Acute necrotizing pancreatitis associated with vildagliptin.
Purnima Kunjathaya1, Pradeep Kakkadasam Ramaswami, Anupama Nagar Krishnamurthy
1Department of Gastroenterology, Columbia Asia Referral Hospital, Bangalore, India. drkrpradeep@gmail.com
JOP : Journal of the Pancreas
|January 12, 2013
Summary
A case report details acute necrotizing pancreatitis in a patient treated with vildagliptin, a drug for type 2 diabetes. This finding highlights potential risks associated with vildagliptin therapy.
Area of Science:
- Endocrinology
- Gastroenterology
- Pharmacology
Background:
- Vildagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor used for type 2 diabetes.
- Incretin-based therapies, including DPP-4 inhibitors, have been linked to pancreatitis.
- The US Food and Drug Administration has issued alerts regarding pancreatitis risk with incretin mimetics.
Observation:
- A 49-year-old male with uncontrolled type 2 diabetes mellitus developed severe abdominal pain three weeks after starting vildagliptin.
- Diagnostic workup revealed acute pancreatitis with significantly elevated serum amylase (2,215 U/L).
- Contrast-enhanced computed tomography confirmed acute pancreatitis, leading to a prolonged hospital stay and surgical intervention.
Findings:
- The patient required laparoscopic pancreatic necrosectomy for biliary obstruction and endoscopic retrograde cholangiopancreatography (ERCP) with biliary stenting due to cystic duct avulsion.
- This case represents the first reported instance of acute necrotizing pancreatitis associated with vildagliptin use in India.
- The clinical presentation underscores a potential link between vildagliptin and severe pancreatic complications.
Implications:
- This case highlights the importance of considering vildagliptin as a potential cause of acute pancreatitis.
- Clinicians should exercise caution and judicious monitoring when prescribing vildagliptin, especially in patients with risk factors for pancreatitis.
- Further research may be warranted to elucidate the precise mechanism and incidence of vildagliptin-induced pancreatitis.
Related Concept Videos
01:21Acute Pancreatitis II: Pathophysiology
The pathophysiology of acute pancreatitis centers on injury to pancreatic acinar cells, which initiates a cascade of harmful intracellular events.This injury leads to premature activation of trypsinogen to trypsin in the pancreas. Trypsin then activates other digestive enzymes, such as chymotrypsin, elastase, and phospholipase A2, which begin breaking down pancreatic tissue. The resulting autodigestion causes local inflammation, tissue swelling, hemorrhage, and fat necrosis.Injured acinar cells...
01:25Acute Pancreatitis I: Introduction
Acute pancreatitis is the sudden inflammation of the pancreas caused by the early activation of digestive enzymes, leading to the autodigestion of pancreatic tissue. This results in local inflammation and, in severe cases, systemic complications.EtiologyUnderstanding the underlying causes is crucial, as identifying the etiology guides treatment and anticipates complications. Acute pancreatitis can be triggered by various factors, typically grouped into the following clinical categories.Biliary...
01:27Acute Pancreatitis I: Introduction
Pancreatitis is inflammation of the pancreas, an organ located behind the stomach. It can be either acute or chronic.
Acute pancreatitis is characterized by rapid inflammation of the pancreas, often caused by factors like gallstone blockage or excessive alcohol consumption. Chronic pancreatitis, on the other hand, is a slow, progressive inflammation that may result from long-term alcohol abuse, obstructions in the pancreatic duct, or genetic factors.
The causes of acute pancreatitis include:
Acute pancreatitis is characterized by rapid inflammation of the pancreas, often caused by factors like gallstone blockage or excessive alcohol consumption. Chronic pancreatitis, on the other hand, is a slow, progressive inflammation that may result from long-term alcohol abuse, obstructions in the pancreatic duct, or genetic factors.
The causes of acute pancreatitis include:
01:30Acute Pancreatitis II: Clinical Manifestations and Management
Acute pancreatitis presents a complex medical emergency characterized by rapid onset inflammation of the pancreas, demanding timely diagnosis and management to prevent complications. The condition primarily manifests through severe upper abdominal pain that often radiates to the back. This pain intensifies following the consumption of fatty foods. Accompanying symptoms such as nausea, vomiting, abdominal distention, fever, dyspnea, cyanosis, and jaundice can vary in intensity but significantly...
01:25Chronic Pancreatitis I: Introduction
Chronic pancreatitis is a long-standing, relapsing inflammation of the pancreas, characterized by irreversible damage to the gland. It results in progressive destruction of the pancreatic parenchyma, fibrosis, and eventual loss of both exocrine and endocrine function. The disease may evolve gradually after multiple episodes of acute pancreatitis or develop independently.EtiologyChronic pancreatitis can arise from a variety of causes:Alcohol use is the leading cause, accounting for 70–80% of...
01:24Chronic Pancreatitis I: Introduction
The pancreas, an elongated and flat gland situated behind the stomach, serves a vital function in digesting food and managing blood sugar levels.
Pancreatitis is the inflammation of the pancreas, which occurs when the immune system becomes active and causes swelling, pain, and disruptions in organ function. Pancreatitis can manifest as either an acute or chronic condition.
Acute pancreatitis arises suddenly and lasts for a brief duration, while chronic pancreatitis is a long-term affliction...
Pancreatitis is the inflammation of the pancreas, which occurs when the immune system becomes active and causes swelling, pain, and disruptions in organ function. Pancreatitis can manifest as either an acute or chronic condition.
Acute pancreatitis arises suddenly and lasts for a brief duration, while chronic pancreatitis is a long-term affliction...