Mar 16, 2014 acute pancreatitis, with an incidence between 0. A woman who developed acute pancreatitis following ingestion of low dose codeine, with positive rechallenge, is described. Its incidence varies among different studies between 0. Dec 17, 2014 alcoholic pancreatitis is more common in individuals who have a long history of alcohol abuse. Drug induced acute pancreatitis was first reported in the 1950s and the list of potential drug associations with acute pancreatitis has increased every year. Drugs and drug classes associated with acute pancreatitis are summarized in table 2. Among 16 patients treated for acute pancreatitis in 1993, drug induced acute pancreatitis was diagnosed in 22 patients incidence 1. The medications have been classified into four subgroups classes iiv depending upon the propensity of the cases discussed in the literature, interval time period between drug initiation to pancreatitis, and reaction to the drug with reintroduction. Less convincing, but suggestive evidence exists for. Researchers have also used latency to classify the potential mechanisms of diap 5. The majority of cases are mild which may contribute to underreporting. The diagnosis of druginduced pancreatitis is often challenging because there are no unique clinical characteristics to distinguish drugs from other causes of pancreatitis.
It is hypothesized that direct immunological effects are usually observed within the first month of drug exposure, whereas toxic effects are noted after a few months of treatment. Druginduced pancreatitis article about druginduced. The aim of our study was to provide updated diap classes considering the updated definition of acute pancreatitis ap and in light of new medications and new case reports. Only a minority of cases associated with acute pancreatitis are linked to drugs and clinical presentation and mechanisms of injury to the pancreas are not well understood or controversial. A number of drugs used to treat medical conditions can trigger acute pancreatitis. Sodium valproate induced acute pancreatitis in a bipolar. Druginduceddruginduced pancreatitispancreatitis christi rileychristi riley pharm. When a patient took 2 or more drugs, each drug was identified as a. Acute pancreatitis affects about 50,000 80,000 americans each year. Druginduced pancreatitis christi riley linkedin slideshare. Druginduced acute pancreatitis diap is a rare gastrointestinal condition but wellknown in the medical literature. Druginduced pancreatitis druginduced pancreatitis nitsche, claudia.
The knowledge of drugs commonly linked to acute pancreatitis table 3 may lead to earlier suspicion of the diagnosis of dip and to more quickly discontinue drug administration in patients where a cause of ap cannot be found. The reported 47 cases of drug induced pancreatitis account for approximately 0. This free and comprehensive source contains chapters written by. The diagnosis of drug induced pancreatitis is often challenging because there are no unique clinical characteristics to distinguish drugs from other causes of pancreatitis. Drugs held responsible were azathioprine, mesalazinesulfasalazine, 2,3dideoxyinosine ddi, oestrogens, frusemide.
Gallstones gallstones including microlithiasis are the most common cause of acute pancreatitis accounting for 40 to 70 percent of cases 14. Objectives the aim of this study was to analyze causes of druginduced acute pancreatitis diap in korea and factors associated with serious diap. Drug induced pancreatitis dip is considered a rare cause of pancreatitis with reports of around 0. Druginduced acute pancreatitis related to medications commonly. Oct 26, 2012 few data exist about the incidence of drug induced pancreatitis in the general population.
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. A retrospective study conducted in germany concluded that the incidence of drug induced ap is 1. Druginduced pancreatitis is less prevalent compared to other causes of acute pancreatitis, the incidence ranges between 0. Etiologies that were ruled out in this case comprise all possible causes of pancreatitis. Drug induced acute pancreatitis diap is a rare gastrointestinal condition but wellknown in the medical literature. Knowing which agents are the likely culprits improves management. Druginduced acute pancreatitis dip is generally considered to be a rare disease. Druginduced acute pancreatitis diap is a rare entity that is often challenging for clinicians.
Drug induced ap is rare but should not be overlooked in a patient who presents with idiopathic ap. Register with us for free to save searches, favorite articles and access email content alerts. Sep 15, 2019 in most cases, acute pancreatitis is caused by gallstones or heavy alcohol use. Pankreas sendiri adalah suatu kelenjar besar yang letaknya dekat dengan duodenum dan mengeluarkan hormon insulin dan glucagon. Hydrolysis of tg by pancreatic lipase, excessive formation of free fatty. The knowledge of drug induced acute pancreatitis is limited by the. Pdf on oct 31, 2017, yeon suk kim and others published drug induced acute pancreatitis find, read and cite all the research you need on researchgate. Typically, drug induced pancreatitis is considered if a patient has pancreatitis without an obvious cause. Aug 26, 2019 pancreatitis caused by heavy drinking is likely to come back if drinking continues.
