Frequency, Predisposing Factors, and Clinical Outcome of Azathioprine-Induced Pancreatitis Among Patients With Inflammatory Bowel Disease: Results From a Tertiary Referral Center. Issue 9 (3rd October 2021)

• Record Type: Journal Article
• Authors: Eskazan, Tugce; Bozcan, Selma; Atay, Kadri; Yildirim, Suleyman; Demir, Nurhan; Celik, Sinem; Tuncer, Murat; Hatemi, Ibrahim; Celik, Aykut Ferhat; Erzin, Yusuf
• Is Part Of: Pancreas. Volume 50:Issue 9(2021)
• Page Start: 1274
• Page End: 1280
• Publication Date: 2021-10-03
• Subjects: azathioprine -- acute pancreatitis -- azathioprine-induced gastrointestinal intolerance -- inflammatory bowel disease; Pancreas -- Diseases -- Periodicals; Pancreas -- Periodicals; Neuroendocrine tumors -- Periodicals; 616.37005
• DOI: 10.1097/MPA.0000000000001914
• Languages: English
• ISSNs: 0885-3177

Abstract

Abstract : Objective: The aim of the study was to identify the frequency of azathioprine-induced acute pancreatitis (AZA-AP) and related factors. Methods: Seven hundred eighty-seven inflammatory bowel disease (IBD) patients on AZA therapy were retrospectively analyzed. Azathioprine-induced AP was diagnosed with positive imaging and/or an at least 3-fold increased amylase level, in presence of typical abdominal pain. The AZA-AP group was compared with patients on AZA therapy with no history of pancreatitis and 4 numerical adjacent cases with the same diagnosis were selected (group B). Results: Fifty-four patients developed gastrointestinal symptoms (6.9%); however, only half of them (26 of 54) had pancreatitis, except 1, all within the first 2 months under AZA. When the AZA-AP group was compared with group B, only budesonide usage and active smoking were significantly more common in group A (46.2% vs 25%, P = 0.034, and 77% vs 51%, P = 0.017, respectively). Active smoking was the only independent risk factor for AZA-AP development (odds ratio, 3.208 [95% confidence interval, 1.192–8.632]). Conclusions: All IBD patients developed AZA-AP nearly all within the first 2 months. Azathioprine intolerance may be a hidden diagnosis in at least half of the patients with AZA-AP symptoms. All smoker IBD patients should be monitored closely for AZA-AP development.