1
|
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
| |
Collapse
|
2
|
Massironi S, Fanetti I, Viganò C, Pirola L, Fichera M, Cristoferi L, Capurso G, Invernizzi P, Danese S. Systematic review-pancreatic involvement in inflammatory bowel disease. Aliment Pharmacol Ther 2022; 55:1478-1491. [PMID: 35505465 PMCID: PMC9322673 DOI: 10.1111/apt.16949] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/28/2022] [Accepted: 04/18/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is a chronic inflammatory immune-mediated disorder of the gut with frequent extra-intestinal complications. Pancreatic involvement in IBD is not uncommon and comprises a heterogeneous group of conditions, including acute pancreatitis (AP), chronic pancreatitis (CP), autoimmune pancreatitis (AIP) and pancreatic exocrine insufficiency (PEI); however, data on such an association remain sparse and heterogeneous. METHOD PubMed/MEDLINE and EMBASE databases were searched for studies investigating pancreatic involvement in patients with IBD. RESULTS Four thousand one hundred and twenty-one records were identified and 547 screened; finally, 124 studies were included in the review. AP is the most frequent pancreatic manifestation in IBD; the majority of AP cases in IBD are due to gallstones and drugs but cases of idiopathic AP are increasingly reported. AIP is a rare disease, but a strong association with IBD has been demonstrated, especially for type 2 and ulcerative colitis. The pathogenetic link between IBD and AIP remains unclear, but an immune-mediated pathway seems plausible. An association between CP and PEI with IBD has also been suggested, but data are to date scarce and conflicting. CONCLUSION This is the first systematic review of the association between IBD and pancreatic diseases. Gallstones and drugs should be considered the most probable causes of AP in IBD, with type 2 AIP also being possible.
Collapse
Affiliation(s)
- Sara Massironi
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, European Reference Network on Hepatological Diseases (ERN RARE‐LIVER)San Gerardo HospitalMonzaItaly
| | - Ilaria Fanetti
- Gastroenterology and Endoscopy Unit, ASST Ovest MilaneseLegnano HospitalLegnanoItaly
| | - Chiara Viganò
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, European Reference Network on Hepatological Diseases (ERN RARE‐LIVER)San Gerardo HospitalMonzaItaly
| | - Lorena Pirola
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, European Reference Network on Hepatological Diseases (ERN RARE‐LIVER)San Gerardo HospitalMonzaItaly
| | - Maria Fichera
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, European Reference Network on Hepatological Diseases (ERN RARE‐LIVER)San Gerardo HospitalMonzaItaly
| | - Laura Cristoferi
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, European Reference Network on Hepatological Diseases (ERN RARE‐LIVER)San Gerardo HospitalMonzaItaly
| | - Gabriele Capurso
- Pancreas Translational & Clinical Research Center, Pancreato‐Biliary Endoscopy & Endosonography DivisionSan Raffaele Scientific Institute IRCCSMilanItaly
| | - Pietro Invernizzi
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, European Reference Network on Hepatological Diseases (ERN RARE‐LIVER)San Gerardo HospitalMonzaItaly
| | - Silvio Danese
- Gastroenterology and EndoscopyIRCCS Ospedale San Raffaele and Vita‐Salute San Raffaele UniversityMilanItaly
| |
Collapse
|
3
|
Mehershahi S, Haider A, Shaikh D, Abbas H, Ihimoyan A. Drug-Induced Acute Pancreatitis After Long-Term Sulfasalazine Therapy. Cureus 2020; 12:e10441. [PMID: 33072451 PMCID: PMC7557114 DOI: 10.7759/cureus.10441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/14/2020] [Indexed: 11/15/2022] Open
Abstract
The list of drugs associated with acute pancreatitis is increasing with each passing year. Nevertheless, knowledge of drug-induced pancreatitis (DIP) are often curtailed by the limited availability of evidence needed to implicate given agents, especially for non-prescription medications. Indeed, the majority of available data are derived from case reports, case series, or case-control studies. We present a case chemically and radiologically proven pancreatitis in a 43-year-old female who was on sulfasalazine as a maintenance therapy for ulcerative colitis.
