Ernesto Robalino Gonzaga, MD1, Saif Borgan, MD1, Kirolus Sourial, MD2, Vishwas Vanar, MD2
1University of Central Florida College of Medicine, Kissimmee, FL; 2University of Central Florida College of Medicine, Orlando, FL
Introduction: Acute pancreatitis is a common condition in the US, with high mortality and burden on the health care system. In the US, it is one of the main causes of gastrointestinal related admissions with more than 291,000 hospitalization per year. The most common causes are alcohol use (30%) and gallstones (40%). Less frequently, drug induced. Interestingly, drug induced pancreatitis has excellent prognosis and low mortality. The mechanisms of drug induced pancreatitis include immunologic reactions, direct toxic effect, accumulation of toxic metabolites, ischemia, and intravascular thrombosis.
Case Description/Methods: A 78 year old woman with surgical history of cholecystectomy presented to the emergency room with a sudden onset of sharp epigastric pain radiating to the back, that was associated with vomiting, 60 minutes after taking Eluxadoline for the first time. She had a history of hypertension, diabetes mellitus, and irritable bowel syndrome with diarrhea (IBS-D) for which Eluxadoline was prescribed. On exam, she was hemodynamically stable and had epigastric tenderness without rebound. Laboratory tests remarkable for elevated lipase, 2754 U/L. Based on the Revised Atlanta criteria, patient had mild pancreatitis. A computed tomography of the abdomen and pelvis was unremarkable without biliary pathology. She was admitted for acute pancreatitis presumed secondary to Eluxadoline ingestion. The patient was treated conservatively and Eluxadoline was discontinued. Five hours later, her lipase was 68 U/L and symptoms resolved. She was advised to discontinue Eluxadoline and discharged home.
Discussion: The diagnosis of drug induced pancreatitis requires first the diagnosis of acute pancreatitis based on symptoms, biomarkers or imaging. Common causes, such as alcohol use and gallstones, must be ruled out. A medication review should be conducted to look for potential culprits. Any medication of suspect should be discontinued and resolution of pancreatitis should be appreciated.
Eluxadoline is used in treatment of IBS-D. It reduces abdominal pain and lessens diarrhea frequency, but has been noted to be associated with acute pancreatitis in 82% of patients who has previously underwent cholecystectomy. It is thought to be due to spasms in the sphincter of oddi, leading to pancreatic duct hypertension. The FDA has suggested to avoid the use of this medication in these cases. Careful attention should be made to the potential adverse events, especially acute pancreatitis, in those patients on Eluxadoline.
Citation: Ernesto Robalino Gonzaga, MD; Saif Borgan, MD; Kirolus Sourial, MD; Vishwas Vanar, MD. P0068 - ABRUPT ONSET OF ACUTE PANCREATITIS FOLLOWING THE INGESTION OF ELUXADOLINE. Program No. P0068. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.