Novel characterization of drug-associated pancreatitis in children

Abstract

Background and objectives: Medications are a major cause of acute pancreatitis; however, little is known about their influence in children. Our primary aims were to identify common comorbidities and concomitant pancreatitis etiologies in children with drug-associated pancreatitis. Our secondary aims were to identify the most commonly associated drugs in the different age groups, evaluate management practices, and compare drug-associated cases with non-drug-associated cases.

Patients and methods: In the present study, we examined children (ages 0-20 years) admitted to Yale-New Haven Children's Hospital with pancreatitis between 1994 and 2007.

Results: Of a total of 271 pediatric cases, drugs were associated with pancreatitis in 25.6% (55). The 3 most common comorbidities in children with drug-associated pancreatitis were seizure disorders, acute lymphocytic leukemia, and Crohn disease. One third of drug-associated cases had an additional pancreatitis etiology. The most commonly associated drugs were valproic acid and corticosteroids. Compared with non-drug-associated cases, children with drug-associated cases were more likely to undergo CT scanning (54.5% vs 28.4%; P < 0.001), stay in the hospital longer (10 vs 4 days; P < 0.001), and transition to parenteral nutrition from a nil per os status (37.5% vs 21.2%; P < 0.05). There was a higher frequency of valproic acid-associated cases in children younger than 11 years (29.4% vs 9.5% in the 11- to 20-year-old age group).

Conclusions: Our study underscores the importance of considering drugs as a cause and a contributor to pancreatitis in children, particularly valproic acid in young children.

FIGURE 1

Concomitant etiologies identified in childhood cases of drug-associated pancreatitis, % (n). CF = cystic fibrosis.

FIGURE 2

Frequency of drugs associated with acute pancreatitis in children, organized according to the 2007 American Gastroenterological Association technical bulletin of risk associations (5). TMP-SMX = trimethoprim/sulfamethoxazole.

FIGURE 3

Comparison of drugs associated with acute pancreatitis in younger (0–10 years) vs older (11–20 years) children. *Indicates P < 0.05 by Fisher exact probability test. TMP-SMX = trimethoprim/sulfamethoxazole.

FIGURE 4

Comparison of drugs associated with acute pancreatitis in younger vs older children who have no additional pancreatitis etiology. *Indicates P < 0.05 by Fisher exact probability test. TMP-SMX = trimethoprim/sulfamethoxazole.