Increased pancreatic enzymes and inflammatory bowel diseases: What correlation?

In the course of Inflammatory Bowel Disease (IBD), the possibility of an increase of pancreatic enzymes has been described, almost always justified with their release by the inflamed bowel. Unusually an acute pancreatitis presents itself as a pathology associated to the IBD, probably with a common pathogenetic mechanism. We report the case of a 25 year old man with fever, epigastralgia and a mild blood-free diarrhea. At palpation there was pain in the right lower quadrant of his abdomen. Diarrhea stopped within the first day, while fever and epigastralgia in the third day. His parasitological examination and fecal culture were negative; the blood exams showed rising values of CRP, fecal calprotectin, amylase, pancreatic isoamylase and lipase, without risk factors for acute pancreatitis. His liver and renal functions were normal. Notwithstanding the complete normalization of symptoms and inflammation indices decrease, in the fourth day pancreatic enzymes reached typical rates of acute pancreatitis (Table 1). Transabdominal ecography, echoendoscopy and CT scan didn't show alterations neither of liver and pancreas, but unexpectedly appeared congestion and thickening of the right colon region, indicative of IBD and likely connected to the patient abdominal pain. Colonoscopy described an active Ulcerative Colitis (UC) confirmed by the histological exam and the elevation of fecal calprotectin up to ten times the normal rates. Tests for HAV, HBV, HCV, thyroid panel and screening for celiac disease were normal and the patient did not present any other clinical manifes-