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* = Presenting author

P527 Frequency and predictors of azathioprine induced pancreatitis amongst inflammatory bowel disease patients: results of a tertiary referral centre

N. Demir*1, T. Eskazan2, Y. Erzin2, I. Hatemi2, S. Bozcan2, K. Atay2, A.F. Celik2

1Istanbul university Cerrahpasa medical school, Gastroenterology, Istanbul, Turkey, 2IstanbuI university Cerrahpasa medical school, Gastroenterology, Istanbul, Turkey

Background

The study aim was to identify the frequency of azathioprine (AZA) induced pancreatitis and related factors in a tertiary referral centre.

Methods

An IBD clinic has been run by our team for 15 years, currently with 2 200 patients with UC or CD under the same registry. These patients’ files retrospectively were analysed, and 630 subjects on AZA Tx with regular follow-up were eligible for the final analysis. Patients’ demographic features such as age, sex, age at diagnosis, disease extension, smoking status, alcohol consumption, family history for IBD, presence of gallstones, lipid and calcium levels, time between diagnosis and AZA initiation, dose of AZA, concomitant medications, and CRP levels at AZA initiation were noted. A patient was regarded to have pancreatitis in the presence of typical upper abdominal pain together with positive imaging and/or raised amylase at least 3-fold. Cases with pancreatitis randomly were matched with patients with the same diagnosis having no pancreatitis under AZA.

Results

In the study, 13 out of 630 (2%) patients developed AZA induced acute pancreatitis. Nine of them developed pancreatitis within the first month and the rest within 2 mo under AZA. None of them had necrotising disease, and only 1 had CRP > 150 mg/l and only 4 (30%) were hospitalised. Imaging (US or CT) only was positive in 7 (53%). When those with pancreatitis (Group 1 = 13) were compared with patients without pancreatitis (Group 2 = 34), there was no difference regarding age, sex, age at diagnosis, disease extension, AZA dose, concomitant medications, and alcohol consumption, but active smokers were significantly more common in Group 1 (p = 0.03).

Table 1 Comparison of both groups

Group 1 (n = 13)Group2 (n = 34)p
Age at diagnosis of IBD31.92 ± 11.3331.32 ± 10.42NS
Age at 
pancreatitis32.53 ± 11.22NA
Sex (female)7 (54%)15 (44%)NS
Hyperlipidaemia0 (0%)1 (3%)NS
Presence of gallstones1 (8%)5 (15%)NS
Smokers11 (85%)17(50%)0.03
Alcohol 
consumption3 (23%)5 (15%)NS
Mean initial AZA dose (mg)100.00 ± 36.7986.53 ± 32.58NS
Mean CRP level (mg/l) at AZA 
initiation64.69 ± 51.7455.29 ± 58.67NS

Conclusion

In accordance with the available literature, the present study shows that only a minority of IBD patients develop AZA induced pancreatitis all within the first 2 months, and fortunately a milder one. Smoking was significantly more common amongst patients developing pancreatitis under AZA treatment. Keeping in mind that smoking is a recently established risk factor for chronic pancreatitis, we think that this interesting finding deserves further evaluation in future studies.