Collapse
Affiliation(s)
| | - Asim Haider
- Internal Medicine, BronxCare Health System, Bronx, USA
| | - Danial Shaikh
- Medicine/Gastroenterology, BronxCare Health System, Bronx, USA
- Internal Medicine, BronxCare Health System, Bronx, USA
| | - Hafsa Abbas
- Gastroenterology, BronxCare Health System, Bronx, USA
| | | |
Collapse
|
4
|
Weissman S, Aziz M, Perumpail RB, Mehta TI, Patel R, Tabibian JH. Ever-increasing diversity of drug-induced pancreatitis. World J Gastroenterol 2020; 26:2902-2915. [PMID: 32587438 PMCID: PMC7304112 DOI: 10.3748/wjg.v26.i22.2902] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/27/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023] Open
Abstract
With over 100000 hospital admissions per annum, acute pancreatitis remains the leading gastrointestinal cause of hospitalization in the United States and has far-reaching impact well beyond. It has become increasingly recognized that drug-induced pancreatitis (DIP), despite accounting for less than 3% of all cases, represents an important and growing though often inconspicuous cause of acute pancreatitis. Nevertheless, knowledge of DIP is often curtailed by the limited availability of evidence needed to implicate given agents, especially for non-prescription medications. Indeed, the majority of available data is derived from case reports, case series, or case control studies. Furthermore, the mechanism of injury and causality for many of these drugs remain elusive as a definitive correlation is generally not established (< 10% of cases). Several classification systems have been proposed, but no single system has been widely adopted, and periodic updates are required in light of ongoing pharmacologic expansion. Moreover, infrequently prescribed medications or those available over-the-counter (including herbal and other alternative remedies) are often overlooked as a potential culprit of acute pancreatitis. Herein, we review the ever-increasing diversity of DIP and the potential mechanisms of injury with the goal of raising awareness regarding the nature and magnitude of this entity. We believe this manuscript will aid in increasing both primary and secondary prevention of DIP, thus ultimately facilitating more expedient diagnosis and a decrease in DIP-related morbidity.
Collapse
Affiliation(s)
- Simcha Weissman
- Department of Medicine, Hackensack University-Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Muhammad Aziz
- Department of Medicine, University of Toledo Medical Center, Toledo, OH 43614, United States
| | - Ryan B Perumpail
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
| | - Tej I Mehta
- Department of Interventional Radiology, Johns Hopkins University Hospital, Baltimore, MD 21205, United States
| | - Rutwik Patel
- Department of Medicine, Hackensack University-Palisades Medical Center, North Bergen, NJ 07047, United States
| | - James H Tabibian
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA 91342 and David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
| |
Collapse
|
5
|
Akhmedov VA, Gaus OV. [Pancreatic diseases and inflammatory bowel diseases: a random or regular combination?]. TERAPEVT ARKH 2020; 92:76-81. [PMID: 32598667 DOI: 10.26442/00403660.2020.01.000463] [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: 04/16/2020] [Indexed: 11/22/2022]
Abstract
Pathology of the pancreas in inflammatory bowel disease (IBD) is more common than in the general population and includes a wide range of manifestations from asymptomatic to severe disorders. Acute pancreatitis, chronic pancreatitis, autoimmune pancreatitis, exocrine pancreatic insufficiency, increased pancreatic enzymes and structural duct anomalies are often associated with IBD. They can be either a manifestation of IBD itself or develop independently.
