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Pancreatitis-Associated Medication Use in Hospitalized Pediatric and Young Adult Patients With Acute Pancreatitis
Lauren V Collen1, Paul D Mitchell2, Victor L Fox1
1From the Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, MA.
Insights
Medications are frequently used in pediatric acute pancreatitis (AP) patients, with use increasing during hospitalization. This highlights a potential under-recognized role of drugs in AP development and management.
Area of Science:
- Pediatric Gastroenterology
- Clinical Pharmacology
- Hospital Medicine
Background:
- Pancreatitis-associated medications (PAMs) may contribute to acute pancreatitis (AP) in pediatric and young adult populations.
- Understanding the prevalence of PAM use is crucial for identifying potential triggers and improving patient outcomes.
Purpose of the Study:
- To determine the prevalence of PAM use at admission and discharge in hospitalized pediatric and young adult AP patients.
- To assess PAM use at admission specifically in patients with idiopathic AP.
Main Methods:
- A retrospective single-center study analyzed 119 patients under 21 years hospitalized with AP.
- Patient charts were reviewed for demographic data, pancreatitis etiology, comorbidities, and PAM use.
- PAMs were classified using an evidence-based system; descriptive statistics reported prevalence.
Main Results:
- 50% of patients used PAMs on admission, increasing to 67% at discharge (P=0.0009).
- 44% of idiopathic AP patients used PAMs on admission.
- Commonly used Class I PAMs included omeprazole, trimethoprim-sulfamethazole, valproic acid, and 6-mercaptopurine.
Conclusions:
- Medications likely play an under-recognized role in pediatric AP.
- Further research into proton pump inhibitor use in AP management is warranted.
Objective:
The objective of this study is (1) to describe the prevalence of pancreatitis-associated medication (PAM) use at admission and discharge in pediatric and young adult patients hospitalized with acute pancreatitis (AP) and (2) to describe the prevalence of PAM use at admission in patients classified as having idiopathic AP.
Study Design:
A single-center retrospective study of patients <21 years who were hospitalized with AP or acute recurrent pancreatitis from March 2015 to July 2017 was performed. Charts were reviewed for demographic data, etiology of pancreatitis, comorbidities, and use of PAMs at admission and discharge. PAMs were defined and scored based on an evidence-based classification system, with class I PAMs having strongest evidence for causation. Standard descriptive statistics were used to report prevalence data.
Results:
Our cohort was comprised of 119 patients; 50% of patients were using a PAM at admission and 67% were taking a PAM at discharge, reflecting a significant change (P = 0.0009); 44% of patients classified as having idiopathic pancreatitis were taking a PAM on admission, reflecting a possibly missed role of medication in their presentation. Comorbidities significantly associated with PAM use included seizure disorder (P = 0.005) and oncologic disease (P = 0.005). The most commonly used class I PAMs were omeprazole, trimethoprim-sulfamethazole, valproic acid, and 6-mercaptopurine. The increase in prevalence of PAM use at discharge compared to admission was partially driven by addition of omeprazole to the outpatient medication regimen during the hospital stay (P = 0.07).
Conclusion:
Medications likely play an under-recognized role in pediatric AP. The practice of using proton pump inhibitors in management of AP warrants further study.
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