Dataset Information

A Drug-Induced Acute Pancreatitis Retrospective Study.

ABSTRACT: Background and Aims:Drugs are considered a relatively rare and understudied cause of acute pancreatitis (AP). The lack of convincing and conclusive data on drug-induced AP (DIAP) complicates the diagnosis as well as the identification of the causative drug. The aim of this study is to document causes of DIAP cases that occurred in the Saguenay-Lac-Saint-Jean (SLSJ) population. Methods:We have conducted a retrospective and descriptive population-based study of DIAP cases that occurred between 2006 and 2014 in the six hospitals serving the entire SLSJ population. Cases were selected from the Quebec Ministry of Health hospitalizations registry (MED-ECHO) administrative public database. A medical chart review was performed in an attempt to characterize DIAP hospitalizations and to identify the imputable drugs. Results:During the studied period, 75 cases (30.7% male, 69.3% female) were included totaling 90 hospitalizations for DIAP. Among them, 50 causative drugs were identified and were distributed in 17 different drug classes. Recurrent DIAPs were documented in 13 cases, and among them, 6 cases have experimented a positive rechallenge. Six drugs (5-fluorouracil, atorvastatin, bortezomib, nilotinib, rosuvastatin, and triamcinolone) were associated with the highest degree of evidence. The most common causative drugs of DIAP hospitalization were azathioprine (n?=?7), followed by atorvastatin (n?=?6), hydrochlorothiazide (n?=?5), rosuvastatin (n?=?4), and codeine (n?=?4). Conclusions:This study has added new evidences about potentially pancreatitis-associated drugs in literature. This is the first study to report definite 5-fluorouracil- and triamcinolone-induced AP. An updated version of the evidence-based literature review is needed to support the clinicians in the identification of the causative drugs.

SUBMITTER: Gagnon AL

PROVIDER: S-EPMC7655261 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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A Drug-Induced Acute Pancreatitis Retrospective Study.

Gagnon Ann-Lorie AL Lavoie Alexandre A Frigon Marie-Pier MP Michaud-Herbst Alban A Tremblay Karine K

Canadian journal of gastroenterology & hepatology 20201103

<h4>Background and aims</h4>Drugs are considered a relatively rare and understudied cause of acute pancreatitis (AP). The lack of convincing and conclusive data on drug-induced AP (DIAP) complicates the diagnosis as well as the identification of the causative drug. The aim of this study is to document causes of DIAP cases that occurred in the Saguenay-Lac-Saint-Jean (SLSJ) population.<h4>Methods</h4>We have conducted a retrospective and descriptive population-based study of DIAP cases that occur ...[more]

PMID: 33204673

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Project description:Drug-induced pancreatitis is a gastrointestinal adverse effect concerning about 2% of drugs. The majority of cases are mild to moderate but severe episodes can also occur, leading to hospitalization or even death. Unfortunately, the mechanisms of this adverse reaction are still not clear, hindering its prevention, and the majority of data available of this potentially life-threatening adverse effect are limited to case reports leading to a probable underestimation of this event. In particular, in this editorial, special attention is given to thiopurine-induced pancreatitis (TIP), an idiosyncratic adverse reaction affecting around 5% of inflammatory bowel disease (IBD) patients taking thiopurines as immunosuppressants, with a higher incidence in the pediatric population. Validated biomarkers are not available to assist clinicians in the prevention of TIP, also because of the inaccessibility of the pancreatic tissue, which limits the possibility to perform dedicated cellular and molecular studies. In this regard, induced pluripotent stem cells (iPSCs) and the exocrine pancreatic differentiated counterpart could be a great tool to investigate the cellular and molecular mechanisms underlying the development of this undesirable event. This particular type of stem cells is obtained by reprogramming adult cells, including fibroblasts and leukocytes, with a set of transcription factors known as the Yamanaka's factors. Maintaining unaltered the donors' genetic heritage, iPSCs represent an innovative model to study the mechanisms of adverse drug reactions in individual patients' tissues not easily obtainable from human probands. Indeed, iPSCs can differentiate under adequate stimuli into almost any somatic lineage, opening a new world of opportunities for researchers. Several works are already available in the literature studying liver, central nervous system and cardiac cells derived from iPSCs and adverse drug effects. However, to our knowledge no studies have been performed on exocrine pancreas differentiated from iPSCs and drug-induced pancreatitis, so far. Hence, in this editorial we focus specifically on the description of the study of the mechanisms of TIP by using IBD patient-specific iPSCs and exocrine pancreatic differentiated cells as innovative in vitro models.

