RESEARCH - Acute pancreatitis in inflammatory bowel disease, with special reference to azathioprine-induced pancreatitis

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Aliment Pharmacol Ther. 2008 Sep 1;28(5):623-8. Epub 2008 May 30.

Acute pancreatitis in inflammatory bowel disease, with special

reference to azathioprine-induced pancreatitis.

Bermejo F, -Sanroman A, Taxonera C, Gisbert JP, Pérez-Calle JL,

Vera I, Menchén L, Martín-Arranz MD, Opio V, Carneros JA,

Van-Domselaar M, Mendoza JL, Luna M, López P, Calvo M, Algaba A.

Department of Gastroenterology, Hospital Universitario de Fuenlabrada,

Community of Madrid, Madrid, Spain.

Abstract

BACKGROUND: Pancreatitis is a potentially severe condition. Patients

with inflammatory bowel disease (IBD) seem to be at increased risk for

acute pancreatitis.

AIM: 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.

PMID: 18513380

http://www.ncbi.nlm.nih.gov/pubmed/18513380

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