Prevalence of Azathioprine Induced Pancreatitis in IBD Patients

Abstract

 Introduction: Azathioprine (AZA)-induced pancreatitis (AIP) is a known, though relatively uncommon, idiosyncratic drug reaction causing inflammation of the pancreas, often seen in patients with Inflammatory Bowel Disease (IBD) (Crohn’s/UC) or autoimmune conditions, manifesting as abdominal pain, nausea, and vomiting, typically resolving quickly after stopping the drug but requiring medical attention for diagnosis and management. It’s an unpredictable reaction, not strictly dose-dependent, linked to certain genetic markers (HLA alleles), and emphasizes the need for monitoring when using AZA.

Aim of Study: To determine the prevalence of Pancreatitis in patients of Inflammatory Bowel Disease who reported in Department of Medical Gastroenterology, PGIMS, Rohtak.

Materials & Methods: It was a prospective study conducted at Department of Medical Gastroenterology, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, over a period of ten years from 1st January, 2016 to 31st December, 2025 during which 5000 patients of IBD. who reported in Medical Gastroenterology OPD were enrolled in the study, after proper written consent. These all IBD patients were confirmed on colonoscopy and histopathological examination of colonic biopsy. They were regularly followed for any episode of pancreatitis which was confirmed by serum amylase, serum lipase levels and Contrast enhanced computed tomography scan and CTSI score was collected. At every visit, all patients were specifically asked about symptoms suggestive of pancreatitis like severe epigastric pain radiating to back, along with non-passage of faeces and flatus.

Results: We enrolled total 5000 patients who reported to Department of Medical Gastroenterology for treatment of Inflammatory bowel disease. Out of these 5000 patients, 4980 (99.60%) were having ulcerative colitis and 20 (0.40%) were having crohn’s disease. In total pool of 5000 IBD patients, 2750 (55%) were male and 2250 (45%) were female. There was predominance of rural background i.e. 3150 patients (62%) and 1850 patients (38%) belonged to urban areas. Majority of IBD patients in study pool belonged to poor socio-economic status i.e. 3300 (66%) and 1700 patients (34%) had good socio-economic status. Out of total 5000 patients, only 3 patients (0.06%) developed pancreatitis and 4997 (99.94%) had no episode of pancreatitis. Out of these three patients who developed pancreatitis, two patients had one episode of pancreatitis and one patient had four episodes. In all these three patients, no further episode of pancreatitis occurred, once azathioprine was stopped, none of these three acute pancreatitis patients progressed to chronic pancreatitis.

Conclusion: Azathioprine is used frequently in IBD patients, as the goal of treatment is to keep patient in remission with steroid sparing regimen. It is relatively safe in respect of causing pancreatitis. Moreover, once pancreatitis occurs, it is stopped, hence does not lead to chronic pancreatitis.