Project description:BackgroundCurrently, the concept of "a single cause results in acute pancreatitis (AP)" has been deeply incorporated into clinical practice, whereas the concept of "compound-etiology" has not attract considerable attention. This study aimed to explore the impact of the category of etiology on AP clinical outcomes.MethodsPatients with AP hospitalized within 72 h of symptom onset were retrospectively enrolled in this study from January 2014 to October 2019. AP etiology was classified into two main categories: single-etiology and compound-etiology category. The single-etiology category mainly includes biliary, hypertriglyceridemia (HTG), and alcohol. The compound-etiology category refers to AP with two or more causes, which mainly include dual-etiology and triple-etiology category, that is the biliary-HTG type, HTG-alcoholic type, and biliary-HTG-alcoholic type. The general information and clinical outcomes were reviewed and compared in AP patients with different etiologies.ResultsTwo hundred sixty-eight out of a total of 904 AP patients belonged to the compound-etiology category. Compared with the single-etiology category, the patients in the compound-etiology category were younger, more predominantly male, more likely to be obese (body mass index ≥30 kg/m2) and more likely to have pre-existing diabetes. The clinical outcomes were worse for patients with increasing complexity of etiology type, as shown by comparison of the incidence of any organ failure (P<0.001); persistent organ failure (POF) (P<0.001); intensive care unit need (P<0.001); local complications (P<0.001). AP with HTG had a higher rate of POF (P=0.032) and acute necrotic collection (P=0.013) than AP with biliary or alcohol involvement. When other etiologies simultaneously accompanied HTG-AP, the clinical outcomes were significantly worse than those in HTG-AP without other etiologies, particularly the biliary-HTG-alcoholic type. The compound-etiology category was independently associated with POF [odds ratio (OR): 2.47, 95% confidence interval (CI): 1.65-3.72, P<0.001].ConclusionsThese results highlight the importance of determining AP etiology and the prevalence of the "compound-type" etiology. The compound-etiology category should be recognized as a separate concept in AP etiology and deserve higher priority.

Project description:BackgroundAcute pancreatitis is an unpredictable and potentially fatal condition for which no definitive cure is currently available. Our research focused on exploring the connection between body mass index, a frequently overlooked risk factor, and both the onset and progression of acute pancreatitis.Material/methodsA total of 247 patients with acute pancreatitis admitted to Jiangsu Provincial Hospital of Chinese Medicine from January 2021 to February 2023 were retrospectively reviewed. After screening, 117 patients with complete height and body weight data were selected for detailed assessment. Additionally, 85 individuals who underwent physical examinations at our hospital during this period were compiled to create a control group. The study received ethical approval from the ethics committee of Jiangsu Province Hospital of Chinese Medicine (Ref: No.2022NL-114-02) and was conducted in accordance with the China Good Clinical Practice in Research guidelines.ResultsA significant difference in body mass index (BMI) was observed between the healthy group and acute pancreatitis (AP) patients (p < 0.05), with a more pronounced disparity noted in cases of hyperlipidemic acute pancreatitis (p < 0.01). A potential risk for AP was identified at a BMI greater than 23.56 kg/m2 (AUC = 0.6086, p < 0.05). Being in the obese stage I (95%CI, [1.11-1.84]) or having a BMI below 25.4 kg/m2 (95%CI, [1.82-6.48]) are identified as risk factors for adverse AP progression. Moreover, BMI effectively predicts the onset of acute edematous pancreatitis and acute necrotizing pancreatitis (AUC = 0.7893, p < 0.001, cut-off value = 25.88 kg/m2). A higher BMI correlates with increased recurrence rates within a short timeframe (r = 0.7532, p < 0.01).ConclusionsElevated BMI is a risk factor for both the occurrence and progression of AP, and underweight status may similarly contribute to poor disease outcomes. BMI is crucial for risk prediction and stratification in AP and warrants ongoing monitoring and consideration.

Dataset Information

A Drug-Induced Acute Pancreatitis Retrospective Study.

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A Drug-Induced Acute Pancreatitis Retrospective Study.

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