Collapse
|
6
|
Abstract
OBJECTIVES This study aimed to compare the clinical course of 5-aminosalicylic acid-derived, drug-induced acute pancreatitis (5-ASA-DIAP) to acute pancreatitis (AP) caused by other etiologies. METHODS A cohort of patients with 5-ASA-DIAP was established through literature search. As a control AP (CAP) group, a cohort was generated from a registry. Data on the diagnostic procedure, symptoms, enzyme elevation, imaging, severity, and recovery parameters were collected. Causality was assessed using the Naranjo algorithm. RESULTS Twenty-nine articles were included, which describe 36 patients with fifty-one 5-ASA-DIAP episodes (60.78% female, 39.22% male). There were 88.2% mild, 3.92% moderate, and 7.84% severe cases of AP in the 5-ASA-DIAP group, and 70.6%, 25.5%, and 3.92% such cases in the CAP population, respectively. Symptoms improved significantly faster (mean ± SE, 2.5 ± 0.34 vs 3.74 ± 0.42 days; P = 0.018); however, pancreatic enzyme levels normalized significantly more slowly (6.27 ± 1.53 vs 3.63 ± 0.61 days, P = 0.008) in the 5-ASA-DIAP cohort compared with the CAP group. This study confirms that there are no diagnostic differences between 5-ASA-DIAP and AP of other etiologies. CONCLUSIONS Fewer moderate but more severe cases were found in the 5-ASA-DIAP group; therefore, 5-ASA-DIAP must be taken as seriously as AP of other etiologies.
Collapse
|
7
|
Fousekis FS, Theopistos VI, Katsanos KH, Christodoulou DK. Pancreatic Involvement in Inflammatory Bowel Disease: A Review. J Clin Med Res 2018; 10:743-751. [PMID: 30214645 PMCID: PMC6135003 DOI: 10.14740/jocmr3561w] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/21/2018] [Indexed: 02/07/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a multisystemic disease, and pancreatic manifestations of IBD are not uncommon. The incidence of several pancreatic diseases in Crohn’s disease and ulcerative colitis is more frequent compared to the general population. Pancreatic manifestations in IBD include a wide heterogenic group of disorders and abnormalities of the pancreas and range from mild self-limited diseases to severe disorders. Acute pancreatitis, chronic pancreatitis, autoimmune pancreatitis, pancreatic autoantibodies, exocrine pancreatic insufficiency and asymptomatic imaging and laboratory abnormalities are included in related-IBD pancreatic manifestations. Involvement of the pancreas in IBD may be the result of IBD itself or of medications used.
Collapse
Affiliation(s)
- Fotios S Fousekis
- Department of Gastroenterology and Hepatology, Medical School of Ioannina, Greece
| | | | | | | |
Collapse
|
8
|
Abstract
Inflammatory bowel disease (IBD) has been increasingly diagnosed in children and adults. Similarly, acute and chronic pancreatitis are increasingly prevalent conditions with potentially devastating consequences. There is a growing body of literature linking these 2 conditions. The purpose of this review is to provide a comprehensive outline of the association between IBD and pancreatitis and to explore their putative pathophysiology. Based on the collective reports, 2 outstanding reasons for pancreatitis in patients with IBD are medications and IBD complications.
Collapse
|
9
|
Kim JH, Lee JH, Koh ES, Park SW, Jang AS, Kim D, Park CS. Acute eosinophilic pneumonia related to a mesalazine suppository. Asia Pac Allergy 2013; 3:136-9. [PMID: 23667838 PMCID: PMC3643058 DOI: 10.5415/apallergy.2013.3.2.136] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 02/24/2013] [Indexed: 12/13/2022] Open
Abstract
It has been well known that mesalazine can cause the interstitial lung disease, such as Bronchiolitis obliterans with organizing pneumonia (BOOP), Non-Specific Interstitial Pneumonia (NSIP), or eosinophilic pneumonia. 5-Aminosalicylic acid (5-ASA), mesalazine, and sulfasalazine are important drugs for treating inflammatory bowel disease. Topical products of these limited systemic absorption and have less frequent side effects, therefore suppository form of these drugs have been used more than systemic drug. Most cases of measalzine-induced lung toxicity develop from systemic use of the drug. A 30-year-old woman had an interstitial lung disease after using mesalazine suppository because of ulcerative colitis. The lung biopsy demonstrated eosinophilic pneumonia combined with BOOP. She was recovered after stopping of mesalazine suppository and treatment with systemic steroid.
