Introduction
Inflammatory bowel disease (IBD) is associated with a range of extraintestinal manifestations, including pancreatic involvement. Pancreatic exocrine insufficiency (PEI) is a recognised complication, but its prevalence in patients with IBD remains poorly defined. Symptoms of PEI may overlap with those of IBD, which can make recognition and assessment challenging in clinical practice.
Aims & Methods
We performed a systematic review and meta-analysis to estimate the prevalence of PEI in IBD. Electronic databases (Embase, Scopus, PubMed) were searched from inception to February 2026. Studies reporting PEI prevalence in IBD were included.
Random-effects meta-analysis of proportions with logit transformation and restricted maximum-likelihood estimation was used to derive pooled prevalence estimates with 95% confidence intervals (CI) and prediction intervals. Heterogeneity was assessed using Cochran’s Q and the I² statistic. Prespecified subgroup analysis was performed for adult populations, with the single paediatric study analysed descriptively.
Results
A total of 2,048 records were identified, with 809 duplicates removed. Following screening of 1,239 records and full-text assessment of 35 studies, 15 studies published between 1988 and 2026 were included in the final analysis.
These comprised 1,339 patients and 243 PEI cases. Fourteen studies included adults (n=1,265), and one study included paediatric patients (n=74). Diagnostic approaches varied, with faecal elastase-1 (FE-1) used in most adult studies alongside other direct and indirect pancreatic function tests. Observed study-level prevalence ranged from 0.0% in Hedstrom et al. (2020) to 56.8% in Fernandez et al. (2023).
The pooled prevalence of PEI in IBD was 18.8% (95% CI 12.7–26.9%), with substantial heterogeneity (I²=88.8%; Q=125.45, p<0.001). The prediction interval ranged from 4.1% to 55.7%, indicating considerable between-study variability.
In adults, the pooled prevalence was 16.9% (95% CI 11.9–23.5%; I²=82.8%). The paediatric subgroup, represented by a single study, reported a prevalence of 56.8%.
Sensitivity analyses demonstrated stability of the overall estimate, with pooled prevalence ranging from 16.9% to 21.0% on leave-one-out analysis. There was no evidence of small-study effects on exploratory assessment.
| Group | k | Events/N | Pooled prevalence |
| Overall | 15 | 243/1339 | 18.8% (12.7–26.9) |
| Adults | 14 | 201/1265 | 16.9% (11.9–23.5) |
| Paediatric | 1 | 42/74 | 56.8% (45.3–67.5) |
Table 1: pooled prevalence of pancreatic exocrine insufficiency by study subgroup
Conclusion
PEI was identified in approximately one in five patients with IBD, although estimates varied widely across studies. Substantial heterogeneity likely reflects differences in study design, populations, and diagnostic methods. These findings highlight a potentially under-recognised burden of pancreatic dysfunction in IBD and support consideration of PEI in symptomatic patients, where recognition may allow targeted management.
References
1) Hedström A, Steiner C, Valente R, Haas SL, Löhr JM, Vujasinovic M. Pancreatic exocrine insufficiency and Crohn’s disease. Minerva Gastroenterol Dietol. 2020;66(1):17–22.
2) Fernandez J, Hopson P, Patel SB, Horvath K, Pandey A. Prevalence of exocrine pancreatic dysfunction based on direct function testing in pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2023;76(4):475–479.