Keywords
How to Cite
Abstract views: 232 PDF Downloads: 150
Abstract
More than 70 drugs are known to induce pancreatitis. The frequency, clinical manifestations, and diagnosis of drug-induced pancreatitis that occurred during tuberculosis treatment have not been studied. In addition, the literature provides information regarding the pancreatic toxicity of certain anti-tuberculosis drugs.
We examined 328 patients with pulmonary tuberculosis that occurred during drug-induced hepatitis treatment. Prior to our observation, 92 (28.0%) patients abused alcohol, so chronic hepatitis had a combined etiology, i.e., it occurred due to the toxic effect of anti-tuberculosis drugs on the liver against the background of alcoholic liver disease. However, the worsening of the course of chronic hepatitis occurred in all cases due to the intake of anti-tuberculosis drugs, so we used the term “chronic, predominantly toxic (drug-induced) hepatitis.” In these patients, we diagnosed chronic pancreatitis (CP), which had both a drug- and alcohol-induced combined etiology. Since the exacerbation of pancreatitis only occurred when anti-tuberculosis drugs were taken, the etiology was predominantly drug-induced. The comparison group included these patients with a combination of predominantly drug-induced hepatitis and drug-induced CP. The main group consisted of 236 (72.0%) patients who did not abuse alcohol, indicating that both hepatitis and CP were drug-induced.
The following conclusions were drawn as a result of our study. Pain and dyspeptic syndromes are typical of drug-induced pancreatitis: patients with pulmonary tuberculosis who do not abuse alcohol experience more intense abdominal pain, while patients with a combined etiology of CP (drug- and alcohol-induced) experience more intense dyspeptic syndrome. The phenomenon of “deviation” of pancreatic enzymes into the blood is more evident in patients with an isolated drug etiology of pancreatitis who are taking first-line anti-tuberculosis drugs at the start of treatment. Exo- and endocrine pancreatic insufficiencies are common and more severe in patients with pulmonary tuberculosis who abuse alcohol and receive pancreatic drugs. In patients with pulmonary tuberculosis who do not abuse alcohol, drug-induced CP is characterized by the following sonographic changes in the pancreas: complete or partial enlargement of the organ, decreased echogenicity, structural heterogeneity, and indistinct boundaries. In the combined etiology of CP, an increase in echogenicity, calcifications, pancreatic pseudocysts, and dilation of the Wirsungʼs duct are more prevalent. In patients with pulmonary tuberculosis who abuse alcohol, the L index is significantly higher and the histographic coefficient Kgst of the ultrasound pancreatic histogram is lower than in patients with only drug-induced CP etiology.
References
Гребенев А. Л. Туберкулез поджелудочной железы. Руководство по гастроэнтерологии. Москва, 1996. Т. 3. С. 113–114.
Губергриц Н. Б. Поджелудочная железа при инфекционных и паразитарных заболеваниях. Донецк: Лебедь, 2008. 224 с.
Губергриц Н. Б., Баринова Н. Е., Беляев В. В., Лукашевич Г. М., Загоренко Ю. А., Ареф А. Р., Фоменко П. Г. Клинико-патогенетическая оценка информативности и современные возможности оптимизации ультразвуковой диагностики хронического рецидивирующего панкреатита. Мед. визуализация. 2002. № 1. С. 48–58.
Лапач С. Н., Чубенко А. В., Бабич П. Н. Статистические методы в медико-биологических исследованиях с использованием Exсel. Киев: Морион, 2000. 320 с.
Про затвердження Інструкції щодо надання допомоги хворим на туберкульоз: наказ МОЗ України від 09.06.2006 № 385. Клінічні протоколи надання медичної допомоги. Фтизіатрія. Наказ МОЗ України № 384 від 09.06.2006. Київ, 2006. 64 с.
Про затвердження Протоколу надання медичної допомоги хворим на туберкульоз: наказ МОЗ України від 09.06.2006 № 384. Клінічні протоколи надання медичної допомоги. Фтизіатрія. Наказ МОЗ України № 384 від 09.06.2006. Київ, 2006. 64 с.
Філіппов Ю. О., Скирда І. Ю. Динаміка поширеності і захворюваності основними хворобами органів травлення в Україні за 10 останніх років (1997–2006 рр.). Гастроентерологія: міжвід. зб. Дніпропетровськ: Журфонд, 2008. Вип. 40. С. 3–10.
Amodio A., Marconato E. Drug-induced acute pancreatitis in ulcerative colitis. Pancreatology. 2021. Vol. 21, No 4. P. 833.
