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Mesalazine-Induced Acute Pancreatitis in Inflammatory Bowel Disease Patients: A Systematic Review

Juan Pan1, Zuyi Li1, Chao Ye2

  • 1Department of Pharmacy, Liuyang Hospital of Traditional Chinese Medicine, Changsha, Hunan, 410300, People's Republic of China.

Therapeutics and Clinical Risk Management
|February 3, 2025
PubMed
Abstract

Insights

Mesalazine can cause acute pancreatitis (AP) in inflammatory bowel disease (IBD) patients, often within two weeks. Stopping the drug usually resolves symptoms, but the reaction can recur if mesalazine is reintroduced.

Area of Science:

  • Gastroenterology
  • Pharmacology
  • Clinical Medicine

Background:

  • Mesalazine is a primary treatment for inflammatory bowel disease (IBD).
  • Acute pancreatitis (AP) is a rare but recognized adverse effect of mesalazine, first reported in 1989.
  • Previous evidence linking mesalazine to AP relies on case reports and limited retrospective studies.

Purpose of the Study:

  • To investigate the characteristics of acute pancreatitis (AP) induced by mesalazine in patients with inflammatory bowel disease (IBD).
  • To analyze the clinical presentation, diagnostic findings, and outcomes of mesalazine-induced AP.
  • To evaluate the recurrence risk of AP upon mesalazine rechallenge.

Main Methods:

  • A systematic literature search was conducted across multiple databases (CNKI, Wanfang Data, VIP, PubMed, Web of Science) up to March 2024.
  • Case reports of mesalazine-related AP in IBD patients were collected.
  • Descriptive analysis of the collected case reports was performed.

Main Results:

  • The study analyzed 34 reports involving 42 patients with mesalazine-induced AP.
  • Pancreatitis onset occurred a median of 14 days after mesalazine initiation, with abdominal pain as the most common symptom (100%).
  • Elevated serum amylase/lipase and imaging findings confirmed pancreatitis; discontinuation led to resolution in all cases, with 93.3% improving within a week. Rechallenge resulted in recurrence in 21 cases.

Conclusions:

  • Mesalazine-induced AP is a rare but significant adverse drug reaction.
  • The onset of AP is not dose-dependent and can occur anytime during treatment, often within two weeks.
  • Discontinuation of mesalazine is effective for resolution, but the condition may recur upon rechallenge.
Keywords:
acute pancreatitisadverse drug reactionsclinical characteristicsmesalazinesystematic review

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