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Lin W, Zheng Q, Wang X, Lin X, Ni X, Pan J, Zippi M, Fiorino S, Hong W. The causality between use of glucocorticoids and risk of pancreatitis: a Mendelian randomization study. Front Immunol 2024; 15:1420840. [PMID: 39221257 PMCID: PMC11363070 DOI: 10.3389/fimmu.2024.1420840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Background and aim To date, the association between glucocorticoid use and the risk of pancreatitis remains controversial. The aim of this study was the investigation of this possible relationship. Methods We carried out a two-sample Mendelian randomization (MR) analysis using GWAS data from European ancestry, East Asian descendants and the FinnGen Biobank Consortium to evaluate this potential causal relationship. Genetic variants associated with glucocorticoid use were selected based on genome-wide significance (p < 5×10-8). Results Our MR analysis of European ancestry data revealed no significant causal relationship between glucocorticoid use and AP (IVW: OR=1.084, 95% CI= 0.945-1.242, P=0.249; MR-Egger: OR=1.049, 95% CI= 0.686-1.603, P=0.828; weighted median: OR=1.026, 95% CI= 0.863-1.219, P=0.775) or CP (IVW: OR=1.027, 95% CI= 0.850-1.240, P=0.785; MR-Egger: OR= 1.625, 95% CI= 0.913-2.890, P= 0.111; weighted median: OR= 1.176, 95% CI= 0.909-1.523, P= 0.218). Sensitivity analyses, including MR-Egger and MR-PRESSO, indicated no evidence of pleiotropy or heterogeneity, confirming the robustness of our findings. Multivariable MR analysis adjusted for alcohol consumption, BMI, cholelithiasis and C-reactive protein levels supported these findings. Replicated analysis was performed on datasets from the FinnGen Biobank Consortium and East Asian descendants, and similar results were obtained. Conclusions This MR analysis suggests that there is no causal association between glucocorticoid use and the risk of pancreatitis.
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Affiliation(s)
- Wenfeng Lin
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qiqi Zheng
- Department of Infection and Liver Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaorong Wang
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaolu Lin
- Department of Digestive Endoscopy Center, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Xixi Ni
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jingye Pan
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Maddalena Zippi
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, Italy
| | - Sirio Fiorino
- Unit of Internal Medicine, Budrio Hospital, Local Health Unit of Bologna, Bologna, Italy
| | - Wandong Hong
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Collen LV, Mitchell PD, Fox VL, Grover AS. Pancreatitis-Associated Medication Use in Hospitalized Pediatric and Young Adult Patients With Acute Pancreatitis. J Pediatr Gastroenterol Nutr 2023; 77:260-266. [PMID: 37477886 DOI: 10.1097/mpg.0000000000003829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
OBJECTIVE The objective of this study is (1) to describe the prevalence of pancreatitis-associated medication (PAM) use at admission and discharge in pediatric and young adult patients hospitalized with acute pancreatitis (AP) and (2) to describe the prevalence of PAM use at admission in patients classified as having idiopathic AP. STUDY DESIGN A single-center retrospective study of patients <21 years who were hospitalized with AP or acute recurrent pancreatitis from March 2015 to July 2017 was performed. Charts were reviewed for demographic data, etiology of pancreatitis, comorbidities, and use of PAMs at admission and discharge. PAMs were defined and scored based on an evidence-based classification system, with class I PAMs having strongest evidence for causation. Standard descriptive statistics were used to report prevalence data. RESULTS Our cohort was comprised of 119 patients; 50% of patients were using a PAM at admission and 67% were taking a PAM at discharge, reflecting a significant change (P = 0.0009); 44% of patients classified as having idiopathic pancreatitis were taking a PAM on admission, reflecting a possibly missed role of medication in their presentation. Comorbidities significantly associated with PAM use included seizure disorder (P = 0.005) and oncologic disease (P = 0.005). The most commonly used class I PAMs were omeprazole, trimethoprim-sulfamethazole, valproic acid, and 6-mercaptopurine. The increase in prevalence of PAM use at discharge compared to admission was partially driven by addition of omeprazole to the outpatient medication regimen during the hospital stay (P = 0.07). CONCLUSION Medications likely play an under-recognized role in pediatric AP. The practice of using proton pump inhibitors in management of AP warrants further study.
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Affiliation(s)
- Lauren V Collen
- From the Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Paul D Mitchell
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA
| | - Victor L Fox
- From the Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Amit S Grover
- From the Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, MA
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3
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Buldukoglu OC, Ocal S, Atar GE, Yildirim MB, Akbay Harmandar F, Duman A, Cekin AH. A RARE CAUSE OF DRUG-INDUCED ACUTE PANCREATITIS: SULFASALAZINE. Gastroenterol Nurs 2023; 46:249-252. [PMID: 37053374 DOI: 10.1097/sga.0000000000000718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/06/2022] [Indexed: 04/15/2023] Open
Affiliation(s)
- Osman Cagin Buldukoglu
- Osman Cagin Buldukoglu, MD, is Specialist Doctor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Serkan Ocal, is Professor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Galip Egemen Atar, is Fellow, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Mustafa Burak Yildirim, is Resident, Department of Internal Medicine, Antalya Training and Research Hospital, Antalya, Turkey
- Ferda Akbay Harmandar, is Assistant Professor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Adil Duman, is Specialist Doctor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Ayhan Hilmi Cekin, is Professor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Serkan Ocal
- Osman Cagin Buldukoglu, MD, is Specialist Doctor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Serkan Ocal, is Professor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Galip Egemen Atar, is Fellow, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Mustafa Burak Yildirim, is Resident, Department of Internal Medicine, Antalya Training and Research Hospital, Antalya, Turkey
- Ferda Akbay Harmandar, is Assistant Professor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Adil Duman, is Specialist Doctor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Ayhan Hilmi Cekin, is Professor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Galip Egemen Atar
- Osman Cagin Buldukoglu, MD, is Specialist Doctor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Serkan Ocal, is Professor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Galip Egemen Atar, is Fellow, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Mustafa Burak Yildirim, is Resident, Department of Internal Medicine, Antalya Training and Research Hospital, Antalya, Turkey
- Ferda Akbay Harmandar, is Assistant Professor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Adil Duman, is Specialist Doctor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Ayhan Hilmi Cekin, is Professor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Mustafa Burak Yildirim
- Osman Cagin Buldukoglu, MD, is Specialist Doctor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Serkan Ocal, is Professor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Galip Egemen Atar, is Fellow, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Mustafa Burak Yildirim, is Resident, Department of Internal Medicine, Antalya Training and Research Hospital, Antalya, Turkey
- Ferda Akbay Harmandar, is Assistant Professor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Adil Duman, is Specialist Doctor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Ayhan Hilmi Cekin, is Professor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ferda Akbay Harmandar
- Osman Cagin Buldukoglu, MD, is Specialist Doctor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Serkan Ocal, is Professor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Galip Egemen Atar, is Fellow, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Mustafa Burak Yildirim, is Resident, Department of Internal Medicine, Antalya Training and Research Hospital, Antalya, Turkey
- Ferda Akbay Harmandar, is Assistant Professor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Adil Duman, is Specialist Doctor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Ayhan Hilmi Cekin, is Professor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Adil Duman
- Osman Cagin Buldukoglu, MD, is Specialist Doctor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Serkan Ocal, is Professor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Galip Egemen Atar, is Fellow, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Mustafa Burak Yildirim, is Resident, Department of Internal Medicine, Antalya Training and Research Hospital, Antalya, Turkey
- Ferda Akbay Harmandar, is Assistant Professor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Adil Duman, is Specialist Doctor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Ayhan Hilmi Cekin, is Professor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ayhan Hilmi Cekin
- Osman Cagin Buldukoglu, MD, is Specialist Doctor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Serkan Ocal, is Professor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Galip Egemen Atar, is Fellow, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Mustafa Burak Yildirim, is Resident, Department of Internal Medicine, Antalya Training and Research Hospital, Antalya, Turkey
- Ferda Akbay Harmandar, is Assistant Professor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Adil Duman, is Specialist Doctor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
- Ayhan Hilmi Cekin, is Professor, Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
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He S, Ikner TP, Taylor BV, Aguiar T, Thakur NP, Chakravorty S. Mirtazapine-associated acute pancreatitis in a patient with insomnia and co-occurring psychiatric disorders. J Natl Med Assoc 2022; 114:617-620. [PMID: 36114064 DOI: 10.1016/j.jnma.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/21/2022] [Accepted: 08/24/2022] [Indexed: 12/15/2022]
Abstract
We report the case of an African American patient who developed drug-associated acute pancreatitis without hypertriglyceridemia, after being treated with mirtazapine for major depressive disorder (MDD). Acute pancreatitis is characterized by rapid inflammation and autodigestion of the pancreas, which may become life-threatening. Although heavy alcohol use and gallstones are the most common causes of acute pancreatitis, some medications are also known to cause drug-induced acute pancreatitis. This report describes a 47-year-old African American female with a history of MDD, insomnia, posttraumatic stress disorder (PTSD), and alcohol use disorder, who was prescribed mirtazapine. A literature search implicated mirtazapine as a rare cause of drug-induced acute pancreatitis. Some reports have suggested that mirtazapine-associated acute pancreatitis may be due to hypertriglyceridemia. This case report instead presents with a normal lipid panel, which is consistent with the majority of prior reports, and it is noteworthy for introducing an alternative mechanism. The Naranjo Adverse Drug Reaction (ADR) Probability Scale calculated an ADR of 5, indicating mirtazapine as the probable cause of the patient's drug-associated acute pancreatitis.
