Drug induced acute pancreatitis: Does it exist?

Abstract

As the incidence of acute pancreatitis continues to rise, establishing the etiology in order to prevent recurrence is important. Although the etiology of acute pancreatitis is not difficult in the majority of patients, almost a quarter of patients are initially labeled as having idiopathic acute pancreatitis. When confronted with a patient with acute pancreatitis and no clear etiology defined as an absence alcoholism, gallstones (ultrasound and/or MRI), a normal triglyceride level, and absence of tumor, it often appears reasonable to consider a drug as the cause of acute pancreatitis. Over 100 drugs have been implicated by case reports as causing acute pancreatitis. While some of these case reports are well written, many case reports represent poorly written experiences of the clinician simply implicating a drug without a careful evaluation. Over-reliance on case reports while ignoring randomized clinical trials and large pharmacoepidemiologic surveys has led to confusion about drug induced acute pancreatitis. This review will explain that drug induced acute pancreatitis does occur, but it is rare, and over diagnosis leads to misconceptions about the disease resulting in inappropriate patient care, increased litigation and a failure to address the true entity: idiopathic acute pancreatitis.

Keywords: Drug induced acute pancreatitis; Idiopathic acute pancreatitis

Core tip: While the literature has reported over 130 drugs as causing acute pancreatitis, the evidence that these drugs have a true causal role is lacking in the vast majority of drugs. While idiopathic pancreatitis is common, accounting for almost a third of patients with acute pancreatitis, drug induced acute pancreatitis is probably an uncommon, perhaps a rare disease. Before a clinician blames a drug as causing acute pancreatitis, a thorough evaluation for more common causes should be made, even a consideration that the disease is merely idiopathic.