A Clinical and Pathophysiological Overview of Intestinal and Systemic Diseases Associated with Pancreatic Disorders: Causality or Casualty?

The relationship between chronic intestinal disease, including inflammatory bowel disease (IBD) and celiac disease (CelD), and pancreatic disorders has been little investigated. Although an increased risk of acute pancreatitis (AP), exocrine pancreatic insufficiency with or without chronic pancreatitis, and chronic asymptomatic pancreatic hyperenzymemia have been described in these patients, the pathogenetic link remains unclear. It may potentially involve drugs, altered microcirculation, gut permeability/motility with disruption of enteric-mediated hormone secretion, bacterial translocation, and activation of the gut-associated lymphoid tissue related to chronic inflammation. In addition, the risk of pancreatic cancer seems to be increased in both IBD and CelD patients with unknown pathogenesis. Finally, other systemic conditions (e.g., IgG4-related disease, sarcoidosis, vasculitides) might affect pancreatic gland and the intestinal tract with various clinical manifestations. This review includes the current understandings of this enigmatic association, reporting a clinical and pathophysiological overview about this topic.

Automated summary

The relationship between chronic intestinal disease and pancreatic disorders, such as inflammatory bowel disease (IBD), celiac disease (CelD), and pancreatic cancer, remains unclear. Possible factors contributing to this association include drug use, changes in microcirculation, disruption of gut permeability/motility, bacterial translocation, and activation of gut-associated lymphoid tissue. Other systemic conditions, like IgG4-related disease or vasculitides, may also affect both the pancreas and the intestinal tract. This review provides an overview of the current understanding of this complex relationship.