Introduction: The problem of the variety of extrarespiratory manifestations and complications of COVID-19 is of particular interest; considering patients with inflammatory bowel disease (IBD) who recovered from COVID-19, the causes of abdominal pain and increased diarrhea are interesting from the aspects of pancreatic damage.
Purpose: To identify the nature of pancreatic lesions in patients with IBD who have undergone COVID-19.
Materials and methods: In the period from March 2020 to February 2022,105 patients with IBD who had undergone COVID-19 were examined; of these, 69(65.7%) had Crohn's disease(CD) and 36(34.3%) ulcerative colitis(UC); aged 18 to 60 years (32.4±1.3) 72(68.6%) women and 33(31.4%) men. The patients were under follow-up from 6 to 18 months (11.5±2.2).In addition to the general clinical examination, the following laboratory markers were determined: vitamin D, albumin, Fe, Mg, antilactopherin IgG, -TNF, IL-1,IL-6,IL-8,IL-10,IL-18,IgG,IgG4 in blood; calprotectin,lactoferrin,fecal elastase in feces. Patients underwent abdominal ultrasound, if necessary,EUS of the pancreas, abdominal CT and MRI. In the statistical processing of the results obtained, the generally accepted methods of descriptive statistics were used with the calculation of the arithmetic mean values of the trait(M), standard deviation(), mean error(m), Student's coefficient(t), error probability(p).
Results: In 76 patients, a decrease in fecal elastase levels(199-9 μg/g) was detected,with concomitant decreases in the levels of vit D(30-10 ng/mL),albumin and iron and increases in the levels of IL-1,IL-6,IL-8,IL-10,IL-18,calprotectin(500-3227 μg/g) and lactoferrin(12-189 μg/g).In 92 cases,abdominal ultrasound revealed changes in echogenicity and 31 cases in the size of the pancreatic ducts;EUS changes were found in 18 patients. Prevailing were drug-induced lesions in 72 cases(mainly against the background of taking 5-ASA drugs,immunosuppressants,antibiotic therapy, steroids and -TNF inhibitors). Acute pancreatitis with hospital outcomes was detected in 21 cases(16 CD, 5 UC) and was characterized by higher levels of IL-6(12-57 pq/ml) and IL-18(275-983 pq/ml).Autoimmune pancreatitis was verified in 13 cases(type I-8 patients,type II-5 patients).
Conclusions: In patients with IBD who underwent COVID-19,in most cases,a decrease in fecal elastase was found;pancreatic lesions were represented by drug-induced,acute and denovo autoimmune pancreatitis.It is possible that a longer observation period in this group of patients will also reveal other pancreatic lesions,unknown both in comorbidity and in the severity of extraintestinal complications.