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Affiliation(s)
- Sean He
- Saint Louis University School of Medicine, Saint Louis, MO 63104, USA.
| | - Taylor P Ikner
- University of Pennsylvania College of Liberal and Professional Studies, USA
| | | | - Taylor Aguiar
- Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Nina P Thakur
- University of New England College of Osteopathic Medicine, Biddleford, ME 04005, USA
| | - Subhajit Chakravorty
- Cpl. Michael J Crescenz VA Medical Center, Philadelphia, PA 19104, USA; Perelman School of Medicine, Philadelphia, PA 19104, USA
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5
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Muacevic A, Adler JR, Ihimoyan A. Azathioprine-Induced Pancreatitis in a Patient With Systemic Lupus Erythematosus. Cureus 2022; 14:e32697. [PMID: 36686137 PMCID: PMC9847485 DOI: 10.7759/cureus.32697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2022] [Indexed: 12/23/2022] Open
Abstract
Acute pancreatitis is an inflammatory disorder of the pancreas and a leading gastrointestinal cause of admission in the United States. The most common causes of acute pancreatitis are gallstones and alcohol. It is rarely caused by medications. Azathioprine-induced pancreatitis is rare and is more common in patients with Crohn's Disease. In this case report, we present a rare case of azathioprine-induced pancreatitis in a 58-year-old African American patient with systemic lupus erythematosus.
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6
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The Pancreas and Known Factors of Acute Pancreatitis. J Clin Med 2022; 11:jcm11195565. [PMID: 36233433 PMCID: PMC9571992 DOI: 10.3390/jcm11195565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/11/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
Pancreatitis is regarded by clinicians as one of the most complicated and clinically challenging of all disorders affecting the abdomen. It is classified on the basis of clinical, morphological, and histological criteria. Causes of acute pancreatitis can easily be identified in 75–85% of patients. The main causes of acute, recurrent acute, and chronic pancreatitis are gallstone migration and alcohol abuse. Other causes are uncommon, controversial, or unexplained. For instance, cofactors of all forms of pancreatitis are pancreas divisum and hypertriglyceridemia. Another factor that should be considered is a complication of endoscopic retrograde cholangiopancreatography: post-endoscopic retrograde cholangiopancreatography acute pancreatitis. The aim of this study is to present the known risk factors for acute pancreatitis, beginning with an account of the morphology, physiology, and development of the pancreas.
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7
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Szatmary P, Grammatikopoulos T, Cai W, Huang W, Mukherjee R, Halloran C, Beyer G, Sutton R. Acute Pancreatitis: Diagnosis and Treatment. Drugs 2022; 82:1251-1276. [PMID: 36074322 PMCID: PMC9454414 DOI: 10.1007/s40265-022-01766-4] [Citation(s) in RCA: 111] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 11/11/2022]
Abstract
Acute pancreatitis is a common indication for hospital admission, increasing in incidence, including in children, pregnancy and the elderly. Moderately severe acute pancreatitis with fluid and/or necrotic collections causes substantial morbidity, and severe disease with persistent organ failure causes significant mortality. The diagnosis requires two of upper abdominal pain, amylase/lipase ≥ 3 ×upper limit of normal, and/or cross-sectional imaging findings. Gallstones and ethanol predominate while hypertriglyceridaemia and drugs are notable among many causes. Serum triglycerides, full blood count, renal and liver function tests, glucose, calcium, transabdominal ultrasound, and chest imaging are indicated, with abdominal cross-sectional imaging if there is diagnostic uncertainty. Subsequent imaging is undertaken to detect complications, for example, if C-reactive protein exceeds 150 mg/L, or rarer aetiologies. Pancreatic intracellular calcium overload, mitochondrial impairment, and inflammatory responses are critical in pathogenesis, targeted in current treatment trials, which are crucially important as there is no internationally licenced drug to treat acute pancreatitis and prevent complications. Initial priorities are intravenous fluid resuscitation, analgesia, and enteral nutrition, and when necessary, critical care and organ support, parenteral nutrition, antibiotics, pancreatic exocrine and endocrine replacement therapy; all may have adverse effects. Patients with local complications should be referred to specialist tertiary centres to guide further management, which may include drainage and/or necrosectomy. The impact of acute pancreatitis can be devastating, so prevention or reduction of the risk of recurrence and progression to chronic pancreatitis with an increased risk of pancreas cancer requires proactive management that should be long term for some patients.
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Affiliation(s)
- Peter Szatmary
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Tassos Grammatikopoulos
- Paediatric Liver, GI and Nutrition Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Wenhao Cai
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,West China Centre of Excellence for Pancreatitis and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Huang
- West China Centre of Excellence for Pancreatitis and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Rajarshi Mukherjee
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Department of Molecular Physiology and Cell Signalling, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool , UK
| | - Chris Halloran
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Georg Beyer
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Robert Sutton
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK. .,Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK. .,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
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8
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Vara-Luiz F, Pé D’Arca Barbosa F, Antunes Albuquerque A, Valada Marques A, Spencer V. An Uncommon Cause of Acute Pancreatitis in a Patient With COVID-19. Cureus 2022; 14:e27910. [PMID: 36110472 PMCID: PMC9464349 DOI: 10.7759/cureus.27910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 12/15/2022] Open
Abstract
Drug-induced pancreatitis is a rare though important condition that remains a diagnostic challenge. Most of the evidence relies on case reports, and clinicians should consider a high suspicion of the diagnosis after ruling out other causes. In particular, steroids are frequently used drugs that have recently been associated with acute pancreatitis. The authors present the case of a 60-year-old female admitted to the emergency room with a fever and shortness of breath. The SARS-CoV-2 test was positive, and the chest radiography was suggestive of COVID-19 pneumonia. The patient started dexamethasone because of respiratory failure. On Day 7, she developed epigastric pain radiating to the back and the amylase level was greater than 10 times the upper reference limit (1354 U/L). A detailed evaluation of the medical history, along with the exclusion of other possible etiologies confirmed the diagnosis of steroid-induced pancreatitis. Supportive care and cessation of the offending drug led to the resolution of symptoms. As steroids are used as part of the treatment of most COVID-19 patients, this case suggests the need to consider this entity, as a delay in the diagnosis may result in complications and prolonged hospital stay.
