Valproic acid-induced acute pancreatitis in pediatric age: case series and review of literature

Cofini, Marta; Quadrozzi, F; Favoriti, Pasqualino; Favoriti, M; Cofini, G

doi:10.11138/gchir/2015.36.4.158

Cited by 23 publications

(27 citation statements)

References 21 publications

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“…5,6 Drug-induced pancreatitis (DIP) has been estimated to account for 13% of cases of pediatric AP. 7 However, the actual incidence and prevalence of DIP appears to be underestimated due to underreporting. The three drugs most commonly associated with DIP include valproic acid, L-aspariginase, and prednisone.…”

Section: Changing Etiologiesmentioning

confidence: 99%

An Update on Pediatric Pancreatitis

Shukla-Udawatta¹,

Madani²,

Kamat³

2017

Pediatr Ann

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There has been a rise in the incidence and number of admissions of children with pancreatitis over the past 20 years. Current management practices for pancreatitis in children are adapted from standards of care for adults, and there are a lack of multicenter, prospective research studies on pancreatitis in children. There are inherent differences in the clinical presentation and natural course of pancreatitis between adults and children. This review focuses on the current understanding of the epidemiology, etiologies, evaluation, and management of children with pancreatitis. [Pediatr Ann. 2017;46(5):e207-e211.].

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Section: Changing Etiologiesmentioning

confidence: 99%

An Update on Pediatric Pancreatitis

Shukla-Udawatta¹,

Madani²,

Kamat³

2017

Pediatr Ann

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“…A PRISMA flow diagram summarises the process of study selection (figure 1). Out of 4948 references screened, 59 eligible studies were identified (table 1) — 14 reported on DIP detection,6 11–23 with seven of those also reporting a DIP diagnostic process, while 45 reported only a DIP diagnostic process 24–68. Forty per cent (n=23) of the studies were published between 2010 and 2016, 29% between 2000 and 2009 and 32% prior to 2000.…”

Section: Resultsmentioning

confidence: 99%

Methods for the early detection of drug-induced pancreatitis: a systematic review of the literature

et al. 2019

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ObjectivesWe systematically reviewed the literature to identify evidence-informed recommendations regarding the detection of drug-induced pancreatitis (DIP) and, secondarily, to describe clinical processes for the diagnosis of DIP.DesignSystematic review.Data sourcesOvid MEDLINE, including Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Embase Classic+Embase, the Cochrane Library.Eligibility criteriaWe included clinical practice guidelines, systematic reviews, narrative reviews and observational studies with a focus of establishing incidence, prevalence or diagnostic approaches for DIP. Clinical trials that diagnosed DIP as an outcome were also included.Data extraction and synthesisTwo reviewers screened citations and performed data extraction. A narrative synthesis of the evidence was prepared.ResultsFifty-nine studies were included. Early published evidence suggested serial pancreatic ultrasound could detect subclinical pancreatitis; however, subsequent studies demonstrated no utility of serial ultrasound or serial monitoring of pancreatic enzymes in the early detection of DIP. Two small studies conducted in patients with a high baseline risk of acute pancreatitis concluded serial monitoring of pancreatic enzymes may be useful to guide early discontinuation of medications with known associations with pancreatitis. Early discontinuation of medication was not advised for lower-risk patients because some medications cause transient elevations of pancreatic enzymes that do not progress to acute pancreatitis. Eight of 52 studies (15%) reporting a clinical diagnostic process for DIP reported using currently accepted criteria for the diagnosis of acute pancreatitis. A variety of methods were used to assess drug-related causality.ConclusionsThere is minimal evidence to support the use of serial monitoring by ultrasound or pancreatic enzymes to detect cases of DIP. Serial monitoring may be useful to guide early discontinuation of DIP-associated drugs in high-risk patients, but not in lower-risk patients. Greater uptake of standardised diagnostic and causality criteria for DIP is needed.Trial registration numberCRD42017060473

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“…However, care has to be applied in the choice of the HDAC inhibitor. For example valproic acid treatment, an antiepileptic drug that also showed a pan-HDACs inhibitory activity, was associated with development of pancreatitis and multiorgan failure in humans [67][68][69]. In mice, it caused disease exacerbation, manifested by increased inflammation, decreased proliferation and persistent acinar de-differentiation with non-resolving ADMs [53].…”

Section: Hdacs In Pancreatic Regenerationmentioning

confidence: 99%