Acute Pancreatitis in Crohnʼs Disease Due to 5-ASA Therapy

Radkë, Michaël; Bartolomaeus, Georg; Müller, Manfred J.; Richter, Ingo

doi:10.1097/00005176-199304000-00022

Cited by 26 publications

(12 citation statements)

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“…In a study of 26 children with Crohn's ileocolitis, renal function was not different in children receiving sulfasalazine, compared with controls (76). Case reports have documented rare side effects of mesalazine in pediatric patients: pancreatitis (77,78), hepatotoxicity (79,80), interstitial nephritis (81) and pericarditis (82). In sulfasalazine hypersensitivity (with symptoms like rash, fever, hives, arthralgia, or hepatitis), desensitization has shown to be successful in approximately 56% of children (83).…”

Section: Aminosalicylatesmentioning

confidence: 99%

Treatment of Inflammatory Bowel Disease in Childhood: Best Available Evidence

Escher

Taminiau

Nieuwenhuis

et al. 2003

Inflammatory Bowel Diseases

113

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The physician treating children with inflammatory bowel disease is confronted with a number of specific problems, one of them being the lack of randomized, controlled drug trials in children. In this review, the role of nutritional therapy is discussed with a focus on primary treatment, especially for children with Crohn's disease. Then, the available medical therapies are highlighted, reviewing the evidence of effectiveness and side effects in children, as compared with what is known in adults. Nutritional therapy has proven to be effective in inducing and maintaining remission in Crohn's disease while promoting linear growth. Conventional treatment consists of aminosalicylates and corticosteroids, whereas the early introduction of immunosuppressives (such as azathioprine or 6-mercaptopurine) is advocated as maintenance treatment. If these drugs are not tolerated or are ineffective, methotrexate may serve as an alternative in Crohn's disease. Cyclosporine is an effective rescue therapy in severe ulcerative colitis, but only will postpone surgery. A novel strategy to treat Crohn's disease is offered by infliximab, a monoclonal antibody to the proinflammatory cytokine tumor necrosis factor (TNF)-alpha. Based on the best-available evidence, suggested usage is provided for separate drugs with respect to dosage and monitoring of side effects in children.

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Section: Aminosalicylatesmentioning

confidence: 99%

Treatment of Inflammatory Bowel Disease in Childhood: Best Available Evidence

Escher

Taminiau

Nieuwenhuis

et al. 2003

Inflammatory Bowel Diseases

113

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“…The severity of AP and length of hospitalization were mostly not described by the authors. In the cases which reported severity, AP was usually mild (73.7%) [2,5,11,19,22,25,28,38], one moderately severe episode was found [31], and of the four severe cases reported [4,20,32], two were lethal; 60.5% of the identified patients (n=26) were rechallenged positively with one of the formulations of the 5-ASA. After discontinuation of the offending drug, symptoms usually disappeared quickly [3,12,14,15,18], as observed in our case as well.…”

Section: Discussionmentioning

confidence: 99%

“…The latency between intake of 5-ASA and onset of pancreatitis usually varied between a few days and a few months, however, DIAP can occur after long term treatment as well [4,12,21,28,35,39]. The route of administration [4,25,29,31,39] (either oral or rectal) and use of coated formulations [1][2][3]17] (time-or pH-dependent) did not appear to affect the risk of AP, and in most of the cases, there was a rapid recurrence if rechallenged [3,12,14,15,18]. 5-ASA induced AP was usually self-limited.…”

Section: Discussionmentioning

confidence: 99%

5-ASA Induces Mild Acute Pancreatitis. Case Report and Review of the Literature

Meczker

Mikó

Hegyi

2018

JGLD

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5-aminosalicylic acid has been reported to be able of inducing acute pancreatitis as an adverse reaction. However, in most case reports, rechallenge of the drug is missing; therefore, evidence is still needed to confirm its role in the clinical course of acute pancreatitis and its influence on the outcome. Here, we report a case of recurrent acute pancreatitis secondary to 5-aminosalicylic acid, with positive unintentional rechallenge. A systematic search of the literature was performed and 42 cases from 35 articles were summarized concerning the clinical course of 5-aminosalicylic acid induced acute pancreatitis.