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9
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Acute Necrotizing Pancreatitis following Long-Term Antipsychotic Use. Case Rep Psychiatry 2021; 2021:7891017. [PMID: 34504720 PMCID: PMC8423555 DOI: 10.1155/2021/7891017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/06/2021] [Accepted: 08/14/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction. Psychiatrists commonly use antipsychotic medications in the treatment of psychotic and mood disorders. A rare but known side effect of atypical antipsychotics is acute pancreatitis. Most cases of antipsychotic-induced pancreatitis occur within six months of initiation. The mechanism believed to cause this reaction is hypertriglyceridemia. Here, we present a unique case of antipsychotic-induced pancreatitis that deviates from previous cases in the time to onset of the pancreatitis and the mechanism of presentation. Case Presentation. We present a case of a patient with treatment-resistant schizophrenia managed for over a decade on olanzapine and haloperidol. Twelve years after stabilization on this medication regimen, the patient developed acute pancreatitis, which after extensive medical workup was attributed to his psychotropic medications. We review his medical and psychiatric history, his medical course and workup during the episode of pancreatitis, and review recommendations for patients at risk for antipsychotic-induced pancreatitis based on this case and the current literature. Discussion. This case illustrates that acute pancreatitis can occur long after the initiation of antipsychotic medications and may be mediated by mechanisms other than hypertriglyceridemia. While there are reports of antipsychotic-induced psychosis occurring within months, and in a limited set of cases, years, after medication initiation, the twelve-year time interval in the present case is by far the longest duration of an antipsychotic precipitating this adverse event recorded in the literature. This case highlights that although exceedingly rare, prescribers should be aware of the risk for drug-induced pancreatitis in patients stable on antipsychotic medications.
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Akazawa Y, Ohtani M, Namikawa S, Nosaka T, Takahashi K, Naito T, Ofuji K, Matsuda H, Hiramatsu K, Nakamoto Y. Severe necrotizing pancreatitis immediately after non-abdominal surgery under general anesthesia with propofol. Clin J Gastroenterol 2021; 14:1798-1803. [PMID: 34436725 DOI: 10.1007/s12328-021-01504-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/18/2021] [Indexed: 11/29/2022]
Abstract
Postoperative pancreatitis is a relatively rare disease and is poorly recognized. Herein, we present a case of necrotizing pancreatitis that developed immediately after non-abdominal surgery under general anesthesia. In this report, 4 h after thyroidectomy under general anesthesia using propofol, the patient developed upper abdominal pain and was diagnosed with severe acute pancreatitis with extensive pancreatic necrosis. Immediately after the diagnosis, the patient received appropriate treatment, and acute pancreatitis was improved. Subsequently, the patient has the formation of non-infectious giant walled-off necrosis and remained in good condition without additional treatment for 1.5 years after pancreatitis onset. In this case report, our detailed causative search suggested that propofol administration could be the cause of this pancreatitis. Propofol-induced pancreatitis is extremely rare but develops often severely, resulting in fatality. In this case, the patient developed severe acute pancreatitis within a very short time after surgery but was able to survive by immediate intervention of treatment. We suggest that clinicians should consider acute pancreatitis as a life-threatening adverse event under general anesthesia with propofol and perform thorough postoperative management.
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Affiliation(s)
- Yu Akazawa
- Faculty of Medical Sciences, Second Department of Internal Medicine, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Fukui, Yoshida-gun, 910-1193, Japan
| | - Masahiro Ohtani
- Faculty of Medical Sciences, Second Department of Internal Medicine, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Fukui, Yoshida-gun, 910-1193, Japan
| | - Shoichi Namikawa
- Faculty of Medical Sciences, Second Department of Internal Medicine, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Fukui, Yoshida-gun, 910-1193, Japan
| | - Takuto Nosaka
- Faculty of Medical Sciences, Second Department of Internal Medicine, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Fukui, Yoshida-gun, 910-1193, Japan
| | - Kazuto Takahashi
- Faculty of Medical Sciences, Second Department of Internal Medicine, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Fukui, Yoshida-gun, 910-1193, Japan
| | - Tatsushi Naito
- Faculty of Medical Sciences, Second Department of Internal Medicine, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Fukui, Yoshida-gun, 910-1193, Japan
| | - Kazuya Ofuji
- Faculty of Medical Sciences, Second Department of Internal Medicine, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Fukui, Yoshida-gun, 910-1193, Japan
| | - Hidetaka Matsuda
- Faculty of Medical Sciences, Second Department of Internal Medicine, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Fukui, Yoshida-gun, 910-1193, Japan
| | - Katsushi Hiramatsu
- Faculty of Medical Sciences, Second Department of Internal Medicine, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Fukui, Yoshida-gun, 910-1193, Japan
| | - Yasunari Nakamoto
- Faculty of Medical Sciences, Second Department of Internal Medicine, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Fukui, Yoshida-gun, 910-1193, Japan.
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11
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A Drug-Induced Acute Pancreatitis Retrospective Study. Can J Gastroenterol Hepatol 2020; 2020:1516493. [PMID: 33204673 PMCID: PMC7655261 DOI: 10.1155/2020/1516493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/25/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND AIMS Drugs are considered a relatively rare and understudied cause of acute pancreatitis (AP). The lack of convincing and conclusive data on drug-induced AP (DIAP) complicates the diagnosis as well as the identification of the causative drug. The aim of this study is to document causes of DIAP cases that occurred in the Saguenay-Lac-Saint-Jean (SLSJ) population. METHODS We have conducted a retrospective and descriptive population-based study of DIAP cases that occurred between 2006 and 2014 in the six hospitals serving the entire SLSJ population. Cases were selected from the Quebec Ministry of Health hospitalizations registry (MED-ECHO) administrative public database. A medical chart review was performed in an attempt to characterize DIAP hospitalizations and to identify the imputable drugs. RESULTS During the studied period, 75 cases (30.7% male, 69.3% female) were included totaling 90 hospitalizations for DIAP. Among them, 50 causative drugs were identified and were distributed in 17 different drug classes. Recurrent DIAPs were documented in 13 cases, and among them, 6 cases have experimented a positive rechallenge. Six drugs (5-fluorouracil, atorvastatin, bortezomib, nilotinib, rosuvastatin, and triamcinolone) were associated with the highest degree of evidence. The most common causative drugs of DIAP hospitalization were azathioprine (n = 7), followed by atorvastatin (n = 6), hydrochlorothiazide (n = 5), rosuvastatin (n = 4), and codeine (n = 4). CONCLUSIONS This study has added new evidences about potentially pancreatitis-associated drugs in literature. This is the first study to report definite 5-fluorouracil- and triamcinolone-induced AP. An updated version of the evidence-based literature review is needed to support the clinicians in the identification of the causative drugs.
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Meczker Á, Hanák L, Párniczky A, Szentesi A, Erőss B, Hegyi P, A M, Zs S, D D, L S, J B, A M, Á V, M M, D C, Pethő G, Pál H. Analysis of 1060 Cases of Drug-Induced Acute Pancreatitis. Gastroenterology 2020; 159:1958-1961.e8. [PMID: 32687926 DOI: 10.1053/j.gastro.2020.07.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Ágnes Meczker
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Lilla Hanák
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Andrea Párniczky
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Department of Gastroenterology, Heim Pál National Pediatric Institute, Budapest, Hungary
| | - Andrea Szentesi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Centre for Translational Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Department of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Centre for Translational Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary; Department of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary.
