysiological relationship between these two diseases.Truven Health MarketScan private insurance claims from 141,017,841 patients (<65 years-old) and 7,457,709 patients from four academic hospitals were analyzed. We calculated prevalence of Crohn's disease or ulcerative colitis with acute or chronic pancreatitis and performed temporal and descriptive analyses.Of 516,724 inflammatory bowel disease patients, 12,109 individuals (2.3%) had pancreatitis. Acute pancreatitis was 2-6x more prevalent than chronic pancreatitis. In adults, acute pancreatitis occurred equally among Crohn's disease and ulcerative colitis (1.8-2.2% vs. 1.6-2.1%, respectively), whereas in children, acute pancreatitis was more frequent in ulcerative colitis (2.3-3.4% vs. 1.5-1.8%, respectively). The highest proportion of pancreatitis (21.7-44.7%) was at/near the time of inflammatory bowel disease diagnosis. Of these, 22.1-39.3% were on steroids at the time of pancreatitis. Individuals with chronic pancreatitis or recurrent pancreatitis hospitalizations had increased risk of a future inflammatory bowel disease diagnosis (odds ratio=1.52 or 1.72, respectively).Pancreatitis in inflammatory bowel disease may not simply be a drug adverse event but may also involve local and/or systemic processes that negatively impact the pancreas. Our analysis of pancreatitis before, during, and after inflammatory bowel disease diagnosis suggests a bi-directional pathophysiologic relationship between inflammatory bowel disease and pancreatitis, with potentially more complexity than previously appreciated.