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Acute Pancreatitis II: Clinical Manifestations and Management01:30

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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...
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Pancreatitis is inflammation of the pancreas, an organ located behind the stomach. It can be either acute or chronic.
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Dipeptidyl peptidase 4 (DPP-4) is a serine protease widely distributed in the body. It's involved in the inactivation of GLP-1 and GIP hormones, which are crucial for insulin regulation. DPP-4 inhibitors, such as sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina), and vildagliptin (Galvus), help increase the proportion of active GLP-1, enhancing insulin secretion. These inhibitors work by competitively binding to DPP-4. This binding causes a...
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Vildagliptin-induced acute pancreatitis without enzyme elevation.

Zeynel Mungan1, Tan Attila, Zeynep Ünal Kabaoğlu

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Vildagliptin, a medication for diabetes mellitus, may cause acute pancreatitis (AP) even with normal enzyme levels. Clinicians should consider this DPP-4 inhibitor in diabetic patients with abdominal pain and normal pancreatic enzymes.

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Area of Science:

  • Endocrinology
  • Gastroenterology
  • Pharmacology

Background:

  • Diabetes mellitus management often involves dipeptidyl peptidase-4 (DPP-4) inhibitors like vildagliptin.
  • Acute pancreatitis (AP) is a serious condition characterized by upper abdominal pain and elevated pancreatic enzymes.

Observation:

  • Two patients with diabetes mellitus presented with upper abdominal pain and imaging consistent with AP.
  • Serum amylase and lipase levels were within normal limits in both cases.
  • Vildagliptin was identified as the sole potential causative agent.

Findings:

  • This case series presents the first documented instances of vildagliptin-induced AP presenting clinically and radiographically without elevated pancreatic enzymes.
  • The findings challenge the typical diagnostic criteria for AP in patients using DPP-4 inhibitors.

Implications:

  • Clinicians should maintain a high index of suspicion for AP in diabetic patients experiencing abdominal pain, even with normal serum amylase and lipase.
  • Vildagliptin and potentially other DPP-4 inhibitors should be considered in the differential diagnosis of AP in this patient population.
  • Further research is warranted to elucidate the mechanism of DPP-4 inhibitor-induced pancreatitis and establish diagnostic guidelines.