Beger H. G., Warshaw A. L., Hruban R. H. (eds). The Pancreas: An Integrated Textbook of Basic Science, Medicine and Surgery. Oxford: Willey Blackwell, 2018. 1173 p.
Berger T. M., Cook M. J., OʼMarcaigh A. S., Zimmerman D. Acute pancreatitis in a 12 years old girl after an erythromycin overdose. Pediatrics. 1992. Vol. 90. P. 624–626.
Cartmell M. T., Kingsnorth A. N., OʼReilly D. A., Porter C., Makhija R. Faecal elastase 1 measurement in chronic pancreatitis. Clin. Chem. Lab. Med. 2005. Vol. 43, No 1. P. 97–98.
de la Iglesia-Garcia D., Vallejo-Senra N., Iglesias-Garcia J., López-López A., Nieto L., Domínguez-Muñoz J. .. Increased risk of mortality associated with pancreatic exocrine insufficiency in patients with chronic pancreatitis. J. Clin. Gastroenterol. 2018. Vol. 52, No 8. P. e63–e72.
Di Serafino M., Ronza R., DʼAuria D., Fiorentino R., Arundine D., De Leone A., Picascia S., Martino A., Crolla E., Campione S., Guida G., Molino C., Riccardi F., Romano L. Stocky/packed pancreas: a case of focal drug-induced acute pancreatitis mimicking cancer. Tomography. 2022. Vol. 8, No 4. P. 2073–2082.
Domínguez-Muñoz J. E. (ed). Clinical pancreatology for practicing gastroenterologists and surgeons. Oxford et al.: A Blackwell Publ. Co., 2005. 535 р.
Gubergrits N. B., Zagorenko Y. A. Drug-induced chronic pancreatitis associated with isoniazide. 5th Meeting of the Pancreas Club Cluj Romania. Ckuj-Napoca (Romania), 2007. P. 16.
Gumaste V. V. Erythromycin induced pancreatitis. Am. J. Med. 1989. Vol. 86. P. 725–728.
Hawksworth M. H. Acute pancreatitis associated with infusion of erythromycin. Br. Med. J. 1989. Vol. 298. P. 190–194.
Lankisch P. G., Dröge M., Gottersleben F. Drug induced pancreatitis: incidence and severity. Gut. 1995. Vol. 37. P. 565–567.
Liu B. A., Knowles S. R., Cohen L. B. Pancreatic insufficiency due to antituberculous therapy. Ann. Pharmacother. 1997. Vol. 31, No 6. P. 724–726.
Mattson K. Side effects of rifampicin: a clinical study. Scand. J. Respir. Dis. 1973. Vol. 82 (Suppl.). P. 8–52.
Paramythiotis D., Karlafti E., Veroplidou K., Fafouti M., Kaiafa G., Netta S., Michalopoulos A., Savopoulos C. Drug-induced acute pancreatitis in hospitalized COVID-19 patients. Diagnostics (Basel). 2023. Vol. 13, No 8. P. 1398.
Rabassa A. A., Trey G., Shukla U., Samo T., Anand B. S. Isoniazid induced acute pancreatitis. Ann. Intern. Med. 1994. Vol. 121. P. 433–434.
Reiche W., Abodunrin F., Destache C., Rangray R., Velagapudi M. Doxycycline induced pancreatitis: an uncommon complication of a common drug. Pharmacy (Basel). 2022. Vol. 10, No 6. P. 144.
Safizadeh Shabestari S. A., Ho S. B., Chaudhary P., Nathwani R. A. Drug-induced acute pancreatitis in a bodybuilder: a case report. J. Med. Case Rep. 2022. Vol. 16, No 1. P. 114.
Saini J., Marino D., Badalov N., Vugelman M., Tenner S. Drug induced acute pancreatitis: an evidence based classification (revised). Clin. Transl. Gastroenterol. 2022. Vol. 14, No 8. Р. e00621.
Tenner S. M., Steinberg W. M. Drug-induced acute pancreatitis. The Pancreas. Oxford et al.: Blackwell Science Ltd., 1998. Vol. 1. P. 331–342.
Trivedi C. D., Pitchumoni C. S. Drug-induced pancreatitis. An update. J. Clin. Gastroenterol. 2005. Vol. 39. P. 709–716.
Turi S., Kraft M., Lerch M. M. Acute pancreatitis associated with metabolic, infectious, and drug-related diseases. The Pancreas: an integrated textbook of basic science, medicine, and surgery. 2nd ed. Oxford et al.: Blackwell Science Ltd., 2008. P. 172–183.