Collapse
Affiliation(s)
- Jung Hyun Kim
- Division of Respiratory and Allergy, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 420-767, Korea
| | | | | | | | | | | | | |
Collapse
|
10
|
|
11
|
Ksiądzyna D. Drug-induced acute pancreatitis related to medications commonly used in gastroenterology. Eur J Intern Med 2011; 22:20-5. [PMID: 21238888 DOI: 10.1016/j.ejim.2010.09.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 08/18/2010] [Accepted: 09/07/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND With the growing number of pharmacological agents available nowadays, the gastrointestinal drug-induced side effects become more common than ever. However, drug-induced pancreatitis belongs to rather seldom reported adverse drug reactions, probably because of the difficulty in proving the relationship between an inflammation of the pancreas and the pharmacotherapy with a certain drug. AIM The aim of this review is to draw attention to an infrequent but real problem of drug-induced acute pancreatitis associated with medications commonly used in the treatment of gastrointestinal disorders. METHODOLOGY For the purpose of that the PubMed database was searched using the keywords "drug-induced pancreatitis", "drug-associated pancreatitis", "acute pancreatitis", "pancreatitis" in various combinations and relevant literature was reviewed. RESULTS A substantial number of drugs commonly prescribed for gastrointestinal disorders are known to cause acute pancreatitis. Case reports and review articles published so far draw attention to medications already known to cause drug-induced pancreatic damage as well as implicate new drugs. Generally, the etiopathological mechanisms involved in drug-induced pancreatitis remain unclear. It is difficult to establish or rule out definitely such unwanted event, especially in patients taking numerous medications prescribed for multiple comorbidities. CONCLUSION Pharmacological agents are among etiologic factors that should be considered in all patients presenting with signs and symptoms consistent with acute pancreatitis. The diagnosis of drug-induced AP is often difficult to established. Therefore a high index of suspicion and thorough drug history are crucial for making the final diagnosis.
Collapse
Affiliation(s)
- Dorota Ksiądzyna
- Silesian Piasts Medical University, Department of Pharmacology, Wrocław, Poland.
| |
Collapse
|
12
|
Abstract
Crohn's disease and ulcerative colitis, together popularly known as inflammatory bowel disease (IBD), are characterized by a number of extraintestinal manifestations. Although infrequent, acute pancreatitis, and less often chronic pancreatitis, may occur as a result of the disease itself or secondary to the medications used in the treatment. The increased incidence of acute pancreatitis in Crohn's disease can be explained based on the high predisposition to cholesterol as well as pigment stones as a result of ileal disease, anatomic abnormalities of the duodenum, immunologic disturbances associated with IBD, and, above all, to the side effects of many medications used in the treatment. Sulfasalazine, 5-aminosalicylic acid, azathioprine, and 6-mercaptopurine are well known to cause acute pancreatitis as a result of a possible idiosyncratic mechanism. Crohn's disease and ulcerative colitis share many clinical manifestations and treatment modalities. Nonspecific elevations of serum pancreatic enzymes in IBD make it difficult to avoid over diagnosis of acute pancreatitis, particularly in patients with Crohn's disease who suffer from abdominal pain often. The IBD-pancreas association is further reflected in many reports of exocrine as well as endocrine pancreatic insufficiency.
Collapse
|
13
|
Fernandez-Becker NQ, Moss AC. Improving delivery of aminosalicylates in ulcerative colitis: effect on patient outcomes. Drugs 2008; 68:1089-103. [PMID: 18484800 DOI: 10.2165/00003495-200868080-00006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Developments in drug delivery technology have expanded the formulations of 5-aminosalicylic acid (5-ASA) available to clinicians over the last 50 years. Delivery of adequate doses of 5-ASA to the colon can be achieved by pH-dependent, delayed-release or pro-drug formulations. Despite some variations in the pharmacokinetics between individual preparations, the clinical effects in induction of response and maintenance of remission in ulcerative colitis appear to be consistent. Direct comparison studies between different preparations have yielded similar results in primary endpoints, although differences in secondary endpoints or post hoc analyses have been noted. The development of delivery methods that allow once-daily administration represents a potential means to improve the low medication adherence rates reported in patients with ulcerative colitis.
