Prospective evaluation of the cause of acute pancreatitis, with special attention to medicines

Table 1 Patient characteristics n (%)

	Prospective group (n = 57)	Retrospective group (n = 613)	P value
Age (yr)	52.4 (17-94)	58.9 (5-96)	0.062
Gender (M:F)	35 (61):22 (39)	320 (52):293 (48)	0.179
Comorbidity
None	14 (25)	219 (36)
Heart disease	13 (23)	127 (21)
Hypertension	19 (33)	170 (28)
Pulmonary disease	5 (9)	69 (11)
Diabetes mellitus	4 (7)	57 (9)
Previous pancreatitis	15 (26)	38 (6)	< 0.001
Duration of pain (h)	24 (0-504)	20 (0-0.592)
Severe pancreatitis
CRP	31 (54)	276 (45)	0.975
CT	3 (10)	33 (10)	0.945
Complications			0.660
None	45 (79)	497 (81)
Systemic	8 (14)	89 (14.9)
Local	4 (7)	43 (7.2)
Mortality	1 (2)	36 (6)	0.356
Severity of pancreatitis			0.713
Mild	50 (88)	521 (85)
Moderate severe	2 (4)	54 (9)
Severe	5 (8)	38 (6)

CT: Computed tomography.

Table 2 Investigations during hospital stay and/or follow-up, n (%)

	Prospective group (n = 57)	Retrospective group (n = 585 evaluable)	P value
All patients with ultrasonography	51 (89.5)	420 (71.8)	0.007
All patients with CT	45 (78.9)	311 (53.1)
All patients with MRI	32 (56.1)	196 (33.5)	0.001
US	5 (8.8)	142 (24.3)
US + CT	16 (28.1)	143 (24.4)
US + MRI	7 (12.3)	86 (14.7)
US + CT+ MRI	23 (40.3)	49 (8.4)
CT alone	4 (7.0)	88 (15.4)
CT + MRI	2 (3.5)	31 (5.3)
MRI alone	0	30 (5.1)
No imaging	0	16 (2.7)

CT: Computed tomography; MRI: Magnetic resonance imaging; US: Ultrasonography.

Table 3 Cause of acute pancreatitis in the prospective and retrospective group n (%)

	Prospective group (n = 57)		Retrospective group (n = 613)		P value
	Patients	Patients using medicines1	Patients	Patients using medicines1
Bile stone	23 (40.4)	13 (57)	271 (44.2)	4 (0.1)	< 0.001
Bile stone or alcohol	4 (7.0)	4 (100)	14 (2.3)
Alcohol	6 (10.5)	1 (17)	87 (14.2)	1 (0.1)
Hypertriglyceridemia	3 (5.2)	3 (100)	8 (1.3)
ERCP	1 (1.8)	0	19 (3.1)
PTC	1 (1.8)	0	0
Tumor/cancer pancreas	1 (1.8)	0	9 (1.5)
Pancreas divisum	2 (3.5)	1 (50)	1 (0.2)
Stone in pancreatic duct	1 (1.8)	0	1 (0.2)
Postoperative pancreatitis	0	0	3 (0.5)
Trauma	0	0	1 (0.2)
Viral infection	0	0	2 (0.3)
Medicines1	11 (19.3)	11 (100)	15 (2.4)	15 (100)
Unknown2	4 (7.0)	0	182 (29.7)	0
All	57 (100)	33 (58)	613 (100)

¹Medicines associated with pancreatitis as a side effect;

²Two of these had a previous cholecystectomy due to bile stones, suggesting small bile-stones as a possible cause. ERCP: Endoscopic retrograde cholangiopancreaticography.

Table 4 Details of drugs used in patients with possible etiologies in the prospective group

Etiology	Generic name	n
Bile stone (n = 23)	Azathioprine	1
of which medicine users (n = 13)	Simvastatin	1
	Diclofenac	1
	Amipril	1
	Enalapril	1
	Drospirenin/etinylostradiol	1
	Simvastatin, Amipril	1
	Atorvastatin, Ezetimib	1
	Amipril	1
	Simvastatin, Amipril, Diclofenac	1
	Methotrexate	1
	Atorvastatin	1
	Simvastatin,	1
	Candesartan hydrochlorothiazide	1
	Simvastatin,	1
	Losartan hydrochlorothiazide
Bile stone or alcohol (n = 4)	Estradiol	1
of which medicine users (n = 4)	Ramipril, Prednisolone	1
	Estradiol	1
	Diclofenac	1
Alcohol (n = 6)	Prednisolone	1
of which medicine users (n = 1)
Hypertriglyceridemia (n = 3)	Gabapentin	1
of which medicine users (n = 3)	Simvastatin	1
	Venlafaxine	1
Medication (n = 11)	Azathioprine	2
of which medicine users (n = 11)	Simvastatin	1
	Atorvastatin	1
	Venlafaxine, Ramipril, Asparginase	1
	Atorvastatin	1
	Methotrexate, Prednisolone, Etanercept	1
	Mycofenolic acid, Tacrolimus, Prednisolone	1
	Cyclosporine, Pravastatin, Simvastatin, Ramipril	1
	Diclofenac	1
	Simvastatin, Losartan hydrochlorothiazide	1
Pancreas divisum (n = 2)	Simvastatin	1
of which medicine users (n = 1)
Total number		34

Table 5 Number of drugs used in patients with medicines as a possible etiology

Use of a single drug		Use of two drugs		Use of three drugs
Name	n	Name	n	Name	n
Azathioprine	3	Simvastatin, Amlodipine	1	Simvastatin, Ramipril.	2
Simvastatin	4	Simvastatin, Candesartan hydrochlorothiazide	1	Diclofenac
Gabapentin	1	Simvastatin, Losartan hydrochlorothiazide	2	Atorvastatin, Ezetimib, Ramipril	1
Methotrexate	1	Simvastatin, Pravastatin	1
Estradiol	1	Ramipril, Prednisolone	1	Atorvastatin, Venlafaxine, Ramipril	1
Asparginase	1			Methotrexate, Etanercept, Prednisolone	1
Diclofenac	2			Mycofenolic acid, Tacrolimus, Prednisolone	1
Atorvastatin	2
Venlafaxine	1
Furosemide	1
Enalapril	1
Drospirenin etinylostradiol	1
Estradiol	1
Prednisolone	1
Sum	21		6		6