Miguel Salazar, MD1, Jodie A. Barkin, MD2, James S. Ramey, MD3, Rudolf Kumapley, MD4, Isaac Paintsil, MBChB, MPH1, Jamie S. Barkin, MD, MACG2, C. Roberto Simons-Linares, MD, MSc5
1John H. Stroger, Jr. Hospital of Cook County, Chicago, IL; 2University of Miami Miller School of Medicine, Miami, FL; 3Baylor College of Medicine, Houston, TX; 4Cook County Health and Hospital Systems, Chicago, IL; 5Cleveland Clinic, Cleveland, OH
Introduction: Cannabis remains the most widely and commonly used substance in the world. There is conflicting data regarding its effects on Acute Pancreatitis. Aim with this study is to investigate the clinical effects of cannabis use and to compare outcomes in cannabis users (CU) vs. non-cannabis users according to acute pancreatitis severity.
Methods: Retrospective design study was conducted on a cohort of patients admitted with acute pancreatitis between January 2012 to April 2018 at a large tertiary hospital in Chicago, IL. Cannabis users were identified via recorded history, urine toxicology or both. Patients who were over 18 years of age at the time of the study and had an episode of acute pancreatitis were included, patients who were pregnant were excluded. Severity of acute pancreatitis was assessed using the revised Atlanta Classification for acute pancreatitis. Multivariate logistic regression model was constructed using STAT software version 13 (STATA Corp LLC, College Station, Texas USA).
Results: Five hundred nineteen patients were included, from which 107 (21%) were CU. 65 (61%) had mild acute pancreatitis and 42 (39%) had moderate or severe pancreatitis. Mild acute pancreatitis outcomes: CU were more likely to have AKI (aOR 5.7, p< 0.001), to come back to the ED for recurrent acute pancreatitis after discharge (aOR 2.77, p=0.004), more likely to require re-hospitalization (aOR 2.43, p=0.006). Moderate or Severe acute pancreatitis outcomes: CU were more likely to have AKI (aOR 1.8, p=0.017) and less likely to have necrosis or any pancreatic fluid collection (aOR 0.15, p=0.018), to require debridement (aOR 0.45, p=0.037), to have bacteremia (aOR 0.27, p=0.066).
Discussion: This is one of the largest studies investigating the clinical effects of cannabis in patients with AP. We found significant difference in AP outcomes according to the severity. CU had higher incidence of AKI either during a mild or moderate/severe pancreatitis attack and were more likely to have recurrent pancreatitis that requires ED visit or re-hospitalization. Interestingly, CU were less likely to have pancreatic necrosis, fluid collection, and bacteremia. Further prospective studies are needed to investigate the acute and long-term factors of cannabis consumption and its impact on AP course and outcomes.
Citation: Miguel Salazar, MD; Jodie A. Barkin, MD; James S. Ramey, MD; Rudolf Kumapley, MD; Isaac Paintsil, MBChB, MPH; Jamie S. Barkin, MD, MACG; C. Roberto Simons-Linares, MD, MSc. P0013 - COMPARISON AND OUTCOMES OF CANNABIS USERS WITH ACUTE PANCREATITIS ACCORDING TO SEVERITY USING THE REVISED ATLANTA CLASSIFICATION OF ACUTE PANCREATITIS. Program No. P0013. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.