Pancreatitis often caused by gallstones

Statins also increase risk, researchers say

Idiopathic pancreatitis is often caused by small gallstones that
are difficult to observe prior to surgery, shows a study. Small gallstones were
found in surgery from two out of three idiopathic pancreatitis patients. The
study also showed that acute pancreatitis was more common in statin users than
non-users

Idiopathic pancreatitis is often caused by small
gallstones that are difficult to observe prior to surgery, shows a study from
the University of Eastern Finland. Small gallstones were found in surgery from
two out of three idiopathic pancreatitis patients. The study also showed that
acute pancreatitis was more common in statin users than non-users.

The main causes of acute pancreatitis in Finland are
alcohol and cholelithiasis. In up to 10-20 per cent of cases, the underlying
cause remains unclear. These cases may be explained by small gallstones that
are not found during regular examination. A gallstone can get stuck in the
junction of the common bile duct and the pancreatic duct, thus causing
pancreatitis.

In a multi-centre gastrointestinal surgery study,
first-time idiopathic pancreatitis patients were randomized into a surgery
group and a control group.. 39 patients underwent gallbladder removal surgery,
and 46 were controls. During an average follow-up of three years, pancreatitis
recurred in 14 persons in the control group and in four persons in the surgery
group, so recurrence was clearly more likely in controls. Similarly, there were
23 pancreatitis cases in controls and only eight in the surgery group. Small
gallstones were found in surgery from two out of three patients, although not
observed in repeated abdominal ultrasound prior to surgery.

This finding is important when charting the causes of
idiopathic pancreatitis and courses of treatment. For instance, alcohol use may
too often be suspected as the cause. The recurrence of idiopathic pancreatitis
can in many cases be prevented by laparoscopic gallbladder removal surgery.

Risk of pancreatitis elevated especially during the first
year of statin use

The study also analysed the association of pancreatitis
with the use of cholesterol-lowering drugs, statins, as gallstones often
contain crystallised cholesterol. Animal studies have shown statins to dissolve
gallstones. The majority of gallstones are found in the elderly, often
asymptomatic. Researchers assumed that statins may also reduce the size of
gallstones in humans, enabling gallstones to travel from the gallbladder to the
junction of the common bile duct and the pancreatic duct, and then manifest as
pancreatitis.

In a retrospective study carried out in Kuopio University
Hospital, idiopathic pancreatitis was found to be more common in statin users
than in non-users. On the other hand, statin users’ gallbladder removal surgery
outcomes were as good as non-users’, and the surgery was ten per cent faster
than that of non-users. The study involved 461 acute pancreatitis patients and
1,140 cholelithiasis patients as well as a cohort of 272 statin users and 272
controls.

In a nationwide study, statin use was found to significantly
increase the risk of acute pancreatitis. The risk was especially elevated
during the first year of statin use. The anonymous register-based study was
carried out with the Finnish Medicines Agency and involved all Finnish first
cases of pancreatitis not caused by alcohol or gallstones in 2008-2010, i.e.
nearly 4,500 persons, as well as nearly 25,000 controls.

“Despite these findings, no one should discontinue
their statin medication without consulting their physician,” says Jukka
Pulkkinen, MD, who presented the results in his doctoral thesis.

The findings were originally published
in Pancreas, BMC Gastroenterology,Pharmacoepidemiology and Drug
Safety, and Annals of Surgery.

The doctoral dissertation of Jukka Pulkkinen, Lic. Med.,
entitled Role of statins in acute pancreatitis and symptomatic
cholelithiasis is available for download at http://epublications.uef.fi/pub/urn_isbn_978-952-61-1937-3/

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