Increased Risk of Acute Pancreatitis with Codeine Use in Patients with a History of Cholecystectomy

Kim, Juhyeun; Tabner, Andrew; Johnson, Graham; Brumback, Babette; Hartzema, Abraham G.

doi:10.1007/s10620-019-05803-3

Cited by 11 publications

(9 citation statements)

References 35 publications

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“…Subgroup analysis of 4 studies between opioids and NSAIDs revealed there was no significant difference in the need for additional analgesic (OR 0.56, 95% CI 0.24 to 1.32, p = 0.18) without heterogeneity (I 2 = 0), -VAS, other clinical outcomes, and adverse events. Recently, a retrospective study conducted by Kim et al (50) showed that opioid was associated with an increased risk of developing AP compared to NSAIDs (OR 2.64, 95% CI 1.54 to 4.52). It is reported that opioids can potentially cause AP in patients with a history of cholecystectomy due to its adverse effect of sphincter of Oddi constriction (50,51).…”

Section: Discussionmentioning

confidence: 99%

Pain Management in Acute Pancreatitis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

et al. 2021

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Background: Pain management is an important priority in the treatment of acute pancreatitis (AP). Current evidence and guideline recommendations are inconsistent on the most effective analgesic protocol. This systematic review and meta-analysis of randomised controlled trials (RCTs) aimed to compare the safety and efficacy of analgesics for pain relief in AP.Methods: A literature search was performed to identify all RCTs assessing analgesics in patients with AP. The primary outcome was the number of participants who needed rescue analgesia. Study quality was assessed using Jadad score. Pooled odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CI) were analysed using a random-effects model.Results: Twelve studies comprising 699 patients with AP (83% mild AP) were analysed. The tested analgesics significantly decreased the need for rescue analgesia (3 studies, OR.36, 95% CI 0.21 to 0.60) vs. placebo or conventional treatment. The analgesics also improved the pain score [Visual Analogue Scale (Δ-VAS)] at 24 h (WMD 18.46, 0.84 to 36.07) and by the 3rd to 7th days (WMD 11.57, 0.87 to 22.28). Opioids vs. non-opioids were associated with a decrease in the need for rescue analgesia (6 studies, OR 0.25, 95% CI 0.07 to 0.86, p = 0.03) but without significance in pain score. In subgroup analyses, opioids were similar to non-steroidal anti-inflammatory drugs (NSAIDs) regarding the primary outcome (4 studies, OR 0.56, 95% CI 0.24 to 1.32, p = 0.18). There were no significant differences in other clinical outcomes and rate of adverse events. Other studies, comparing epidural anaesthesia vs. patient-controlled analgesia and opioid (buprenorphine) vs. opioid (pethidine) did not show significant difference in primary outcome. Study quality issues significantly contributed to overall study heterogeneity.Conclusions: NSAIDs and opioids are equally effective in decreasing the need for rescue analgesia in patients with mild AP. The relative paucity of trials and high-quality data in this setting is notable and the optimal analgesic strategy for patients with moderately severe and severe AP still requires to be determined.

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Section: Discussionmentioning

confidence: 99%

Pain Management in Acute Pancreatitis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

et al. 2021

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“…Opioids were described in a total of forty-two cases, including five re-exposure cases and codeine was most commonly identified [7][8][9][12][13][14][15]. An important feature of this [11] publication is that they also looked at commonly prescribed medication involved in the development of drug-induced pancreatitis, and oxycodone was reported in 55 cases [11].…”

Section: Discussionmentioning

confidence: 99%

“…In a review by Trivedi et al [ 11 ], all reported cases of drug-induced pancreatitis from 1966 to April 30, 2004, were evaluated and grouped into three classes where class I represented the medications with the strongest evidence of correlation with acute pancreatitis. Opioids along with azathioprine, asparaginase, didanosine, valproic acid, mercaptopurine, mesalamine, estrogen, steroids, sulfasalazine, etc., are categorized as class I. Opioids were described in a total of forty-two cases, including five re-exposure cases and codeine was most commonly identified [ 7 - 9 , 12 - 15 ]. An important feature of this [ 11 ] publication is that they also looked at commonly prescribed medication involved in the development of drug-induced pancreatitis, and oxycodone was reported in 55 cases [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Heroin-Induced Acute Pancreatitis

Ciobanu¹,

Jadav²,

Ramos³

et al. 2021

Cureus

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Heroin-induced pancreatitis (HIP) is rare with only a few cases reported previously in the literature and the pathophysiology mechanism is yet to be investigated. We present two cases of acute pancreatitis (AP) in the setting of acute heroin (diacetylmorphine) intoxication. Both patients presented with nausea, vomiting and severe abdominal pain after intranasal heroin use. On laboratory analysis were found to have elevated serum lipase, positive urine toxicology for opioids, without any other obvious causes for AP. Both patients had a full recovery with supportive treatment. As a general approach, drug-induced pancreatitis is a diagnosis of exclusion and a high index of suspicion is required when the most common etiologies are ruled out.

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“…Pain in subjects with SAP is typically managed with opioids in the USA; however, there are significant geographical variations in AP pain management worldwide, which highlights the need for additional evidence in this domain [55]. In animals with AP, morphine worsens the severity of AP and inhibits pancreatic regeneration [56•]; also codeine, a different opioid, has been implicated as a risk factor for AP among patients who undergo cholecystectomy [57]. Postulated mechanisms include increased bacterial translocation due to intestinal dysmotility, increased sphincter of Oddi pressure, and delay in regenerative immune response [56•].…”

Section: Pain Managementmentioning

confidence: 99%

Management of Severe Acute Pancreatitis

Lee

Papachristou

2020

Curr Treat Options Gastro

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Purpose of review There have been significant advancements in different aspects of management of severe acute pancreatitis (SAP). Our review of the most recent literature focuses on severity prediction, fluid resuscitation, analgesic administration, nutrition, and endoscopic intervention for SAP and its extra-pancreatic complications. Recent findings Recent studies on serum cytokines for the prediction of SAP have shown superior prognostic performance when compared with conventional laboratory tests and clinical scoring systems. In patients with established SAP and vascular leak syndrome, intravenous fluids should be administered with caution to prevent intra-abdominal hypertension and volume overload. Endoscopic retrograde cholangiopancreatography improves outcomes only in AP patients with suspected cholangitis. Early enteral tubefeeding does not appear to be superior to on-demand oral feeding. Abdominal compartment syndrome is a highly lethal complication of SAP that requires percutaneous drainage or decompressive laparotomy. Endoscopic transmural drainage followed by necrosectomy (i.e., "step-up approach") is the treatment strategy of choice in patients with symptomatic or infected walled-off pancreatic necrosis. Summary SAP is a complex clinical syndrome associated with a high mortality rate. Early prediction of SAP remains challenging due to the limited accuracy of the available prediction tools. Early fluid resuscitation, organ support, enteral nutrition, and prevention of/or prompt recognition of abdominal compartment syndrome remain cornerstones of its management. A step-up, minimally invasive drainage/debridement is the preferred approach for patients with infected pancreatic necrosis.

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Increased Risk of Acute Pancreatitis with Codeine Use in Patients with a History of Cholecystectomy

Cited by 11 publications

References 35 publications

Pain Management in Acute Pancreatitis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Pain Management in Acute Pancreatitis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Heroin-Induced Acute Pancreatitis

Management of Severe Acute Pancreatitis

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