ROLE OF ANGIOTENSIN RECEPTOR BLOCKERS IN POST-ERCP PANCREATITIS

Numerous drugs have been reported to cause pancreatitis. Such medications were investigated for increasing the risk of post ERCP pancreatitis. Data from consecutive patients with ICD -9 procedure code for ERCP was consecutively analyzed from 2001-2004. Records were reviewed for medications used, including type of sedation used. Exclusion criteria were age below 18 or incomplete procedure. Data was analyzed using the chi-square test for categorical data of medications used as risk factors for post-ERCP pancreatitis. Drugs analyzed were angiotensin converting enzyme inhibitors (ACEI), antibiotics, angiotensin receptor blockers (ARB), aspirin, beta blockers, calcium channel blockers, diuretics, glucophage, insulin, steroids, sulfonylurea. Drugs that appeared to be associated with pancreatitis in the unvaried analysis (p < 0.10) were included in a logistic regression model. 509 charts were included in the final analysis (299F, 210M, median age 66) In comparing subjects with pancreatitis vs. those without there was a significant difference found only with the use of ARB. 42 patients were on ARBs and 8 or 22% developed pancreatitis, 4 times that of patients not on ARBs. (p = 0.006) ARB have been reported in the past as potential etiology for pancreatitis in numerous case reports, but generally in lower rates. Furthermore, there are animal studies demonstrating ARB and ACEI attenuate pancreatic inflammation and fibrosis. It is unclear as to the pathology of the relationship. Further investigation is needed to evaluate if this is a direct effect or co-founding factors are present.