Letter to Editor
Drug-induced Acute Pancreatitis – ‘Scope for Secondary Prevention’
Savio George Barreto1* MBBS, MS, PhD
1Department of Gastrointestinal Surgery, Gastrointestinal Oncology, and Bariatric Surgery, Medanta Institute of Digestive and
Hepatobiliary Sciences, Medanta, The Medicity, Gurgaon – India
I read with interest the article by Chang et al.  in which the authors adopt a systematic approach (including taking into account binary clinical conditions such as the presence of hypertriglyceridemia, alcohol and / or tobacco use, gallstone, obesity and bilio-pancreatic cancers, estimating dose response effects and performing sensitivity analyses) to tease out the relationship of various anti-diabetic drugs and the risk of Acute pancreatitis (AP). In the end, they provide compelling evidence that sulfonylureas carry a more significant risk of causing AP compared to metformin which in turn carry a more significant risk that dipeptidyl peptidase-4.
The study  reaffirms the role played by drugs in the causation of AP. It is well appreciated that diabetic patients are at an increased risk of developing AP and are more likely to suffer the severe form of the disease . Hyperglycaemia,coupled with the factors influencing insulin resistance (tumournecrosis-α, NFκB, amylin) which cause an increase in reactive oxygen species generation in acinar cells, have been hypothesized to play a role in the pathophysiology of AP in patient with diabetes mellitus .
While literature is abound with case reports, case series and even reviews on drug-induced AP there continue to be doubts raised as to the extent to which drugs actually play in causing an episode of AP . Such arguments are very valid as reports on drug-induced AP may result from an incomplete aetiological work-up. The more concerning off shoot of presumptuously arriving at such a diagnosis, though, is the risk that in the haste to label a patient with drug-induced AP, a more sinister cause of AP (eg. a tumour) may be overlooked.
Commentary on the manuscript: Chang HY, Hsieh CF, Singh S, Tang W, Chiang YT, Huang WF. Anti-diabetic therapies and the risk of acute pancreatitis: a nationwide retrospective cohort study from Taiwan. Pharmacoepidemiol Drug Saf. 2015
1.Chang HY, Hsieh CF, Singh S, Tang W, Chiang YT, Huang WF. Anti-diabetic therapies and the risk of acute pancreatitis: a nationwide retrospective cohort study from Taiwan. Pharmacoepidemiol Drug Saf. 2015.
Cite this article: Barreto S G. Drug-induced Acute Pancreatitis – ‘Scope for Secondary Prevention’. J J Gastro Hepato. 2015, 2(3): 019.