Acute pancreatitis in inflammatory bowel disease, with special reference to azathioprine-induced pancreatitis.
BACKGROUND
Pancreatitis is a potentially severe condition. Patients with inflammatory bowel disease (IBD) seem to be at increased risk for acute pancreatitis.


OBJECTIVE
To describe the incidence, main causes and possible predictive factors of acute pancreatitis in inflammatory bowel disease.


METHODS
Information was retrospectively extracted from the clinical records of patients followed in the IBD Units of nine hospitals in Madrid (n = 5073).


RESULTS
A total of 82 acute pancreatitis episodes were diagnosed (cumulative incidence, 1.6%); 98% of them were mild. Recurrent acute pancreatitis developed in 13% of patients. Most cases of acute pancreatitis (63.4%) were attributed to drug exposure [azathioprine/mercaptopurine (AZA/MP) n = 46, mesalazine (mesalamine) n = 6]; 20.7% were idiopathic, and 12.2% were biliary. Incidence of acute pancreatitis in patients treated with AZA/MP was 3.1%. In patients with acute pancreatitis, female gender (OR 3.4 95% CI: 1.3-9.3; P = 0.012) and Crohn's disease (CD) (OR 5.8 95% CI: 1.6-20.6; P = 0.007) were risk factors for AZA/MP-associated acute pancreatitis, the latter also when analysed only in patients treated with AZA/MP (n = 1477) (OR 5.2 95% CI: 1.8-14; P = 0.002).


CONCLUSIONS
The incidence of acute pancreatitis in our IBD patients (1.6%) is similar to that previously described. Drugs, mainly AZA/MP, are the leading cause. AZA-induced acute pancreatitis is always mild. Patients with CD are at a higher risk for AZA/MP-associated acute pancreatitis. The frequency of idiopathic acute pancreatitis is higher than expected, suggesting that part of these cases could be extraintestinal manifestations of IBD.
Department of Gastroenterology, Hospital Universitario de Fuenlabrada, Community of Madrid, Madrid, Spain. Fbermejo.hflr@salud.madrid.org
F
F
Bermejo
A
A
Lopez-Sanroman
C
C
Taxonera
J P
JP
Gisbert
J L
JL
Pérez-Calle
I
I
Vera
L
L
Menchén
M D
MD
Martín-Arranz
V
V
Opio
J A
JA
Carneros
M
M
Van-Domselaar
J L
JL
Mendoza
M
M
Luna
P
P
López
M
M
Calvo
A
A
Algaba
D000208:Acute Disease; D000328:Adult; D000963:Antimetabolites / Q000009:adverse effects*; D001379:Azathioprine / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D008297:Male; D019804:Mesalamine / Q000009:adverse effects*; D010195:Pancreatitis / Q000139:chemically induced*; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
D000963:Antimetabolites; D019804:Mesalamine; D001379:Azathioprine