Accurate diagnosis is an important step to prevent recurrence and decrease mortality due to acute pancreatitis. The pathogenesis of nsaidassociated pancreatitis is likely to be prostaglandinmediated because animal experiments suggest a protective role of prostaglandins on pancreatic cells. Out of 47 cases as many as 31 different drugs were found to be associated with druginduced pancreatitis. Acute pancreatitis is usually treated with intravenous fluids, pain medication, and sometimes antibiotics. The elderly may be especially susceptible to drug induced pancreatitis due to polypharmacotherapy and mixed drug interactions nitsche et al, 2010. The majority of cases are mild, but severe and even fatal cases may occur, thus making identification of the offending agent critical. Diagnosis of acute pancreatitis is based on a threefold increase in the blood of either amylase or lipase. Drugs are thought to be a rare cause for acute pancreatitis. Background the majority of druginduced pancreatitis cases are mild to moderate in severity, but severe and even fatal cases can occur. Acute pancreatitis is a sudden inflammatory process of the pancreas that may also involve peripancreatic tissues or remote organ systems 1. Due to a variable latent period between the initial drug exposure and the onset of clinical symptoms, drug induced pancreatitis must remain as a differential diagnosis in patients receiving chemotherapy regimens and presenting with the constellation of symptoms typical of acute pancreatitis. When evaluating potential drug induced pancreatitis, first check to make sure a more common cause such as alcohol useabuse, gallstones, hypertriglyceridemia, or a history of recent ercp is not present. Adam malik medan pendahuluan pankreatitis akut adalah proses peradangan pada pancreas. Out of 47 cases as many as 31 different drugs were found to be associated with drug induced pancreatitis.
The majority of druginduced pancreatitis cases are mild to moderate in severity. Acute pancreatitis was frequently reported in men 58. Association of oral glucocorticoid use with an increased risk of acute pancreatitis. Druginduced acute pancreatitis confirmed by positive rechallenge. Candidate 2009 october 16, 2008october 16, 2008 university of kentucky college of pharmacyuniversity of kentucky college of pharmacy 2. Other causes are usually due to medications and, very rarely, infections, trauma or. A medline search 19502018 of the english language literature was. Typically, druginduced pancreatitis is considered if a patient has pancreatitis without an obvious cause. Although we know that activation of trypsin can lead to pancreatic. Nsaids, can be attributable to the majority of cases reported. A retrospective study conducted in germany concluded that the incidence of druginduced ap is 1. First updated edition of the bibliographic database of acute pancreatitis and related drugs biour m, delcenserie r, grange jd, weissenburger j. To determine the incidence and severity of drug induced acute pancreatitis, data from 45 german centres of gastroenterology were evaluated. Medical imaging such as ultrasound and ct scan may also be useful.
The proposed mechanisms of action of valproic acidinduced acute pancreatitis are a direct toxic effect of free radicals on the. Drugs held responsible were azathioprine, mesalazinesulfasalazine, 2,3dideoxyinosine ddi, oestrogens. The mechanism by which the passage of gallstones induces pancreatitis is unknown. Cureus nonsteroidal antiinflammatory druginduced acute. It is a condition that arises suddenly and may be quite severe, although patients usually have a complet e recovery from an acute attack. List of chronic pancreatitis medications 10 compared. Hereby, we present a case of bipolar disorder with sodium valproateinduced acute pancreatitis.
However, only 3 to 7 percent of patients with gallstones develop pancreatitis 15,16. Due to a variable latent period between the initial drug exposure and the onset of clinical symptoms, druginduced pancreatitis must remain as a differential diagnosis in patients receiving chemotherapy regimens and presenting with the constellation of symptoms typical of acute pancreatitis. As this is the first case report of pancreatitis being induced solely by codeine, this side effect must be rare in view of the widespread consumption of this drug. Management of drug induced pancreatitis requires withdrawal of the offending agent and supportive care. Ibuprofeninduced acute pancreatitis, a diagnosis secondary to the use of nonsteroidal antiinflammatory drugs nsaids, is an extremely rare occurrence. Few cases have been reported so far, mainly on the pediatric patients who underwent antiepileptic treatment. It is associated with over 210,000 hospital admissions per year in the united states and the annual incidence of acute pancreatitis ranges from 5 to 80 cases per 100,000 persons, making it one of the most common gastroenterological conditions 2,3. Background the majority of drug induced pancreatitis cases are mild to moderate in severity, but severe and even fatal cases can occur. Among several hundreds of drugs reported as causative for druginduced pancreatitis, only a few have a sufficiently strong evidence base to be clearly associated with this rare adverse drug reaction. Druginduced pancreatitis 3 definite drug reaction a reasonable temporal sequence from administration of the drug b follows a known response pattern that is c confirmed by cessation of the drug dechallenge d confirmed by reappearance of the symptoms upon repeated exposure to the drug rechallenge probable drug reaction. The diagnosis of druginduced acute pancreatitis often is difficult to establish. The proportion of cases of pancreatitis caused by drugs is estimated to be around 2% in the general population, with much higher proportions in specific subpopulations, such as children and patients who are hiv.
