Contemporary review of drug-induced pancreatitis: A different perspective

Abstract

Although gallstone and alcohol use have been considered the most common causes of acute pancreatitis, hundreds of frequently prescribed medications are associated with this disease state. The true incidence is unknown since there are few population based studies available. The knowledge of drug induced acute pancreatitis is limited by the availability and the quality of the evidence as the majority of data is extrapolated from case reports. Establishing a definitive causal relationship between a drug and acute pancreatitis poses a challenge to clinicians. Several causative agent classification systems are often used to identify the suspected agents. They require regular updates since new drug induced acute pancreatitis cases are reported continuously. In addition, infrequently prescribed medications and herbal medications are often omitted. Furthermore, identification of drug induced acute pancreatitis with new medications often requires accumulation of post market case reports. The unrealistic expectation for a comprehensive list of medications and the multifactorial nature of acute pancreatitis call for a different approach. In this article, we review the potential mechanisms of drug induced acute pancreatitis and provide the perspective of deductive reasoning in order to allow clinicians to identify potential drug induced acute pancreatitis with limited data.

Keywords: Drug-induced pancreatitis; Mechanism

Core tip: The knowledge of drug-induced acute pancreatitis (DIAP) is limited by the availability and the quality of the evidence. Potential publication bias may also impact our knowledge of DIAP. Several causative agent classification systems have been proposed, but they require regular updates. In addition, Infrequent prescribed medications and herbal medications are often omitted from those summarized lists. We review the potential mechanisms of DIAP and provide the perspective of deductive reasoning in order to allow clinicians to identify potential DIAP with limited data.