OBJECTIVE -To evaluate risk factors, notably drugs, for acute pancreatitis.RESEARCH DESIGN AND METHODS -A population-based case-control study was conducted of 1.4 million inhabitants, aged 20 -85 years, of four regions in Sweden between 1 January 1995 and 31 May 1998. A total of 462 case subjects were hospitalized in surgery departments for their first episode of acute pancreatitis without previous gallbladder disease. A total of 1,781 control subjects were randomly selected from a population register. Information was obtained from case records and through telephone interviews.RESULTS -A total of 27 case subjects (6%) and 55 control subjects (3%) had prevalent diabetes. A total of 53 case subjects (11%) and 130 control subjects (7%) had a BMI Ͼ30 kg/m 2 . Use of glyburide had a crude odds ratio (OR) of 3.2 (95% CI 1.5-5.9), and in a multivariate logistic regression adjusted for covariates, the OR for use of glyburide was 2.5 (1.1-5.9). BMI had a continuous OR of 1.2 (1.1-1.4) per 5 units of BMI. The relative risk for hospitalization longer than 14 days or treatment in an intensive care unit was 2.4 (1.1-5.4) among patients with a BMI Ͼ30 kg/m 2 when compared with patients with a BMI between 20 and 25 kg/m 2 .CONCLUSIONS -Use of glyburide and obesity may both be risk factors for acute pancreatitis. Obesity is associated with an extended hospitalization time in subjects with acute pancreatitis. Diabetes Care 25:298 -302, 2002A cute pancreatitis may be caused by intrapancreatic activation of digestive enzymes leading to autodigestion. Activation of trypsin is regarded as central for initiating the process. The major causes are reported to be excessive intake of alcohol and cholelithiasis, which account for ϳ80 -90% of cases (1,2). Pancreatic trauma, gastrointestinal perforations and infections, tumors, hyperlipidemia, hypercalcemia, inflammatory bowel disease, and exposure to pancreatoxic drugs have been suggested as additional risk factors. Diabetes is a known complication of severe acute pancreatitis (3,4), but there are no studies describing diabetes or its treatment as risk factors for acute pancreatitis. High BMI has been associated with increased risk of complications in the clinical course of acute pancreatitis (5-10).In a nationwide case-control study, we investigated risk factors for acute pancreatitis. In this first report, we analyzed whether use of glyburide, diabetes, and obesity are risk factors for acute pancreatitis and whether obesity is related to the severity of the disease. RESEARCH DESIGN AND METHODS -The Medical ProductAgency is responsible for pharmacovigilance in Sweden. The operation is decentralized; one surveillance center is located in each of the six health care regions. The centers are staffed by nurses who trained in clinical pharmacology, pharmacovigilance, and epidemiology in the Departments of Clinical Pharmacology at the regional university hospitals, and clinical pharmacologists serve as consultants. The centers run both the reporting system for suspected adverse drug reactions a...

In addition to cholelithiasis, smoking and heavy alcohol use, drugs may be an important risk factor for acute pancreatitis.

Current IBD without treatment and gastritis/GERD without treatment were found to be associated with increased risks to develop acute pancreatitis but the nature of the latter association needs to be further evaluated. On balance, we judge that the observed associations between current use of H(2)-antagonists and PPIs and increased risk of acute pancreatitis are unlikely to be explained by bias.