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Drug-Induced Acute Pancreatitis: Time for a Uniform Classification System

2007; Elsevier BV; Volume: 5; Issue: 12 Linguagem: Inglês

10.1016/j.cgh.2007.08.017

1542-7714

B.W.M. Spanier, Marco J. Bruno,

Liver Disease Diagnosis and Treatment

Badalov et al1Badalov N. Baradarian R. Iswara K. et al.Drug-induced acute pancreatitis: an evidence-based review.Clin Gastroenterol Hepatol. 2007; 5: 648-661Abstract Full Text Full Text PDF PubMed Scopus (364) Google Scholar recently published an evidence-based review about drug-induced acute pancreatitis (DIP). They categorized 120 drugs in 4 classes of drugs based on the published weight of evidence with acute pancreatitis (AP). The investigators do not discuss their newly introduced classification system of DIP in relation to previously published classification systems. In 1980, Mallory and Kern2Mallory A. Kern Jr, F. Drug-induced pancreatitis: a critical review.Gastroenterology. 1980; 78: 813-820PubMed Scopus (354) Google Scholar proposed a system in which a drug was classified as having either a definite, probable, or possible association with pancreatitis based on multiple criteria. Since that time, several review articles have used this 3-group classification system. In 2005, Trivedi and Pitchumoni3Trivedi C.D. Pitchumoni C.S. Drug-induced pancreatitis: an update.J Clin Gastroenterol. 2005; 39: 709-716Crossref PubMed Scopus (308) Google Scholar introduced an adapted 3-group classification system and gave more weight to the number of reported cases and a positive rechallenge. However, in the recent classification system by Badalov et al,1Badalov N. Baradarian R. Iswara K. et al.Drug-induced acute pancreatitis: an evidence-based review.Clin Gastroenterol Hepatol. 2007; 5: 648-661Abstract Full Text Full Text PDF PubMed Scopus (364) Google Scholar the number of reports are less important and more weight is given to a positive rechallenge, the exclusion of other causes, and the time relation between drug use and the onset of AP. Clearly, since 1980, classification systems of DIP frequently have been adapted and subject to different viewpoints. It stands without doubt that for their efforts, Mallory and Kern,2Mallory A. Kern Jr, F. Drug-induced pancreatitis: a critical review.Gastroenterology. 1980; 78: 813-820PubMed Scopus (354) Google Scholar Trivedi and Pitchumoni,3Trivedi C.D. Pitchumoni C.S. Drug-induced pancreatitis: an update.J Clin Gastroenterol. 2005; 39: 709-716Crossref PubMed Scopus (308) Google Scholar and now Badalov et al1Badalov N. Baradarian R. Iswara K. et al.Drug-induced acute pancreatitis: an evidence-based review.Clin Gastroenterol Hepatol. 2007; 5: 648-661Abstract Full Text Full Text PDF PubMed Scopus (364) Google Scholar are to be commended and congratulated. However, for future research a uniform classification system that is accepted and used by a wide audience of physicians is of great importance. The initiation of an international scientific working group, building further on the work and efforts of these investigators, should be the first step to reach this goal. Drug-Induced Acute Pancreatitis: An Evidence-Based ReviewClinical Gastroenterology and HepatologyVol. 5Issue 6PreviewThe diagnosis of drug-induced acute pancreatitis often is difficult to establish. Although some medications have been shown to cause acute pancreatitis with a large body of evidence, including rechallenge, some medications have been attributed as a cause of acute pancreatitis merely by a single published case report in which the investigators found no other cause. In addition, some medications reported to have caused acute pancreatitis have obvious patterns of presentation, including the time from initiation to the development of disease (latency). Full-Text PDF ReplyClinical Gastroenterology and HepatologyVol. 5Issue 12PreviewWe appreciate the comments of Drs Spanier and Bruno. The letter submitted to the editor suggests that we should have compared our classification system with prior published classification systems on drug-induced acute pancreatitis. We would like to point out that no other system of classification exists. The prior articles are reviews that describe the evidence of drugs causing pancreatitis in vague categories (definite, probable, and possible) with unclear inclusion criteria for which a drug becomes placed in the various categories. Full-Text PDF