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Kim HJ, Han JJ, Maeng CH, Baek SK. Lenvatinib-Induced Acute Pancreatitis in a Patient with Metastatic Thyroid Cancer: A Case Report. Int J Gen Med 2020; 13:699-704. [PMID: 33061538 PMCID: PMC7522403 DOI: 10.2147/ijgm.s272375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/10/2020] [Indexed: 12/12/2022] Open
Abstract
Background Lenvatinib, a novel multi-target tyrosine kinase inhibitor, has been approved for treating differentiated thyroid cancer. Herein, we describe a rare case of acute pancreatitis that developed during lenvatinib treatment in a 65-year-old man with recurrent thyroid cancer. Case Presentation The patient was admitted to our department following a complaint of acute-onset epigastric pain and indigestion. He had been receiving lenvatinib since 34 days. Although his serum amylase and lipase levels were normal, he had acute-onset persistent epigastric pain and typical computed tomography findings, which were consistent with those of acute pancreatitis. As other common etiologies were excluded, it was concluded that the patient had lenvatinib-induced acute pancreatitis. On admission day 14, he could consume food orally, after conservative care, including drug cessation, intravenous hydration, and pain control. Conclusion Physicians should consider acute pancreatitis as a differential diagnosis for patients complaining of abdominal pain while on lenvatinib, regardless of hyperamylasemia or hyperlipasemia. Systematic collection of data on acute pancreatitis development during lenvatinib treatment should be considered, and further research is warranted to identify the mechanism of acute pancreatitis associated with multi-target tyrosine kinase inhibitors such as lenvatinib.
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Affiliation(s)
- Hong Jun Kim
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Jae Joon Han
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Chi Hoon Maeng
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Sun Kyung Baek
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea
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Hao S, Wu Y, Kang Y, Niu X, Zhu G, Huang W. A single-center analysis of primary nephrotic syndrome with acute pancreatitis in children. Medicine (Baltimore) 2020; 99:e21056. [PMID: 32629733 PMCID: PMC7337457 DOI: 10.1097/md.0000000000021056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Primary nephrotic syndrome (PNS) is one of the most common primary glomerular diseases in children. Patients complicated nephrotic syndrome with pancreatic lesions are rarely reported, and the clinical manifestations in children are atypical. This study has observed the incidence, clinical types, and prognosis of acute pancreatitis (AP) in children with primary nephrotic syndrome, and analyzed its related factors, early diagnosis, and treatment.Seven children with PNS and AP in Shanghai Children's Hospital from January 2015 to December 2017 were reviewed. The clinical data including age, height, weight, body mass index (BMI), diet, biliary tract disease, PNS durations, drugs, proteinuria, creatinine, glucose, glycated hemoglobin, amylase and lipase, albumin, cholesterol, triglyceride, ultrasound, computerized tomography (CT), renal pathology and estimated glomerular filtration rate (eGFR) were retrospectively analyzed. All patients were followed for >2 years.Ten in 589 patients with PNS were detected pancreatic lesions by abdominal ultrasound. Seven were diagnosed as AP, which the incidence was 1.2%. Only 1 of 7 patients had elevated serum amylase. Lesions of pancreas were found by ultrasound and/or enhanced CT. Four of 7 patients had been treated with tacrolimus. All patients with AP were improved after octreotide acetate injection and supportive treatment. Only 1 patient suffered recurrent AP during the relapse of PNS 10 months later.AP in children with PNS is not common, and the clinical manifestations are not typical. Abdominal ultrasound and enhanced CT are of high value in diagnosis. The adverse effects of tacrolimus should be concerned. Early diagnosis and timely treatment can be helpful for a prognosis.
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Affiliation(s)
- Sheng Hao
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
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15
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Ashraf M. Acute Pancreatitis Caused by Isotretinoin. Cureus 2020; 12:e8710. [PMID: 32699705 PMCID: PMC7372240 DOI: 10.7759/cureus.8710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Isotretinoin, a retinoid derivative, is used widely as a treatment for severe acne and other dermatological conditions. Its effect on lipid metabolism, especially the induction of hypertriglyceridemia, is well documented. There are some case reports in the literature about drug-induced pancreatitis secondary to isotretinoin. We describe another interesting case of acute pancreatitis related to severe hypertriglyceridemia due to isotretinoin.
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Wolfe D, Kanji S, Yazdi F, Skidmore B, Moher D, Hutton B. Methods for the early detection of drug-induced pancreatitis: a systematic review of the literature. BMJ Open 2019; 9:e027451. [PMID: 31694842 PMCID: PMC6858245 DOI: 10.1136/bmjopen-2018-027451] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 10/02/2019] [Accepted: 10/10/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES We systematically reviewed the literature to identify evidence-informed recommendations regarding the detection of drug-induced pancreatitis (DIP) and, secondarily, to describe clinical processes for the diagnosis of DIP. DESIGN Systematic review. DATA SOURCES Ovid MEDLINE, including Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Embase Classic+Embase, the Cochrane Library. ELIGIBILITY CRITERIA We included clinical practice guidelines, systematic reviews, narrative reviews and observational studies with a focus of establishing incidence, prevalence or diagnostic approaches for DIP. Clinical trials that diagnosed DIP as an outcome were also included. DATA EXTRACTION AND SYNTHESIS Two reviewers screened citations and performed data extraction. A narrative synthesis of the evidence was prepared. RESULTS Fifty-nine studies were included. Early published evidence suggested serial pancreatic ultrasound could detect subclinical pancreatitis; however, subsequent studies demonstrated no utility of serial ultrasound or serial monitoring of pancreatic enzymes in the early detection of DIP. Two small studies conducted in patients with a high baseline risk of acute pancreatitis concluded serial monitoring of pancreatic enzymes may be useful to guide early discontinuation of medications with known associations with pancreatitis. Early discontinuation of medication was not advised for lower-risk patients because some medications cause transient elevations of pancreatic enzymes that do not progress to acute pancreatitis. Eight of 52 studies (15%) reporting a clinical diagnostic process for DIP reported using currently accepted criteria for the diagnosis of acute pancreatitis. A variety of methods were used to assess drug-related causality. CONCLUSIONS There is minimal evidence to support the use of serial monitoring by ultrasound or pancreatic enzymes to detect cases of DIP. Serial monitoring may be useful to guide early discontinuation of DIP-associated drugs in high-risk patients, but not in lower-risk patients. Greater uptake of standardised diagnostic and causality criteria for DIP is needed. TRIAL REGISTRATION NUMBER CRD42017060473.
