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. 2020 Sep;20(6):1103-1108.
doi: 10.1016/j.pan.2020.07.008. Epub 2020 Jul 24.

Drug induced pancreatitis is the leading known cause of first attack acute pancreatitis in children

Maisam Abu-El-Haija  1 , Lindsey Hornung  2 , Tom K Lin  3 , Jaimie D Nathan  4 , Tyler Thompson  5 , David S Vitale  3 , Alexander Nasr  6 , Sohail Z Husain  7 , Lee Denson  3
Affiliations

Drug induced pancreatitis is the leading known cause of first attack acute pancreatitis in children

Maisam Abu-El-Haija et al. Pancreatology. 2020 Sep.

Abstract

Background/objectives: Drug induced acute pancreatitis (DIAP) as one of the acute pancreatitis (AP) risks factors is a poorly understood entity. The aim of the current study was to compare the characteristics and course of DIAP cases in children presenting with a first attack of AP.

Methods: Patients presenting with AP were included in a prospective database. We enrolled 165 AP patients that met criteria for inclusion. DIAP patients were included in that group if they were exposed to a drug known to be associated with AP and the rest were included in the non-drug induced-acute pancreatitis (non-DIAP) group.

Results: DIAP was observed in 40/165 (24%) of cases, 24 cases had drug-induced as the sole risk factor, and 16 had DIAP with another risk factor(s). The two groups were similar in intravenous fluid and feeding managements, but ERCP was more commonly performed in the non- DIAP group, 14 (11%), vs 0% in the DIAP group, p = 0.02. Moderately severe [9 (23%) vs 11 (9%)] and severe AP [7 (18%) vs 6 (5%)] were more commonly associated with DIAP than non- DIAP, p = 0.001. DIAP was more commonly associated with ICU stay, 10 (25%), vs 12 (10%), p = 0.01, hospital stay was longer in DIAP median (IQR) of 6 (3.9-11) days vs 3.3 (2-5.7) days in non- DIAP, p = 0.001. The DIAP group had a significantly higher proportion of comorbidities (p < 0.0001).

Conclusions: DIAP is a leading risk factor for a first attack of AP in children and is associated with increased morbidity and severity of the pancreatitis course. DIAP warrants further investigation in future studies.

Keywords: Children; Drug induced; Pancreatitis.

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Conflict of interest statement

Declaration of competing interest LAD has received research support unrelated to this work from FrieslandCampina, Glycosyn, and Janssen. SZH has equity in Prevcon, advises for Atias Pharmaceutical, and has received research support from Servier.

Figures

Figure 1:
Figure 1:. Etiologies and risk factors of first attack acute pancreatitis in our cohort.
Total cohort (n=165), DIAP was the most common known risk factor for AP 40/165 (24%); DIAP as the sole risk factor n=24 (16%), DIAP with other risks n=16 (10%). Followed by other risk factors for AP, as listed in the pie chart: divisum and obstructive causes, biliary pancreatitis, trauma, genetics, viral, systemic and toxic etiologies. Idiopathic or no known cause was found in 59 (36%) of cases. Genetic testing was not done on all AP patients.
Figure 2:
Figure 2:. Name of drugs involved in the DIAP cases along with their classification.
Class I medications were most commonly associated with AP cases in our cohort, with the leading causes from steroids, valproic acid, PEG asparaginase, and thiopurines.
See this image and copyright information in PMC

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