Is there any connection between Crohn's disease and pancreatitis?

B.M.

Crohn's disease is a chronic, inflammatory disease that typically involves the small and/or large intestine. However, some Crohn's patients experience symptoms not directly related to the bowel. These can include skin rashes, joint inflammation and arthritis, eye inflammation, hepatitis (liver inflammation) and bile-duct inflammation. It is unknown why these organs, which are not in direct contact with the bowel, are affected.

To answer your question, the pancreas is only very rarely directly affected by Crohn's disease. However, it is not uncommon for pancreatitis (inflammation of the pancreas)to arise as a secondary result of Crohn's. If Crohn's involves the upper small bowel, or duodenum, the inflammatory process can extend to the opening of the duct that drains the pancreas. Inflammation at this opening, called the sphincter of Oddi, can lead to obstruction and pressure on the pancreas, resulting in pancreatitis. In addition, inflammation of the sphincter can result in scarring that leaves the duct open to the intestinal contents found in the duodenum. Reflux of these contents into the pancreatic duct is also hypothesized to cause pancreatitis.

An even more common reason for pancreatitis in Crohn's patients is drug reactions. Several of the prescription medications used to control the inflammation associated with Crohn's can lead to pancreatitis. These include sulfasalazine, mesalamine, azathioprine and 6MP. While there is some controversy, most gastroenterologists believe that the steroid drugs, such as prednisone, often used to treat Crohn's pose a minimal risk of pancreatitis.

Given the range of possibilities, it is important to investigate the exact cause of pancreatitis in a patient with Crohn's disease to determine how best to prevent further episodes.