From the Guidelines
Pancreatitis is primarily caused by gallstones and alcohol abuse, which account for approximately 70% of cases, with other causes including medications, hypertriglyceridemia, autoimmune conditions, genetic factors, anatomical abnormalities, trauma, infections, and post-ERCP complications. The etiology of acute pancreatitis should be established in at least three fourths of patients, and the initial history should focus on previous symptoms or documentation of gallstones, alcohol use, history of hypertriglyceridemia or hypercalcemia, family history of pancreatic disease, prescription and nonprescription drug history, history of trauma, and the presence of concomitant autoimmune diseases 1.
Causes of Pancreatitis
- Gallstones: block the pancreatic duct and cause digestive enzymes to build up in the pancreas
- Alcohol abuse: chronic heavy drinking causes toxic effects on pancreatic cells
- Medications: certain antibiotics (sulfonamides), diuretics (thiazides), immunosuppressants (azathioprine), and anti-seizure drugs (valproic acid) can trigger pancreatitis
- Hypertriglyceridemia: levels exceeding 1,000 mg/dL can lead to pancreatitis by causing inflammation when triglycerides are broken down by pancreatic lipase
- Autoimmune conditions: the body's immune system attacks the pancreas
- Genetic factors: mutations in the PRSS1, SPINK1, or CFTR genes
- Anatomical abnormalities: pancreas divisum
- Trauma: to the abdomen
- Infections: mumps, coxsackievirus
- Post-ERCP complications: can occur after endoscopic retrograde cholangiopancreatography
Diagnosis and Management
Abdominal ultrasonography should be obtained at admission to look for cholelithiasis or choledocholithiasis, and CT or EUS should be performed in those patients with unexplained pancreatitis who are at risk for underlying pancreatic malignancy (age older than 40 years) 1. In patients with chronic pancreatitis, nutritional support is crucial to prevent malnutrition and related complications, and enteral nutrition is preferred over parenteral nutrition 1. Understanding the causes of pancreatitis is essential for proper management and prevention of recurrent episodes, and a comprehensive diagnostic approach should be taken to establish the etiology of the disease.
From the FDA Drug Label
Cases of life-threatening pancreatitis have been reported in both children and adults receiving valproate. Pancreatitis has been reported in patients taking fenofibrate, gemfibrozil and clofibrate.
The different causes of pancreatitis include:
- Valproate use: Valproate has been associated with an increased risk of pancreatitis, with some cases being life-threatening and resulting in death.
- Fenofibrate use: Fenofibrate has also been linked to pancreatitis, which may be related to its effects on bile ducts and cholesterol excretion.
- Biliary tract stone or sludge formation: Fenofibrate may increase the risk of pancreatitis by causing biliary tract stone or sludge formation, leading to obstruction of the common bile duct.
- Severe hypertriglyceridemia: Pancreatitis may occur in patients with severe hypertriglyceridemia, potentially as a result of fenofibrate treatment.
- Direct drug effect: Fenofibrate may have a direct effect on the pancreas, increasing the risk of pancreatitis. 2 3
From the Research
Causes of Pancreatitis
- The most common causes of acute pancreatitis are gallstones and alcohol consumption 4, 5, 6, 7
- Other important causes include:
- Metabolic conditions can also cause pancreatitis, including:
- In about 15% of cases, the cause of pancreatitis remains unknown (idiopathic pancreatitis) 4
- Smoking is a co-factor in the development of chronic pancreatitis, and may also contribute to recurrent acute pancreatitis 7