Collapse
|
14
|
Bermejo F, Lopez-Sanroman A, Taxonera C, Gisbert JP, Pérez-Calle JL, Vera I, Menchén L, Martín-Arranz MD, Opio V, Carneros JA, Van-Domselaar M, Mendoza JL, Luna M, López P, Calvo M, Algaba A. Acute pancreatitis in inflammatory bowel disease, with special reference to azathioprine-induced pancreatitis. Aliment Pharmacol Ther 2008; 28:623-8. [PMID: 18513380 DOI: 10.1111/j.1365-2036.2008.03746.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pancreatitis is a potentially severe condition. Patients with inflammatory bowel disease (IBD) seem to be at increased risk for acute pancreatitis. AIM To describe the incidence, main causes and possible predictive factors of acute pancreatitis in inflammatory bowel disease. METHODS Information was retrospectively extracted from the clinical records of patients followed in the IBD Units of nine hospitals in Madrid (n = 5073). RESULTS A total of 82 acute pancreatitis episodes were diagnosed (cumulative incidence, 1.6%); 98% of them were mild. Recurrent acute pancreatitis developed in 13% of patients. Most cases of acute pancreatitis (63.4%) were attributed to drug exposure [azathioprine/mercaptopurine (AZA/MP) n = 46, mesalazine (mesalamine) n = 6]; 20.7% were idiopathic, and 12.2% were biliary. Incidence of acute pancreatitis in patients treated with AZA/MP was 3.1%. In patients with acute pancreatitis, female gender (OR 3.4 95% CI: 1.3-9.3; P = 0.012) and Crohn's disease (CD) (OR 5.8 95% CI: 1.6-20.6; P = 0.007) were risk factors for AZA/MP-associated acute pancreatitis, the latter also when analysed only in patients treated with AZA/MP (n = 1477) (OR 5.2 95% CI: 1.8-14; P = 0.002). CONCLUSIONS The incidence of acute pancreatitis in our IBD patients (1.6%) is similar to that previously described. Drugs, mainly AZA/MP, are the leading cause. AZA-induced acute pancreatitis is always mild. Patients with CD are at a higher risk for AZA/MP-associated acute pancreatitis. The frequency of idiopathic acute pancreatitis is higher than expected, suggesting that part of these cases could be extraintestinal manifestations of IBD.
Collapse
Affiliation(s)
- F Bermejo
- Department of Gastroenterology, Hospital Universitario de Fuenlabrada, Community of Madrid, Madrid, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Affiliation(s)
- Anil R Balani
- Division of Gastroenterology, Hepatology and Nutrition, Winthrop University Hospital, Mineola, New York 11501, USA
| | | |
Collapse
|
16
|
Badalov N, Baradarian R, Iswara K, Li J, Steinberg W, Tenner S. Drug-induced acute pancreatitis: an evidence-based review. Clin Gastroenterol Hepatol 2007; 5:648-61; quiz 644. [PMID: 17395548 DOI: 10.1016/j.cgh.2006.11.023] [Citation(s) in RCA: 346] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The diagnosis of drug-induced acute pancreatitis often is difficult to establish. Although some medications have been shown to cause acute pancreatitis with a large body of evidence, including rechallenge, some medications have been attributed as a cause of acute pancreatitis merely by a single published case report in which the investigators found no other cause. In addition, some medications reported to have caused acute pancreatitis have obvious patterns of presentation, including the time from initiation to the development of disease (latency). There also appear to be patterns in the severity of disease. After reviewing the literature, we have classified drugs that have been reported to cause acute pancreatitis based on the published weight of evidence for each agent and the pattern of clinical presentation. Based on our analysis of the level of evidence, 4 classes of drugs could be identified. Class I drugs include medications in which at least 1 case report described a recurrence of acute pancreatitis with a rechallenge with the drug. Class II drugs include drugs in which there is a consistent latency in 75% or more of the reported cases. Class III drugs include drugs that had 2 or more case reports published, but neither a rechallenge nor a consistent latency period. Class IV drugs were similar to class III drugs, but only 1 case report had been published. Our analysis allows an evidence-based approach when suspecting a drug as causing acute pancreatitis.
