Incidence, severity, and etiology of drug-induced acute pancreatitis.
BACKGROUND
Drug-induced acute pancreatitis is considered to be a rare diagnosis. The incidence of drug-induced acute pancreatitis is usually estimated from case reports.


OBJECTIVE
The aim of this study was to determine the incidence, etiology, and severity of drug-induced pancreatitis during a 2-year period in a tertiary hospital.


METHODS
The study was conducted as a retrospective analysis of all cases of pancreatitis in the University Hospital in Olomouc (1,432 beds) in 2006-2007. All cases of acute pancreatitis were re-evaluated and divided according to the causative factor. In drug-induced cases, the WHO Probability Scale for the evaluation of causality relationship was used.


RESULTS
The inclusion criteria were met by 170 medical files. There were 91 (53%) cases in men and 79 (47%) in women, and mean age was 57 years old (5-91 years old). The etiology was in 53% biliary, 31% alcohol-induced, 12% other determined, and in 4% the cause could not be established. The proportion of drug-induced acute pancreatitis was 5.3% and it was the third most frequent cause of the AP. Azathioprine was the most frequent causative factor (three cases in two patients); all the other causative drugs were documented only in single cases: mesalazine, dexamethasone, ramipril, mycophenolate mofetil, cytarabine, and valproate.


CONCLUSIONS
The diagnosis of drug-induced acute pancreatitis seems to be underestimated because of the difficulties in determining the causative agent and the need for a retrospective re-evaluation of the suspected causative factors. The disease is more probable in younger persons, women, and patients suffering from Crohn's disease.
Vinklerová
Ilona
I
2nd Department of Internal Medicine, Faculty of Medicine and University Hospital, Palacký University, Olomouc, Czech Republic.
Procházka
Michal
M
Procházka
Vlastimil
V
Urbánek
Karel
K
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001379:Azathioprine / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000188:drug therapy / Q000453:epidemiology; D003561:Cytarabine / Q000009:adverse effects; D003907:Dexamethasone / Q000009:adverse effects; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D008297:Male; D019804:Mesalamine / Q000009:adverse effects; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives; D010195:Pancreatitis / Q000139:chemically induced* / Q000453:epidemiology*; D017257:Ramipril / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014635:Valproic Acid / Q000009:adverse effects; D055815:Young Adult
D007166:Immunosuppressive Agents; D003561:Cytarabine; D019804:Mesalamine; D014635:Valproic Acid; D003907:Dexamethasone; D009173:Mycophenolic Acid; D017257:Ramipril; D001379:Azathioprine