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Novel Characterization of Drug-associated Pancreatitis in Children

Bai, Harrison X.*; Ma, Michael H.*; Orabi, Abrahim I.*; Park, Alexander; Latif, Sahibzada U.; Bhandari, Vineet*; Husain, Sohail Z.*

Journal of Pediatric Gastroenterology & Nutrition: October 2011 - Volume 53 - Issue 4 - p 423–428
doi: 10.1097/MPG.0b013e318228574e
Original Articles: Gastroenterology

Background and Objectives: Medications are a major cause of acute pancreatitis; however, little is known about their influence in children. Our primary aims were to identify common comorbidities and concomitant pancreatitis etiologies in children with drug-associated pancreatitis. Our secondary aims were to identify the most commonly associated drugs in the different age groups, evaluate management practices, and compare drug-associated cases with non–drug-associated cases.

Patients and Methods: In the present study, we examined children (ages 0–20 years) admitted to Yale-New Haven Children's Hospital with pancreatitis between 1994 and 2007.

Results: Of a total of 271 pediatric cases, drugs were associated with pancreatitis in 25.6% (55). The 3 most common comorbidities in children with drug-associated pancreatitis were seizure disorders, acute lymphocytic leukemia, and Crohn disease. One third of drug-associated cases had an additional pancreatitis etiology. The most commonly associated drugs were valproic acid and corticosteroids. Compared with non–drug-associated cases, children with drug-associated cases were more likely to undergo CT scanning (54.5% vs 28.4%; P < 0.001), stay in the hospital longer (10 vs 4 days; P < 0.001), and transition to parenteral nutrition from a nil per os status (37.5% vs 21.2%; P < 0.05). There was a higher frequency of valproic acid–associated cases in children younger than 11 years (29.4% vs 9.5% in the 11- to 20-year-old age group).

Conclusions: Our study underscores the importance of considering drugs as a cause and a contributor to pancreatitis in children, particularly valproic acid in young children.

*Department of Pediatrics, Yale University School of Medicine, New Haven, CT

Department of Internal Medicine, University of Washington, Seattle

Department of Internal Medicine, University of Alabama, Birmingham.

Address correspondence and reprint requests to Sohail Z. Husain, Department of Pediatrics, 333 Cedar St, PO Box 208064, New Haven, CT 06520 (e-mail: sohail.husain@yale.edu).

Received 18 March, 2011

Accepted 8 April, 2011

The present study was supported by a Children's Digestive Health and Nutrition Young Investigator Award (to S.Z.H.).

The authors report no conflicts of interest.

Copyright 2011 by ESPGHAN and NASPGHAN