Drug induced pancreatitis is less prevalent compared to other causes of acute pancreatitis, the incidence ranges between 0. Over time, permanent damage may be done to the pancreas. The chart showing pdf series, word series, html series, scan qr codes. The proposed mechanisms of action of valproic acidinduced acute pancreatitis are a direct toxic effect of free radicals on the pancreatic tissue and a depletion of superoxide dismutase, catalase, and glutathione peroxidase. Sodium valproate is one of the most widely used antiepileptics and mood stabilizers. Underreporting of druginduced pancreatitis dip is often a result of a low index of suspicion, mild cases with unrecognized subclinical enzyme elevations, missing the time frame for drugrelated exposures, and erroneous classification.
Most of the cases were reported in the last decade of the reporting period. Druginduced pancreatitis, current gastroenterology reports. Research shows that excessive alcohol use over several years typically leads to the first case of acute, alcoholinduced pancreatitis. Published case reports of drug induced ap exist for at least 40 drugs of the top 200 most prescribed medications.
Ibuprofen induced acute pancreatitis, a diagnosis secondary to the use of nonsteroidal antiinflammatory drugs nsaids, is an extremely rare occurrence. The true incidence is not entirely clear since only few systematic population based studies exist. Chronic pancreatitis involves persistent inflammation of the pancreas an elongated, tapered gland that is located behind the stomach and secretes digestive enzymes and the hormones insulin and glucagon. Druginduced ap is rare but should not be overlooked in a patient who presents with idiopathic ap. Pancreatitis is an uncommon disease characterized by inflammation of the pancreas. The elderly may be especially susceptible to druginduced pancreatitis due to polypharmacotherapy and mixed drug interactions nitsche et al, 2010. It is a condition that arises suddenly and may be quite severe, although patients usually have a. The following list of medications are in some way related to, or used in the treatment of this condition. One speculative mechanism of metronidazoleinduced pancreatitis is that under aerobic conditions, it may undergo redox cycling and yield hydrogen peroxide, superoxide, and other free radicals, which can be toxic to pancreatic beta cells and induce pancreatitis. Drug induced acute pancreatitis juwita sembiring, reny fahila divisi gastroentero hepatologi departemen ilmu penyakit dalam fkusu rsup h.
Druginduced pancreatitis definition of druginduced. The diagnosis of drug induced acute pancreatitis often is difficult to establish. Feb 08, 2012 drug induced pancreatitis drug induced pancreatitis nitsche, claudia. Alcohol and pancreatitis alcoholinduced pancreatitis. Drugs commonly associated with druginduced pancreatitis. A national survey performed in japan in 1999 reported that 1. Although chronic pancreatitis is an incurable condition, the severity, frequency, and type of symptoms can vary. The proportion of cases of pancreatitis caused by drugs is estimated to be around 2% in the general population, with much higher proportions in specific subpopulations, such as children and patients.
Since that time, there have been reports of pancreatitis occurring in association with at least 25 different drugs. Many of them are widely used to treat highly prevalent diseases. Sep 15, 2019 people with acute pancreatitis are typically treated with iv fluids and pain medications in the hospital. The majority of cases are mild, but severe and even fatal cases may occur, thus making identification of. Druginduced pancreatitis is a rare but severe adverse drug reaction with an incidence of. In 1959, johnston and cornish reported 4 patients with acute pancreatitis associated with thiazide therapy. Methods for the early detection of druginduced pancreatitis. Drug induced pancreatitis is a rare entity and difficult to diagnose. There is no one main mechanism behind druginduced acute pancreatitis, but several potential mechanisms are currently based on theories. When evaluating potential druginduced pancreatitis, first check to make sure a more common cause such as alcohol useabuse, gallstones, hypertriglyceridemia, or a history of recent ercp is not present. Objectives the aim of this study was to analyze causes of drug induced acute pancreatitis diap in korea and factors associated with serious diap. Few data exist about the incidence of druginduced pancreatitis in the general population. Drug induced pancreatitis 3 definite drug reaction a reasonable temporal sequence from administration of the drug b follows a known response pattern that is c confirmed by cessation of the drug dechallenge d confirmed by reappearance of the symptoms upon repeated exposure to the drug rechallenge probable drug reaction. The ability of dmas to provide meaningful signals of drug.
1057 1427 551 328 102 1138 1393 1116 1251 1161 875 580 732 1437 617 1037 71 1508 107 1239 738 278 1307 1282 972 1387 942 1238 467 248 7 143 372 49 24 880