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Affiliation(s)
- Dianna Wolfe
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Salmaan Kanji
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Fatemeh Yazdi
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Becky Skidmore
- Independent Information Specialist, Ottawa, Ontario, Canada
| | - David Moher
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Youssef I, Saeed N, El Abdallah M, Huevelhorst K, Zakharia K. Metronidazole-Induced Pancreatitis: Is There Underrecognition? A Case Report and Systematic Review of the Literature. Case Rep Gastrointest Med 2019; 2019:4840539. [PMID: 31281684 PMCID: PMC6590551 DOI: 10.1155/2019/4840539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/06/2019] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Acute pancreatitis (AP) is the most common cause of gastroenterological hospitalization in the USA, with a mortality ranging from 5 to 20%. Up to 80% of cases are caused by cholelithiasis and alcohol abuse. Less common etiologies that need to be explored include hypertriglyceridemia, trauma, ERCP, infections, and drugs. A number of medications are known to cause acute pancreatitis, with 0.3-1.4% of all cases of pancreatitis being drug induced (DIP). Here, we present a case of metronidazole-induced acute pancreatitis. CASE SUMMARY A 60-year-old female presented with constant severe epigastric pain associated with nausea, vomiting, and anorexia for one day. She had no past medical history of alcohol use or hypertriglyceridemia and was s/p cholecystectomy in the distant past. Symptoms had begun three days after starting metronidazole for Clostridium difficile colitis. Lipase was > 396, and CT abdomen revealed peripancreatic fat stranding. She was diagnosed with AP, metronidazole was suspected to be responsible and hence stopped, and supportive management initiated. Her symptoms improved rapidly, and pancreatic enzymes normalized within 2 days. Of note, she had had an episode of acute pancreatitis 3 years ago, also following metronidazole use, with resolution at discontinuation of the drug. She had concurrently been on omeprazole during both episodes. DISCUSSION Metronidazole is a commonly used antibiotic and is infrequently reported as a cause of DIP. Our review suggests the possibility of a dose-response and duration-response effect between metronidazole use and occurrence of pancreatitis. The most common presenting symptom and sign was moderate to severe epigastric pain and tenderness, accompanied by nausea/vomiting. Symptoms usually start within 2-7 days of starting the medication and usually resolve 2-5 days after discontinuation of therapy and pancreatitis treatment. The most common causative dose was 1-1.5 g/day. Our review also supports findings by Norgaard et al. suggesting that concurrent use of omeprazole potentiates the risk of metronidazole-induced pancreatitis. CONCLUSION Metronidazole is a commonly used antibiotic that may cause metronidazole-induced pancreatitis, especially if patients are concurrently taking PPIs. Awareness needs to be raised amongst clinicians regarding this association, in order to correctly identify etiology of pancreatitis and discontinue metronidazole promptly when suspected as the causative factor.
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Affiliation(s)
- Ibrahim Youssef
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Naba Saeed
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Beaumont Health, Dearborn, Michigan, USA
| | | | - Kara Huevelhorst
- Department of Radiology, Beaumont Health–Dearborn, Dearborn, Michigan, USA
| | - Kais Zakharia
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
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Chatila AT, Bilal M, Guturu P. Evaluation and management of acute pancreatitis. World J Clin Cases 2019; 7:1006-1020. [PMID: 31123673 PMCID: PMC6511926 DOI: 10.12998/wjcc.v7.i9.1006] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/19/2018] [Accepted: 03/26/2019] [Indexed: 02/05/2023] Open
Abstract
Acute pancreatitis (AP) is one of the most common gastrointestinal causes for hospi-talization in the United States. In 2015, AP accounted for approximately 390000 hospitalizations. The burden of AP is only expected to increase over time. Despite recent advances in medicine, pancreatitis continues to be associated with a substantial morbidity and mortality. The most common cause of AP is gallstones, followed closely by alcohol use. The diagnosis of pancreatitis is established with any two of three following criteria: (1) Abdominal pain consistent with that of AP; (2) Serum amylase and/or lipase greater than three times the upper limit of normal; and (3) Characteristics findings seen in cross-sectional abdominal imaging. Multiple criteria and scoring systems have been established for assessing severity of AP. The cornerstones of management include aggressive intravenous hydration, appropriate nutrition and pain management. Endoscopic retrograde cholangiopancreatography and surgery are important aspects in management of acute gallstone pancreatitis. We provide a comprehensive review of evaluation and management of AP.
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Affiliation(s)
- Ahmed T Chatila
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Mohammad Bilal
- Division of Gastroenterology and Hepatology, The University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Praveen Guturu
- Division of Gastroenterology and Hepatology, the University of Texas Medical Branch, Galveston, TX 77555, United States
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Önder AH, Öztürk B, Tatlı AM, Kayıkçıoğlu E. Acute pancreatitis linked to bevacizumab: A case report. JOURNAL OF ONCOLOGICAL SCIENCES 2018. [DOI: 10.1016/j.jons.2018.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Management of Acute Pancreatitis in the Pediatric Population: A Clinical Report From the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas Committee. J Pediatr Gastroenterol Nutr 2018; 66:159-176. [PMID: 29280782 PMCID: PMC5755713 DOI: 10.1097/mpg.0000000000001715] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although the incidence of acute pancreatitis (AP) in children is increasing, management recommendations rely on adult published guidelines. Pediatric-specific recommendations are needed. METHODS The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas committee performed a MEDLINE review using several preselected key terms relating to management considerations in adult and pediatric AP. The literature was summarized, quality of evidence reviewed, and statements of recommendations developed. The authorship met to discuss the evidence, statements, and voted on recommendations. A consensus of at least 75% was required to approve a recommendation. RESULTS The diagnosis of pediatric AP should follow the published INternational Study Group of Pediatric Pancreatitis: In Search for a CuRE definitions (by meeting at least 2 out of 3 criteria: (1) abdominal pain compatible with AP, (2) serum amylase and/or lipase values ≥3 times upper limits of normal, (3) imaging findings consistent with AP). Adequate fluid resuscitation with crystalloid appears key especially within the first 24 hours. Analgesia may include opioid medications when opioid-sparing measures are inadequate. Pulmonary, cardiovascular, and renal status should be closely monitored particularly within the first 48 hours. Enteral nutrition should be started as early as tolerated, whether through oral, gastric, or jejunal route. Little evidence supports the use of prophylactic antibiotics, antioxidants, probiotics, and protease inhibitors. Esophago-gastro-duodenoscopy, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasonography have limited roles in diagnosis and management. Children should be carefully followed for development of early or late complications and recurrent attacks of AP. CONCLUSIONS This clinical report represents the first English-language recommendations for the management of pediatric AP. Future aims should include prospective multicenter pediatric studies to further validate these recommendations and optimize care for children with AP.
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Cao CL, Duan PY, Zhang WJ, Li L, Qu FZ, Sun B, Wang G. Acute pancreatitis induced by etoposide-lobaplatin combination chemotherapy used for the treatment of lung cancer: A case report and literature review. Medicine (Baltimore) 2017; 96:e7601. [PMID: 28723805 PMCID: PMC5521945 DOI: 10.1097/md.0000000000007601] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
RATIONALE Drug-induced pancreatitis (DIP) is a rare type of pancreatitis that is not usually observed in the clinical practice. It is generally difficult to distinguish from acute pancreatitis (AP) induced by other causes. PATIENT CONCERNS Here, we report a 62-year-old Chinese female patient with "small cell lung cancer" as the initial presentation. Because the patient could not bear the surgical treatment, the chemotherapy composed of lobaplatin and etoposide was performed. Three days later, the patient displayed sudden abdominal pain, distension, nausea, and vomiting without obvious inducements. Laboratory tests showed that the levels of serum and urine amylase were enhanced; abdominal computed tomography (CT) result showed the enlargement of the pancreas, peripancreatic effusion, and a rough edge, which suggested the diagnosis of AP. The patient had no history of biliary tract disease, alcoholism, binge overeating, hyperlipidemia, and hereditary pancreatitis. DIAGNOSES The patient was diagnosed with DIP. INTERVENTIONS The chemotherapy was stopped at once and we performed fluid resuscitation, pain alleviation, prophylactic antibiotics, and nutritional support, etc on the patient. Later, the patient's clinical symptoms were obviously relieved, and she recovered successfully. OUTCOMES The chemotherapy was continued, but later, the patient showed abdominal pain, distension, nausea, and vomiting again. The levels of serum amylase and urine amylase were enhanced again. Further imaging examination strongly indicated the recurrence of AP. LESSONS We should raise awareness of the clinicians regarding DIP, thereby enabling its timely diagnosis and accurate treatment, as well as promoting the rational and safe use of drugs.
