A Study on Pancreatitis and Its Causing Factors and the Association of Methimazole with Acute Pancreatitis: A Cross-Sectional Study

Abstract

Background: Acute pancreatitis (AP) is an inflammatory disorder of the pancreas with diverse aetiologies—gallstones, alcohol, metabolic abnormalities, and drugs. Methimazole, an antithyroid thionamide, has occasionally been linked to drug-induced AP. Acute pancreatitis (AP) is increasing in incidence across the world, and in all age groups. Major changes in management have occurred in the last decade. Avoiding total parenteral nutrition and prophylactic antibiotics, avoiding overly aggressive fluid resuscitation, initiating early feeding, avoiding endoscopic retrograde cholangiopancreatography in the absence of concomitant cholangitis, same-admission Objective: To determine the major etiological factors of AP in a tertiary-care cohort and to explore the possible association between methimazole use and AP. Methods: In this cross-sectional study (February/2019 – October/2019) 136 adults with AP were enrolled. Demographics, laboratory and imaging data, risk factors, and full drug histories (with special attention to methimazole) were recorded. Methimazole cases were evaluated for causality using latent period, de-challenge response, and exclusion of alternative causes. The study was conducted in a tertiary hospital. After obtaining institutional ethical committee approval It was Observational cross sectional study study conducted on 136 patients with Pancreatitis in the department of General Surgery, at a tertiary care centre Results: Mean age was 46.8 ± 13.6 years; 71/136 (52.2 %) were male. Leading causes were gallstones (36.8 %), alcohol misuse (30.1 %), hypertriglyceridemia (7.3 %), and drug-induced (5.1 %). Recent methimazole exposure was found in 5 patients (3.7 %); 4 of these lacked other identifiable causes and recovered promptly after drug withdrawal—supporting a “probable” causal link. Conclusion: Although rare, methimazole should be considered among potential causes of apparently idiopathic AP. Thorough medication review and early cessation of suspected agents can speed recovery and prevent recurrence. The present study supports the warning and addition of acute pancreatitis to the list of serious side-effects of methimazole.