Collapse
Affiliation(s)
- Nison Badalov
- Division of Gastroenterology, Maimonides Medical Center, Mount Sinai School of Medicine, Brooklyn, New York 11235, USA
| | | | | | | | | | | |
Collapse
|
17
|
van Bodegraven AA, Mulder CJJ. Indications for 5-aminosalicylate in inflammatory bowel disease: is the body of evidence complete? World J Gastroenterol 2006; 12:6115-23. [PMID: 17036381 PMCID: PMC4088103 DOI: 10.3748/wjg.v12.i38.6115] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2005] [Revised: 11/28/2005] [Accepted: 02/20/2006] [Indexed: 02/06/2023] Open
Abstract
Mesalazine is a safe drug, although adverse events may be seen in a minority of patients. This applies also to pregnant women and children. The role of mesalazine in combination therapy to improve efficacy and concomitant drug pharmacokinetics, or in chemoprevention against inflammatory bowel disease (IBD)-related colonic carcinoma has not yet been completely elucidated. Therapeutic success of mesalazine may be optimized by a combination of high dose and low frequency of dosage to improve compliance. Therefore, due to its superior safety profile and pharmacokinetic characteristics, mesalazine is preferable to sulphasalazine. This paper reviews the literature concerning mechanisms of action, indications and off-label use, pharmacokinetic properties and formulations, therapeutic efficacy, compliance, paediatric indications, chemoprevention, and safety issues and adverse event profile of mesalazine treatment versus sulphasalazine. It also highlights these controversies in order to clarify the potential benefits of mesalazines in IBD therapy and evidence for its use.
Collapse
Affiliation(s)
- A A van Bodegraven
- Department of Gastroenterology, VU University medical centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
| | | |
Collapse
|
18
|
Abstract
A 34-year-old lady developed a constellation of dermatitis, fever, lymphadenopathy and hepatitis, beginning on the 17th day of a course of oral sulphasalazine for sero-negative rheumatoid arthritis. Cervical and inguinal lymph node biopsies showed the features of severe necrotising lymphadenitis, associated with erythrophagocytosis and prominent eosinophilic infiltrates, without viral inclusion bodies, suggestive of an adverse drug reaction.A week later, fulminant drug-induced hepatitis, associated with the presence of anti-nuclear autoantibodies (but not with other markers of autoimmunity), and accompanied by multi-organ failure and sepsis, supervened. She subsequently died some 5 weeks after the commencement of her drug therapy.Post-mortem examination showed evidence of massive hepatocellular necrosis, acute hypersensitivity myocarditis, focal acute tubulo-interstitial nephritis and extensive bone marrow necrosis, with no evidence of malignancy. It is thought that the clinico-pathological features and chronology of this case bore the hallmarks of the so-called "3-week sulphasalazine syndrome", a rare, but often fatal, immunoallergic reaction to sulphasalazine.
Collapse
Affiliation(s)
- G Lau
- Department of Forensic Medicine, Institute of Science and Forensic Medicine, Outram Road, Singapore 169608, Singapore
| | | | | |
Collapse
|
19
|
Herrlinger KR, Stange EF. The pancreas and inflammatory bowel diseases. INTERNATIONAL JOURNAL OF PANCREATOLOGY : OFFICIAL JOURNAL OF THE INTERNATIONAL ASSOCIATION OF PANCREATOLOGY 2000; 27:171-9. [PMID: 10952399 DOI: 10.1385/ijgc:27:3:171] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This article reviews the literature and gives an overview on prevalence and possible explanations for pancreatic involvement in inflammatory bowel diseases (IBD). IBD patients have a markedly elevated risk for developing acute pancreatitis as well as pancreatic insufficiency. Multiple potential causes for pancreatitis in IBD patients exist. In the majority of cases acute pancreatitis appears to be related to drug side effects or local structural complications rather than a true extraintestinal manifestation of IBD. Nevertheless, some cases of acute pancreatitis remain unexplained. Prevalence of chronic pancreatitis in IBD patients also seems to be relatively high. However, etiology of pancreatic duct changes and/or the occurrence of exocrine insufficiency remain unclear. In most cases chronic pancreatitis is clinically unapparent, although in some patients it may be accompanied by clinically relevant exocrine insufficiency.