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Epidemiology of Recurrent Acute and Chronic Pancreatitis: Similarities and Differences. Dig Dis Sci 2017; 62:1683-1691. [PMID: 28281168 PMCID: PMC5478431 DOI: 10.1007/s10620-017-4510-5] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 02/21/2017] [Indexed: 02/06/2023]
Abstract
Emerging data in the past few years suggest that acute, recurrent acute (RAP), and chronic pancreatitis (CP) represent a disease continuum. This review discusses the similarities and differences in the epidemiology of RAP and CP. RAP is a high-risk group, comprised of individuals at varying risk of progression. The premise is that RAP is an intermediary stage in the pathogenesis of CP, and a subset of RAP patients during their natural course transition to CP. Although many clinical factors have been identified, accurately predicting the probability of disease course in individual patients remains difficult. Future studies should focus on providing more precise estimates of the risk of disease transition in a cohort of patients, quantification of clinical events during the natural course of disease, and discovery of biomarkers of the different stages of the disease continuum. Availability of clinically relevant endpoints and linked biomarkers will allow more accurate prediction of the natural course of disease over intermediate- or long-term-based characteristics of an individual patient. These endpoints will also provide objective measures for use in clinical trials of interventions that aim to alter the natural course of disease.
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Abstract
Once considered uncommon, pancreatic diseases are increasingly recognized in the pediatric age group. Acute pancreatitis, acute recurrent pancreatitis, and chronic pancreatitis occur in children with an incidence approaching that of adults. Risk factors are broad, prompting the need for a completely different diagnostic and therapeutic approach in children. Although cystic fibrosis remains the most common cause of exocrine pancreatic insufficiency, other causes such as chronic pancreatitis may be as common as Shwachman Diamond syndrome. Long-term effects of pancreatic diseases may be staggering, as children suffer from significant disease burden, high economic cost, nutritional deficiencies, pancreatogenic diabetes, and potentially pancreatic cancer.
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Affiliation(s)
- Aliye Uc
- Division of Pediatric Gastroenterology, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, BT 1120-C, 200 Hawkins Drive, Iowa City, IA 52242, USA.
| | - Douglas S. Fishman
- Texas Children’s Hospital; Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine
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Kuoppala J, Enlund H, Pulkkinen J, Kastarinen H, Jyrkkä J, Happonen P, Paajanen H. ACE inhibitors and the risk of acute pancreatitis-a population-based case-control study. Pharmacoepidemiol Drug Saf 2017; 26:853-857. [DOI: 10.1002/pds.4179] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 01/18/2017] [Accepted: 01/19/2017] [Indexed: 01/12/2023]
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Das R, Clarke B, Tang G, Papachristou GI, Whitcomb DC, Slivka A, Yadav D. Endoscopic sphincterotomy (ES) may not alter the natural history of idiopathic recurrent acute pancreatitis (IRAP). Pancreatology 2016; 16:770-7. [PMID: 27450967 DOI: 10.1016/j.pan.2016.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 07/09/2016] [Accepted: 07/11/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND The role of endoscopic sphincterotomy (ES) in idiopathic recurrent acute pancreatitis (IRAP) is unclear. We hypothesized that ES will alter the natural history of IRAP. METHODS We retrospectively studied the course of 50 IRAP patients from the NAPS2 study from UPMC based on whether they underwent ES or were managed medically. Data included age at first AP, rate of attacks, and history of severe AP. Primary outcomes were any subsequent AP and rate of attacks; secondary outcome was chronic pancreatitis (CP) diagnosis during follow-up. Similar data was abstracted for alcoholic RAP. RESULTS When compared with medically managed IRAP patients (n = 24, 48%), those who underwent ES (n = 26, 52%) had similar rate of attacks/year (median 1.54 vs. 1.41, p = 0.63), but significantly more attacks (median 3 vs. 2, p = 0.04) at baseline. During follow-up (median 7 years), rate of attacks/year decreased significantly, and were similar in both groups (median 0.16 vs. 0, p = ns). Predictors for rate of attacks during follow-up were sex (ratio 0.54 in females, p = 0.045) and rate of attacks at baseline (ratio for doubling 1.2, p = 0.025), but not ES. Alcoholic RAP patients had lower rate of attacks at baseline, but higher risk of subsequent AP (80 vs. 46%, p = 0.021) and rate of attacks/year (median 0.25 vs. 0, p = 0.016) during follow-up. Progression to CP occurred in IRAP and ES, medically managed IRAP, and alcoholic RAP in 27%, 8% and 27% respectively (p = ns). CONCLUSIONS ES, chosen in patients with higher burden of attacks, does not seem to impact the natural history of IRAP.
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Affiliation(s)
- Rohit Das
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Bridger Clarke
- South Hills Gastroenterology Associates, Clairton, PA, USA
| | - Gong Tang
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Georgios I Papachristou
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - David C Whitcomb
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Adam Slivka
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Inayat F, Virk HUH, Yoon DJ, Riaz I. Drug-Induced Pancreatitis: A Rare Manifestation of Doxycycline Administration. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2016; 8:117-20. [PMID: 27042611 PMCID: PMC4791899 DOI: 10.4103/1947-2714.174348] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Context: Drug-induced pancreatitis (DIP) is rare, but as there are no systematic data on it, the true incidence is not known. Although numerous and varied drugs have been associated with DIP, the clinical evidence on doxycycline-induced pancreatitis is sparse. Case Report: We present the case of a 58-year-old female who presented with complaints of nausea and severe epigastric pain. Her medications included doxycycline which she had been on for only 2 days. Computed tomography of her abdomen showed mild enlargement of body of the pancreas with peripancreatic fatty infiltration, along with lipase level suggestive of acute pancreatitis. In the absence of classical risk factors for acute pancreatitis, a diagnosis of DIP secondary to doxycycline therapy was made. Immediate withdrawal of the drug was accompanied by relief of symptoms and resolution of pancreatitis. Conclusion: This report implicates doxycycline as an etiological factor for acute pancreatitis. Knowledge regarding doxycycline related pancreatitis is of paramount importance in order to diagnose cases early and institute effective treatment in patients who are undergoing therapy with this drug.
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Affiliation(s)
- Faisal Inayat
- Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York City, New York, USA
| | - Hafeez Ul Hassan Virk
- Department of Medicine, Mount Sinai St. Luke's and Mount Sinai Roosevelt Hospitals, Icahn School of Medicine, New York City, New York, USA
| | - Daniel J Yoon
- Department of Radiology, Mount Sinai St. Luke's and Mount Sinai Roosevelt Hospitals, Icahn School of Medicine, New York City, New York, USA
| | - Iqra Riaz
- Department of Medicine, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
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Acute Pancreatitis Associated With Antipsychotic Medication: Evaluation of Clinical Features, Treatment, and Polypharmacy in a Series of Cases. J Clin Psychopharmacol 2016; 36:169-72. [PMID: 26859276 DOI: 10.1097/jcp.0000000000000459] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Antipsychotic-associated acute pancreatitis presents like pancreatitis from other causes, requiring clinical judgment, tests, and decision support to establish the diagnosis. Many new cases of atypical antipsychotic pancreatitis have been established, and current decision supports are out of date as antipsychotic polypharmacy is being recognized. Given the population frequency of psychosis and frequency of antipsychotic prescribing, we reviewed published cases summarizing common clinical findings and antipsychotics associated with acute pancreatitis to updating earlier decision support. METHODS Case reports of antipsychotic pancreatitis from 1990 to 2015 were reviewed and abstracted by independent reviewers. Demographic, clinical features, management, and Naranjo and probability scores were abstracted and reviewed for associations. Appropriate statistical tests were selected for normally and non-normally distributed data. RESULTS We summarized 41 cases of acute pancreatitis associated with antipsychotics, and cases were younger men (59%) (mean age, 39 years). Alcohol, diabetes, and previous lithiasis appeared in 27%; polypharmacy was associated with 53% of cases, and 80% had concomitant use of other medication linked to pancreatitis.The median lipase, amylase, and alkaline phosphate during acute presentation were 1210 IU/L (range, 243-5482 IU/L), 492 IU/L (range, 3-2916 IU/L), and 152 IU/L (range, 119-367 IU/L), respectively. Median exposure to antipsychotics were 49 days (range, 5-3,650 days); most were mild (63%, n = 26), several severe (27%, n = 11), and few fatal (10%, n = 4). DISCUSSION We identified 41 reports of antipsychotic-related acute pancreatitis, many associated with antipsychotic polypharmacy. Olanzapine, risperidone, quetiapine, aripiprazole, and ziprasidone are associated with acute pancreatitis and often in combination with mood stabilizers.
