Miguel Salazar, MD1, Chimezie Mbachi, MD1, Mohamed A. Elkhouly, MD, MSc2, Madhu Mathew, MD1, Rudolf Kumapley, MD2, Isaac Paintsil, MBChB, MPH1, C. Roberto Simons-Linares, MD, MSc3
1John H. Stroger, Jr. Hospital of Cook County, Chicago, IL; 2Cook County Health and Hospital Systems, Chicago, IL; 3Cleveland Clinic, Cleveland, OH
Introduction: Drug adverse reactions stands as a rare cause of acute pancreatitis; the incidence is mostly estimated from case reports and case series. Our aim was to determine the incidence, presentation, course, etiology (causative drugs), severity and outcome of drug induced pancreatitis in a 6-year period in a large tertiary hospital.
Methods: We conducted a retrospective investigation of all cases of acute pancreatitis at a large tertiary teaching hospital in Chicago, IL from January 2012 to April 2018, Diagnosis and severity of was determined according to the Revised Atlanta Classification. Patients were divided according to etiology. Regarding cases where was stablished, we further subcategorized them using the Naranjo score and Badalov et al 2008 classification to assess and determine the likelihood of drug adverse reaction as a causative factor of drug induced pancreatitis. The revised Atlanta Classification was used to determined severity of AP.
Results: A total of 531 patients with acute pancreatitis were reviewed, most common etiologies for AP were Biliary 206(38.79%), Alcohol 179 (33.7%), Hypertriglyceridemia 55(10.35%), DIP 16 (3.01%), post-ERCP 13 (2.44%), Idiopathic 56 (10.54%), Miscellaneous 6 (1%). DIP ranked fourth in the most common cause for acute pancreatitis. Gender distribution was 9 men (56%) and 7 women (43.7%), The most commonly associated drug was azathioprine 5 cases (31.25%) followed by Bactrim 2 cases (12.5%), all other were reported as single cases (6.25%) including: mesalamine, enalapril, L-asparaginase, isoniazid, diazepam, metformin, hydrochlorothiazide. Diazepam case was reported as an overdose. First exposure adverse reaction occurred in most cases 15 (93.75%).
Discussion: Drug induced pancreatitis stands as an uncommon cause of acute pancreatitis, diagnosis is often underestimated and made by exclusion of other more common etiologies, or by retrospective evaluation of individual cases, the number of commonly used drugs associated with drug induced pancreatitis is relatively high. The disease seems more common in patients with Crohn’s disease on Azathioprine regimen.
Citation: Miguel Salazar, MD; Chimezie Mbachi, MD; Mohamed A. Elkhouly, MD, MSc; Madhu Mathew, MD; Rudolf Kumapley, MD; Isaac Paintsil, MBChB, MPH; C. Roberto Simons-Linares, MD, MSc. P0014 - DRUG-INDUCED PANCREATITIS: A RETROSPECTIVE COHORT STUDY ON INCIDENCE, ETIOLOGY, PRESENTATION AND OUTCOMES. Program No. P0014. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.