Pancreatic involvement in children with newly diagnosed inflammatory bowel disease

OBJECTIVES: Pancreatic involvement in inflammatory bowel disease (IBD) represents a heterogeneous group of conditions. Our study assessed the prevalence of hyperlipasemia and pancreatic imaging involvement in children with newly diagnosed IBD. We also evaluated predictors of pancreatic changes on magnetic resonance imaging in this population. METHODS: This retrospective study analysed the standard magnetic resonance enterography (MRE) protocol with additional sequences for pancreatic assessment. The serum activity of lipase, aminotransferases, and total immunoglobulin G (IgG) and its subclasses concentrations were measured at diagnosis, as well as body mass index percentile (pBMI) and IBD activity. RESULTS: Data from 68 children were analysed. Increased IgG concentrations were observed in 25 patients (36.6%) for total IgG and in 25 patients (36.6%) for IgG1. Among 27 patients (39.7%) with increased lipase, 8 (29.6%) had increased IgG concentration and 10 (37.1%) had increased IgG1 concentration; both IgG and IgG1 concentration were elevated in 7 (87.5%) patients. MRE revealed pancreatic involvement in 20.59%. Patients with pancreatic involvement on MRE had higher total IgG (p = 0.012) and IgG1 (p = 0.024) levels and lipase activity 3x higher than the normal limit (p = 0.04). Total IgG and IgG1 concentrations were significantly associated with MRE findings and their combination yielded the highest discriminatory performance. IgG subclasses proved to be useful in a multivariate model incorporating IgG1 and IgG2 concentrations (0.75; 95% confidence interval: 0.59-0.92). CONCLUSION: Structural pancreatic involvement was observed in one-fifth of our patients. They had significantly higher total IgG and IgG1 levels. The IgG1 + IgG2 model performed best in prediction pancreatic MRE changes.