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Moy BT, Kapila N. Probable doxycycline-induced acute pancreatitis. Am J Health Syst Pharm 2016; 73:286-91. [DOI: 10.2146/ajhp150298] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Brian T. Moy
- Department of Medicine, University of Connecticut Health Center–Farmington, Farmington, CT
| | - Nikhil Kapila
- Department of Medicine, University of Connecticut Health Center–Farmington, Farmington, CT
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Labgaa I, Uldry E, Doerig C, Schmidt S, Demartines N, Halkic N. Loperamide-induced recurrent acute pancreatitis. Clin Res Hepatol Gastroenterol 2016; 40:e13-4. [PMID: 26184348 DOI: 10.1016/j.clinre.2015.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 06/11/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Ismaïl Labgaa
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
| | - Emilie Uldry
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Christopher Doerig
- Division of Gastroenterology and Hepatology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Sabine Schmidt
- Department of Radiology and Interventional Radiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Nermin Halkic
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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Liaw GW, Hung DZ, Chen WK, Lin CL, Lin IC, Kao CH. Relationship Between Acute Benzodiazepine Poisoning and Acute Pancreatitis Risk: A Population-Based Cohort Study. Medicine (Baltimore) 2015; 94:e2376. [PMID: 26717383 PMCID: PMC5291624 DOI: 10.1097/md.0000000000002376] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
We designed a population-based retrospective cohort study to investigate the association between the event of benzodiazepine (BZD) poisoning and the risk of acute pancreatitis.In the present study, 12,893 patients with BZD poisoning during 2000 to 2011 were enrolled and matched with 4 comparison patients according to mean age and sex. We determined the cumulative incidences and adjusted hazard ratios of acute pancreatitis.A significant association was observed between BZD poisoning and acute pancreatitis. After adjustment for potential risk factors, the patients with BZD poisoning had a 5.33-fold increased risk of acute pancreatitis compared with the controls without BZD poisoning (HR = 5.33, 95% CI = 2.26-12.60). The results revealed that acute pancreatitis in patients with BZD poisoning occurred in a follow-up time of ≤1 month (HR = 50.0, P < .001), and the risk of acute pancreatitis was no different between the patients with and without BZD poisoning when the follow-up time was >1 month (HR = 1.07, P > .05).This population-based study revealed the positive correlation between the event of BZD poisoning and an increased risk of acute pancreatitis. The findings warrant further large-scale and in-depth investigation.
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Affiliation(s)
- Geng-Wang Liaw
- From the Department of Emergency Medicine (G-WL, D-ZH, W-KC), China Medical University Hospital, Taichung, Taiwan, Management Office for Health Data (C-LL), China Medical University Hospital, College of Medicine (C-LL), China Medical University, Taichung, Department of Family Medicine (I-CL), Changhua Christian Hospital, Changhua, School of Medicine (I-CL), Chung Shan Medical University, Department of Nuclear Medicine and PET Center (C-HK), China Medical University Hospital, Taichung; and Graduate Institute of Clinical Medical Science (C-HK), College of Medicine, China Medical University, Taiwan
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31
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Bertilsson S, Kalaitzakis E. Acute Pancreatitis and Use of Pancreatitis-Associated Drugs: A 10-Year Population-Based Cohort Study. Pancreas 2015; 44:1096-104. [PMID: 26335010 DOI: 10.1097/mpa.0000000000000406] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To assess the use of acute pancreatitis (AP)-associated drugs in patients with AP, the relation between sales of these drugs and the incidence of AP, and the potential impact on AP severity and recurrence. METHODS All patients with incident AP between 2003 and 2012, in a well-defined area, were retrospectively identified. Data regarding AP etiology, severity, and recurrence and use of AP-associated drugs were extracted from medical records. Drugs were classified according to an evidence-based classification system. Annual drug sales data were obtained from the Swedish drug administration service. RESULTS Overall, 1457 cases of incident AP were identified. Acute pancreatitis-associated drug users increased from 32% in 2003 to 51% in 2012, reflecting increasing user rates in the general population. The incidence of AP increased during the study period but was not related to AP-associated drug user rates (P > 0.05). Recurrent AP occurred in 23% but was unrelated to AP-associated drug use (P > 0.05). In logistic regression analysis, after adjustment for comorbidity, AP-associated drug use was not related to AP severity (P > 0.05). CONCLUSIONS Use of AP-associated drugs is increasingly frequent in patients with AP. However, it does not have any major impact on the observed epidemiological changes in occurrence, severity, or recurrence of AP.
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Affiliation(s)
- Sara Bertilsson
- From the Department of Gastroenterology, Skåne University Hospital, University of Lund, Lund, Sweden
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Abstract
PURPOSE OF REVIEW The purpose of this review is to describe recent developments in paediatric pancreatitis and to discuss causes and current management. RECENT FINDINGS Although recent studies have estimated the annual incidence of paediatric acute pancreatitis approaching that of adults, there are no established guidelines about its diagnosis and treatment in children. Genetic and structural/congenital abnormalities are emerging as the primary risk factors for paediatric acute recurrent and chronic pancreatitis. Specifically, chronic pancreatitis is associated with a significant socioeconomic burden in children. Both medical and surgical therapies are proposed for paediatric chronic pancreatitis, but there is little evidence that they are beneficial. SUMMARY Acute recurrent and chronic pancreatitis create significant health issues in the paediatric population. Medical and surgical therapies exist to potentially treat these conditions, but the paediatric data are limited and the cohorts are small. A multidisciplinary and multicentre approach is necessary to better determine pancreatic disease processes and treatment options in children.
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Affiliation(s)
- John F. Pohl
- Department of Pediatric Gastroenterology, Primary Children’s Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - Aliye Uc
- Department of Pediatric Gastroenterology, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Wurm S, Schreiber F, Spindelboeck W. Mefenamic acid: A possible cause of drug-induced acute pancreatitis. Pancreatology 2015; 15:570-572. [PMID: 26347329 DOI: 10.1016/j.pan.2015.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 08/12/2015] [Accepted: 08/17/2015] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Drug-induced acute pancreatitis (AP) is rare, but as there are no systematic data on it, the true incidence is not known. CASE REPORT This case report is a first description of two episodes of AP occurring after administration and subsequent re-administration of mefenamic acid to a young woman without comorbidities. Other common causes of AP could be ruled out. With both episodes, the latency of AP was less than 24 h after drug intake. CONCLUSION Mefenamic acid should be considered as a possible cause of drug-induced AP.
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Affiliation(s)
- S Wurm
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Austria
| | - F Schreiber
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Austria
| | - W Spindelboeck
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Austria.
