Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2020; 26(22): 2902-2915
Published online Jun 14, 2020. doi: 10.3748/wjg.v26.i22.2902
Ever-increasing diversity of drug-induced pancreatitis
Simcha Weissman, Muhammad Aziz, Ryan B Perumpail, Tej I Mehta, Rutwik Patel, James H Tabibian
Simcha Weissman, Rutwik Patel, Department of Medicine, Hackensack University-Palisades Medical Center, North Bergen, NJ 07047, United States
Muhammad Aziz, Department of Medicine, University of Toledo Medical Center, Toledo, OH 43614, United States
Ryan B Perumpail, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
Tej I Mehta, Department of Interventional Radiology, Johns Hopkins University Hospital, Baltimore, MD 21205, United States
James H Tabibian, Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA 91342 and David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
Author contributions: Weissman S and Aziz M considered as co-first authors; Weissman S, Aziz M, Perumpail RB, Mehta TI, and Patel R assisted with manuscript preparation and editing; Weissman S and Tabibian JH critically revised the manuscript; Perumpail RB critically revised the manuscript; Tabibian JH provided direct supervision and guidance; Weissman S and Tabibian JH are the article guarantors; all authors agree to the final version of this manuscript.
Conflict-of-interest statement: None relevant to this submission.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: James H Tabibian, MD, PhD, FACP, Department of Medicine, UCLA-Olive View Medical Center, 14445 Olive View Dr 2B-182, Sylmar, CA 91342, United States.
Received: January 24, 2020
Peer-review started: January 24, 2020
First decision: February 27, 2020
Revised: March 27, 2020
Accepted: May 28, 2020
Article in press: May 28, 2020
Published online: June 14, 2020

With over 100000 hospital admissions per annum, acute pancreatitis remains the leading gastrointestinal cause of hospitalization in the United States and has far-reaching impact well beyond. It has become increasingly recognized that drug-induced pancreatitis (DIP), despite accounting for less than 3% of all cases, represents an important and growing though often inconspicuous cause of acute pancreatitis. Nevertheless, knowledge of DIP is often curtailed by the limited availability of evidence needed to implicate given agents, especially for non-prescription medications. Indeed, the majority of available data is derived from case reports, case series, or case control studies. Furthermore, the mechanism of injury and causality for many of these drugs remain elusive as a definitive correlation is generally not established (< 10% of cases). Several classification systems have been proposed, but no single system has been widely adopted, and periodic updates are required in light of ongoing pharmacologic expansion. Moreover, infrequently prescribed medications or those available over-the-counter (including herbal and other alternative remedies) are often overlooked as a potential culprit of acute pancreatitis. Herein, we review the ever-increasing diversity of DIP and the potential mechanisms of injury with the goal of raising awareness regarding the nature and magnitude of this entity. We believe this manuscript will aid in increasing both primary and secondary prevention of DIP, thus ultimately facilitating more expedient diagnosis and a decrease in DIP-related morbidity.

Keywords: Drug-induced pancreatitis, Acute pancreatitis, Pharmacology, Mechanism of action, Inflammation, Etiology

Core tip: Despite living in an era of pharmacologic expansion, our knowledge of drug-induced pancreatitis (DIP) is often curtailed by evidence needed to implicate particular medications. Several causative agent classification systems (with medication lists) have been reported and their mechanisms proposed. Nonetheless, they require regular updates and a complete review of this topic is warranted. In addition, infrequently prescribed medications or those available over-the-counter are often omitted from those summarized lists. We review the ever-increasing diversity of DIP and their potential mechanisms of injury to aid in increasing both primary and secondary prevention of DIP.