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Hyperlipasemia in Pediatric Inflammatory Bowel Diseases

To the Editor: A cute pancreatitis is a known, albeit rare, complication of inflammatory bowel diseases (IBDs). In pediatric patients, acute pancreatitis is diagnosed on the basis of the presence of 2 of the following 3 features: (1) abdominal pain characteristic of acute pancreatitis, (2) serum amylase or lipase 3 or more times the upper limit of normal (ULN), and (3) characteristic findings of acute pancreatitis on imaging. There is a subset of patients with IBD (up to 20%) reported to have hyperamylasemia and/or hyperlipasemia without the diagnosis of acute pancreatitis. Therefore, this diagnosis can be difficult to make in the setting of IBD, because many patients will present with the complaint of abdominal pain secondary to their underlying disease, but with simultaneous elevation in pancreatic enzymes.We hypothesized that hyperlipasemia in the setting of pediatric IBD is rarely associated with radiographically proven pancreatitis but is instead a unique feature of IBD activity itself. We conducted a retrospective chart review of 275 pediatric patients with IBD presenting to Texas Children's Hospital between January 2010 and December 2012. We specifically noted the type of IBD (Crohn disease [CD], ulcerative colitis [UC], or indeterminate colitis), laboratory examination for lipase, how often this was noted to be elevated, presence of thiopurine, 5-ASA, and/or corticosteroid medications at the time of hyperlipasemia, screening for IgG4 subclass, as well as radiographic imaging to support the diagnosis of pancreatitis. In those patients with hyperlipasemia, we