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Chowdhary M, Kabbani AA, Chhabra A. Canagliflozin-induced pancreatitis: a rare side effect of a new drug. Ther Clin Risk Manag 2015; 11:991-4. [PMID: 26170677 PMCID: PMC4489815 DOI: 10.2147/tcrm.s86641] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Acute pancreatitis is most commonly attributed to gallstones, alcohol abuse, and metabolic disorders such as hyperlipidemia and hypercalcemia. Medications are an infrequent yet commonly overlooked etiology of pancreatitis. Although several drugs have been implicated, antidiabetic agents are a rare cause for drug-induced pancreatitis. Canagliflozin is a new drug in the class of SGLT-2 inhibitors used for the treatment of type 2 diabetes mellitus. Serious reported side effects include renal impairment, hyperkalemia, and hypotension. Pancreatitis as a result of canagliflozin, however, is exceedingly rare. Here we describe a case of a 33-year old female who presented with severe acute pancreatitis in the setting of recent initiation of canagliflozin. Given the timing of her presentation and after excluding all other possible etiologies, it was determined that canagliflozin was the likely source of her illness. This case highlights the importance of identifying drug-induced pancreatitis, especially in novel drugs, as it is commonly neglected in patients with multiple medical comorbidities and those taking numerous medications. Prompt identification of drug-induced pancreatitis can improve management as well as decrease morbidity and mortality in these individuals.
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Affiliation(s)
- Mudit Chowdhary
- Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
| | - Ahmad A Kabbani
- Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
| | - Akansha Chhabra
- Department of Internal Medicine, New York University Langone Medical Center, New York, NY, USA
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Russo L, Schneider G, Gardiner MH, Lanes S, Streck P, Rosen S. Role of pharmacoepidemiology studies in addressing pharmacovigilance questions: a case example of pancreatitis risk among ulcerative colitis patients using mesalazine. Eur J Clin Pharmacol 2014; 70:709-17. [PMID: 24609467 PMCID: PMC4025187 DOI: 10.1007/s00228-014-1660-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 02/16/2014] [Indexed: 12/16/2022]
Abstract
PURPOSE Well-designed pharmacoepidemiology studies address several limitations of postmarketing spontaneous reports in regard to signal evaluation. This study evaluated a signal of disproportionate reporting of acute pancreatitis cases observed in patients with ulcerative colitis (UC) treated with MMX Multi Matrix System® (MMX®) mesalazine and demonstrated how inherent limitations of postmarketing reports were overcome. METHODS Adults with UC who were new users of MMX mesalazine or another branded mesalazine (controlled-release, delayed-release, or extended-release mesalazine; balsalazide disodium; olsalazine sodium; sulfasalazine; or sulfasalazine delayed-release) were identified from a large US administrative healthcare claims database. Acute pancreatitis incidence rates were compared between patients on MMX mesalazine versus comparator therapies. Propensity scores were used to match patients on MMX mesalazine with patients on comparator drugs to achieve a balance of baseline patient factors. RESULTS Crude incidence rates [95 % confidence interval (CI)] of acute pancreatitis among patients on MMX mesalazine were similar to those of patients on comparator therapies [8.55 (5.54-13.21) vs 10.05 (7.54-13.41) per 1000 person-years]; the resulting incidence rate ratio (IRR) was [0.85 (0.48-1.47)]. Propensity score-matching had little influence on the IRR [0.84 (0.46-1.55)]; nor did further adjustment by demographic characteristics, daily dose, and causes of acute pancreatitis [0.76 (0.41-1.43)]. CONCLUSION Findings of no increase in pancreatitis risk with MMX mesalazine demonstrate the value of pharmacoepidemiology studies for evaluating a drug's postmarket safety profile when confronted with spontaneous reporting data suggestive of a safety issue.
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Affiliation(s)
- Leo Russo
- Shire Development LLC, Wayne, PA, USA,
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Abstract
BACKGROUND AND AIMS Prospective and population-based studies on the incidence of acute pancreatitis (AP) are lacking. Alcohol consumption has increased considerably in Iceland during the last decade. We aimed to determine the incidence, etiology, severity, and complications of AP and compare the results with a previous study on AP in Iceland. METHODS A prospective population-based study of patients diagnosed with AP at the National University Hospital of Iceland during 1 year (2010-2011). Information on symptoms, etiology, and complications was registered. RESULTS During the study period, 134 patients were diagnosed with AP, 78 men (58%), median age 57 years (interquartile range 42-71). Overall, 89/104 (86%) patients had their first attack of pancreatitis, yielding a crude incidence of 40/100 000 inhabitants/year. The major etiological groups were as follows: gallstones, 52 cases (42%); alcohol 29, (23%); postendoscopic retrograde cholangio-pancreatography in 12 (9.5%); medications in eight (6.3%); and idiopathic in 15 (12%). Alcohol was more often the cause in men (25 vs. 4, P<0.05) but the incidence of gallstone-induced pancreatitis was similar in men and women (26 vs. 27). Seven patients had severe complications, three had pancreatic necrosis, two had pseudocysts, and one developed renal failure. Another patient developed acute respiratory distress syndrome and was admitted to the ICU. No patient died of AP during the study period. CONCLUSION The incidence of AP has not increased significantly in Iceland in the last decade. Alcohol-induced pancreatitis has not increased proportionally despite increased alcohol consumption in Iceland. In a population-based setting, the vast majority of AP is of mild severity.
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Abstract
Sorafenib and sunitinib are oral tyrosine kinase inhibitors, commonly used in the treatment of metastatic renal cell carcinoma. Known adverse events associated with tyrosine kinase inhibitors include hypertension and palmarplantar erythrodysesthesia. We report two cases of acute pancreatitis associated with tyrosine kinase inhibitors.
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Affiliation(s)
- Adrienne Sevin
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adrienne Chen
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brad Atkinson
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Abraham A, Raghavan P, Patel R, Rajan D, Singh J, Mustacchia P. Acute pancreatitis induced by methimazole therapy. Case Rep Gastroenterol 2012; 6:223-31. [PMID: 22679409 PMCID: PMC3369408 DOI: 10.1159/000338652] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Among the causative factors for acute pancreatitis, adverse drug reactions are considered to be rare. The diagnosis of drug-induced pancreatitis (DIP) is challenging to establish, and is often underestimated because of the difficulties in determining the causative agent and the need for a retrospective re-evaluation of the suspected agent. We present the case of an 80-year-old woman who presented with complaints of abdominal pain. Her medications included methimazole (MMI) which she had been on for the past 3 months. Computed tomography of her abdomen showed peripancreatic fat stranding with trace amount of surrounding fluid, along with amylase and lipase levels suggestive of acute pancreatitis. In the absence of classical risk factors for acute pancreatitis, a diagnosis of DIP secondary to MMI use was made. Withdrawal of the drug from her medication regimen was accompanied by relief of symptoms and resolution of clinical evidence of pancreatitis. The aim of this paper is to report only the fourth case of MMI-induced pancreatitis in the published literature, and to illustrate the significance of an appropriate and timely diagnosis of DIP.
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Affiliation(s)
- Albin Abraham
- Department of Internal Medicine, Nassau University Medical Center, East Meadow, N.Y
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De Socio GV, Vispi M, Fischer MJ, Baldelli F. A giant pancreatic pseudocyst in a patient with HIV infection. ACTA ACUST UNITED AC 2012; 11:227-9. [PMID: 22553316 DOI: 10.1177/1545109712444164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This article describes the first case of a giant pancreatic pseudocyst in a 48-year-old man with HIV infection under combination antiretroviral therapy. The patient presented with an abdominal mass involving the epigastrium, left hypochondrium, and left flank. An enhanced abdominal computed tomography (CT) scan showed a well-defined cyst of 21 cm in diameter, with a liquid content that dislocated adjacent viscera. Microbiological and cytological tests on fluid were negative, confirming diagnosis of pancreatic pseudocyst. The CT-guided percutaneous drainage was carried out and the patient's clinical condition gradually improved.
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Affiliation(s)
- Giuseppe Vittorio De Socio
- 1Department of Infectious Diseases, "Santa Maria della Misericordia" Hospital, University of Perugia, Italy
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