Collapse
Affiliation(s)
- K R Herrlinger
- Department of Internal Medicine, Medical University of Luebeck, Germany.
| | | |
Collapse
|
20
|
Eland IA, van Puijenbroek EP, Sturkenboom MJ, Wilson JH, Stricker BH. Drug-associated acute pancreatitis: twenty-one years of spontaneous reporting in The Netherlands. Am J Gastroenterol 1999; 94:2417-22. [PMID: 10484002 DOI: 10.1111/j.1572-0241.1999.01367.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Drugs are considered a rare cause of acute pancreatitis. We conducted a descriptive study to assess which drugs have been associated with acute pancreatitis in spontaneous adverse drug reaction reports in The Netherlands. METHODS Our study is based on reports of drug-associated acute pancreatitis reported to the Netherlands Center for Monitoring of Adverse Reactions to Drugs and The Netherlands Pharmacovigilance Foundation LAREB between 1 January 1977 and 1 January 1998. We used an algorithm to validate the diagnosis and to assess the causal relationship between acute pancreatitis and use of the suspected drug. RESULTS A total of 55 cases were available for review. We excluded 11 (20.0%) reports, as we could not confirm the diagnosis of acute pancreatitis. Another 10 (18%) cases were excluded, as the causal relationship with the suspected drug was unlikely. In the remaining 34 reports, acute pancreatitis was labeled as definite in 11 (32%) and as probable in 23 (68%). The age of the patients ranged from 17 to 84 yr with a median of 41; 24 (71%) patients were female. Of the 34 cases, 27 (79%) recovered, five (15%) died, and in two (6%) the outcome is unknown. Azathioprine, cimetidine, interferon-alpha, methyldopa, metronidazole, olsalazine, and oxyphenbutazon all had a definite causal relationship with acute pancreatitis. Doxycycline, enalapril, famotidine, ibuprofen, maprotiline, mesalazine, and sulindac had a probable causal relationship with acute pancreatitis. CONCLUSIONS A variety of drugs was associated with acute pancreatitis in Dutch adverse drug reaction reports. Quantitative information about drug-induced pancreatitis is scanty. Epidemiological studies to assess the risk of drug-induced acute pancreas, therefore, are needed.
Collapse
Affiliation(s)
- I A Eland
- Department of Internal Medicine, Erasmus University Medical School, Rotterdam, The Netherlands
| | | | | | | | | |
Collapse
|
21
|
Affiliation(s)
- D J Keljo
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, USA
| | | |
Collapse
|
22
|
|
23
|
Sviri S, Gafanovich I, Kramer MR, Tsvang E, Ben-Chetrit E. Mesalamine-induced hypersensitivity pneumonitis. A case report and review of the literature. J Clin Gastroenterol 1997; 24:34-6. [PMID: 9013348 DOI: 10.1097/00004836-199701000-00007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A 49-year-old man with Crohn's disease treated with prednisone and mesalamine (5-ASA) developed worsening respiratory distress and fever. Symptoms improved after discontinuation of mesalamine. A rechallenge 3 months later caused similar pulmonary symptoms, confirming the association between the drug and the respiratory system. Mesalamine may cause hypersensitivity pneumonitis in patients with Crohn's disease.
Collapse
Affiliation(s)
- S Sviri
- Division of Medicine, Hadassah University Hospital, Jerusalem, Israel
| | | | | | | | | |
Collapse
|
24
|
Abstract
Drugs are a relatively uncommon cause of pancreatitis in adult patients, but should be considered when other reasonable causes of pancreatitis are not present. A wide variety of drugs have been reported to cause pancreatitis. Drug-induced pancreatitis is almost always acute and may be mild to fatal in severity. Definite proof that a drug causes pancreatitis requires that pancreatitis develops during treatment with the drug, that other likely causes of pancreatitis are not present, that pancreatitis resolves upon discontinuing the drug, and that pancreatitis usually recurs upon readministration of the drug. For ethical reasons, rechallenge with the suspect drug can be done only if the drug is necessary to treat a serious condition; thus this highly convincing piece of evidence relating the drug to pancreatitis may not be available. Information about drug-related pancreatitis is often not readily available, particularly for newer drugs. Clinicians should consider obtaining information directly from regulatory agencies and manufacturers as well as the literature.
