title: Azathioprine-induced Acute Pancreatitis in Patients with Inflammatory Bowel Diseases--A Prospective Study on Incidence and Severity.
abstract: OBJECTIVE
  Azathioprine [AZA] is recommended for maintenance of steroid-free remission in inflammatory bowel disease IBD. The aim of this study has been to establish the incidence and severity of AZA-induced pancreatitis, an idiosyncratic and major side effect, and to identify specific risk factors.
  
  
  METHODS
  We studied 510 IBD patients [338 Crohn's disease, 157 ulcerative colitis, 15 indeterminate colitis] with initiation of AZA treatment in a prospective multicentre registry study. Acute pancreatitis was diagnosed in accordance with international guidelines.
  
  
  RESULTS
  AZA was continued by 324 [63.5%] and stopped by 186 [36.5%] patients. The most common cause of discontinuation was nausea [12.2%]. AZA-induced pancreatitis occurred in 37 patients [7.3%]. Of these: 43% were hospitalised with a median inpatient time period of 5 days; 10% had peripancreatic fluid collections; 24% had vomiting; and 14% had fever. No patient had to undergo nonsurgical or surgical interventions. Smoking was the strongest risk factor for AZA-induced acute pancreatitis [p < 0.0002] in univariate and multivariate analyses.
  
  
  CONCLUSIONS
  AZA-induced acute pancreatitis is a common adverse event in IBD patients, but in this study had a mild course in all patients. Smoking is the most important risk factor.
authors.affiliation: Internistische Gemeinschaftspraxis Leipzig Germany teich@igvs.de.
authors.forename: Niels
authors.initials: N
authors.lastname: Teich
authors.affiliation: Gemeinschaftspraxis - Endoskopiezentrum Saarbrücken Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Mohl
authors.affiliation: Gastroenterologische Schwerpunktpraxis Minden Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Bokemeyer
authors.affiliation: Praxis Eschweiler Germany.
authors.forename: Burkhard
authors.initials: B
authors.lastname: Bündgens
authors.affiliation: Universitätsklinikum Schleswig-Holstein Lübeck Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Büning
authors.affiliation: Magen-Darm-Zentrum, Internistische Kooperation Eppendorf Hamburg Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Miehlke
authors.affiliation: Gastroenterologische Gemeinschaftspraxis Herne Germany.
authors.forename: Dietrich
authors.initials: D
authors.lastname: Hüppe
authors.affiliation: Städtisches Klinikum, Lüneburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Maaser
authors.affiliation: Internistische Gemeinschaftspraxis Leipzig Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Klugmann
authors.affiliation: Evangelisches Krankenhaus Kalk Köln Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Kruis
authors.affiliation: Charité, Berlin, Germany.
authors.forename: Britta
authors.initials: B
authors.lastname: Siegmund
authors.affiliation: Internistische Praxengemeinschaft Oldenburg Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Helwig
authors.affiliation: Gastroenterologische Gemeinschaftspraxis Koblenz Germany.
authors.forename: Joseph
authors.initials: J
authors.lastname: Weismüller
authors.affiliation: Universität Münster Germany.
authors.forename: Attyla
authors.initials: A
authors.lastname: Drabik
authors.affiliation: Universitätsklinikum, Jena, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Stallmach
mesh_terms: D000208:Acute Disease; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D001379:Azathioprine / Q000008:administration & dosage / Q000009:adverse effects*; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000473:pathology; D003424:Crohn Disease / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D005858:Germany; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy / Q000473:pathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010186:Pancreatic Function Tests; D010195:Pancreatitis / Q000139:chemically induced* / Q000453:epidemiology* / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution
chemical_list: D001379:Azathioprine
keywords: Azathioprine; Crohn’s disease; inflammatory bowel disease; lipase; pancreatitis; smoking; ulcerative colitis