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“…[116,117] with adverse effects including worsening colitis, pancreatitis, hepLong-term adverse effects associated with systemic corticosteatitis, anemia, interstitial nephritis, and proteinuria. [107][108][109][110] As roid use have limited their clinical utility. These include excessive such, all patients treated with sulfasalazine or mesalamine should bone loss, weight gain, cataracts, glucose intolerance, hypertenundergo yearly urinalysis, twice-yearly complete blood count sion, and a variety of neuropsychiatric complaints.…”

Section: Postoperative Recurrence Of CDmentioning

confidence: 99%

Current Therapy of Inflammatory Bowel Disease in Children

Rufo

Bousvaros

2006

Pediatric Drugs

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Ulcerative colitis (UC) and Crohn disease (CD) are chronic intestinal inflammatory diseases that can present as bloody diarrhea, abdominal pain, and malnutrition. Collectively, these disorders are referred to as inflammatory bowel disease (IBD). All patients with IBD share a common pathophysiology. However, there are a number of developmental, psychosocial, and physiologic issues that are unique to the approximate, equals 20% of patients that present during childhood or adolescence. These include the possibility of disease-induced delays in linear growth or physical development, differences in drug dosing, and the changes in social and cognitive development that occur as children move from school-age years into adolescence and early adulthood. Gastroenterologists caring for these children must therefore develop an optimal regimen of pharmacologic therapies, nutritional management, psychologic support, and properly timed surgery (when necessary) that will maintain disease remission, minimize disease and drug-induced adverse effects, and optimize growth and development. This article reviews current approaches to the management of patients with UC and CD and highlights issues specific to the treatment of children with IBD. The principal medical therapies used to induce disease remission in patients with UC are aminosalicylates (for mild disease), corticosteroids (for moderate disease), and cyclosporine (ciclosporin) (for severe disease). If a patient responds to the induction regimen, maintenance therapies that are used to prevent disease relapse include aminosalicylates, mercaptopurine, and azathioprine. Colectomy with creation of an ileal pouch anal anastomosis (J pouch) has become the standard of care for patients with severe or refractory colitis and results in an improved quality of life in most patients. Therefore, the risks associated with using increasingly potent immunosuppressant agents must be balanced in each case against a patient's desire to retain their colon and avoid a temporary or potentially permanent ileostomy. Decisions about drug therapy in the management of patients with CD are more complex and depend on both the location (e.g. gastroduodenal vs small intestinal vs colonic), as well as the behavior of the disease (inflammatory/mucosal vs stricturing vs perforating) in a given patient. Induction therapies for CD typically include aminosalicylates and antibiotics (for mild mucosal disease), nutritional therapy (including elemental or polymeric formulas), corticosteroids (for moderate disease), and infliximab (for corticosteroid-resistant or fistulizing disease). Aminosalicylates, mercaptopurine, azathioprine, methotrexate, and infliximab can be used as maintenance therapies. Because surgical treatment of CD is not curative, it is typically reserved for those patients either with persistent symptoms and disease limited to a small section of the intestine (e.g. the terminal ileum and cecum) or for the management of complications of the disease including stricture or abdominal abscess. When surgery...

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Acute Pancreatitis in Crohnʼs Disease Due to 5-ASA Therapy

Cited by 26 publications

References 0 publications

Treatment of Inflammatory Bowel Disease in Childhood: Best Available Evidence

Treatment of Inflammatory Bowel Disease in Childhood: Best Available Evidence

5-ASA Induces Mild Acute Pancreatitis. Case Report and Review of the Literature

Current Therapy of Inflammatory Bowel Disease in Children

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