Collapse
Affiliation(s)
- K E McArthur
- Department of Veterans Affairs Medical Center, University of Texas Southwestern Medical Center, Dallas, TX 75216, USA
| |
Collapse
|
25
|
|
26
|
French DL, Mauger JW. Evaluation of the physicochemical properties and dissolution characteristics of mesalamine: relevance to controlled intestinal drug delivery. Pharm Res 1993; 10:1285-90. [PMID: 8234164 DOI: 10.1023/a:1018909527659] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The physicochemical properties of mesalamine and the effect of pH and buffer concentration on the dissolution rate of pure mesalamine and mesalamine with Carbopol 974P were investigated. The aqueous solubilities at 25 and 37 degrees C were 0.844 and 1.41 mg/mL, respectively. Consistent with the observed pKa1 (2.30) and pKa2 (5.69) or mesalamine, the solubility-pH profile is increased at pH < 2.0 and pH > 5.5 and is minimized from pH 2.0 to pH 5.5. The flux data were consistent with the solubility data from pH 1.0 to pH 5.5. The flux increased and plateaued at pH values 5.5 to 7.0 and was dependent on the bulk buffer concentration. At low bulk buffer concentrations, mesalamine reduces the pH in the diffusion layer, which results in a decrease in flux. The medium with the highest buffer capacity has a greater ability to increase the surface pH and dissolution rate. The addition of Carbopol reduces the flux and the sensitivity of the dissolution rate of mesalamine to increasing bulk buffer concentration. This reduction is postulated to be due to neutralization of the basic dissolution media, gel formation, and possible drug-polymer interactions.
Collapse
Affiliation(s)
- D L French
- Department of Pharmaceutical Sciences College of Pharmacy, University of Nebraska Medical Center 68198-6025
| | | |
Collapse
|
27
|
Hautekeete ML, Bourgeois N, Potvin P, Duville L, Reynaert H, Devis G, Adler M, Klöppel G. Hypersensitivity with hepatotoxicity to mesalazine after hypersensitivity to sulfasalazine. Gastroenterology 1992; 103:1925-7. [PMID: 1360436 DOI: 10.1016/0016-5085(92)91453-b] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
A 21-year-old woman with Crohn's disease of the colon developed a skin rash after 3 weeks of treatment with sulfasalazine. Administration of sulfasalazine was discontinued. When mesalazine was instituted 1 week later, she developed a severe hypersensitivity reaction characterized by fever, diarrhea, skin rash with subsequent desquamation, marked atypical lymphocytosis, and severe hepatotoxicity. Recovery was complete. The clinical and biological features as well as liver pathology of this case bear a striking resemblance to earlier reports of hypersensitivity reaction with severe hepatotoxicity to sulfasalazine. The authors urge caution when mesalazine is given to a patient with known hypersensitivity to sulfasalazine.
Collapse
Affiliation(s)
- M L Hautekeete
- Department of Hepatogastroenterology, Free University of Brussels (Academic Hospital-VUB and Hôpital Erasme-ULB), Belgium
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Tromm A, Hüppe D, Micklefield GH, Schwegler U, May B. Acute pancreatitis complicating Crohn's disease: mere coincidence or causality? Gut 1992; 33:1289-91. [PMID: 1385273 PMCID: PMC1379504 DOI: 10.1136/gut.33.9.1289] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
An example of acute pancreatitis developing five weeks after initial treatment with 5-aminosalicylic acid (5-ASA) and methylprednisolone for severe Crohn's disease is reported in a 37 year old female patient. She had undergone cholecystectomy for gall stones some years earlier. There was no evidence of acute or chronic pancreatitis. No morphological changes of the upper gastrointestinal tract were found except for some irregularity of the main pancreatic duct and the secondary ducts on endoscopic retrograde pancreatography. Rechallenge with 5-ASA did not induce recurrent pancreatitis or changes in pancreatic enzymes. This case report supports the concept of an association between acute pancreatitis and Crohn's disease.
Collapse
Affiliation(s)
- A Tromm
- Department of Medicine, University Hospital, Bergmannsheil, Ruhr University of Bochum, Germany
| | | | | | | | | |
Collapse
|
29
|
|