[Acute pancreatitis after treatment by celecoxib]. / Pancréatite aiguë survenant après la prise de celecoxib.

Drug-induced pancreatitis injury due to celecoxib, a first generation Cox-2 inhibitor, has been rarely reported. We describe one case of severe pancreatitis after treatment with celecoxib for 3 months in a woman. No aetiology has been found for pancreatitis. The role of celecoxib in the etiology of colitis was considered probable. This report and a few other cases in the literature suggest to seek a pancreatitis in the event of pains abdominal when there is a catch of the cyclooxygenase-2 selective non-steroidal anti-inflammatory drug inhibitor.

Incidence and severity of non alcoholic and non biliary pancreatitis in a gastroenterology department.

AIMS: Etiological investigations proposed for patients with acute pancreatitis have been evolving considerably these past few years, significantly limiting the number of cases labeled idiopathic. The aim of this study was to determine the incidence of non alcoholic non biliary pancreatitis and identify causes, comparing severity by etiology. PATIENT AND METHODS: This retrospective analysis included 108 patients managed from October 1996 to April 2005. Standar-dized extensive etiological investigations were performed. The following criteria of severity were recorded: peak CRP value, Ranson score, Balthazar score, duration of hospital stay and pseudocyst occurrence. RESULTS: The cause of acute pancreatitis was alcohol (N=45), gallstones (N=50), obstruction (N=10), unknown (N=10), drugs (N=9), auto-immunity (N=4), infections (N=3), post-operative (N=2), post-ERCP (N=2), trauma (N=1), hypertriglyceridemia (N=1), genetic (N=1). The main criteria of severity were significantly different between non alcoholic non biliary pancreatitis and the other causes (CRP>120 mg/L, Ranson score>3 and Balthazar score > or =D) while other criteria (pseudocyst occurrence and duration of hospitalisation) were similar. Mean peak CRP was 79.5 mg/L for the overall population and varied significantly by etiology: peak CRP for drug-induced acute pancreatitis (4.6 mg/L) was significantly lower than for the other causes (P<10(-6)). CONCLUSION: This study shows that non alcoholic non biliary causes account for one third of the cases of acute pancreatitis, usually with a mild to moderate presentation. As the mean peak CRP value is significantly lower in drug-induced acute pancreatitis, careful search for an adverse drug reaction is appropriate in patients with acute pancreatitis of unknown cause and a low peak CRP level.

[Acute diarrhoea revealing a coeliac disease]. / Diarrhée aiguë révélatrice d'une maladie coeliaque.

INTRODUCTION: The classical mode of revelation of a coeliac disease is chronic diarrhoea. We report the case of a patient in whom acute diarrhoea revealed the disease. OBSERVATION: In a 40 year-old man with acute diarrhoea with 7 non-bleeding stools per day, upper digestive tract endoscopy showed a villosity atrophy aspect confirmed by the histological examination. The search for specific antibodies of a coeliac disease was positive. A gluten-free diet led to the disappearance of the diarrhoea, followed by the disappearance of the specific antibodies and the regression of the villosity atrophy. COMMENTS: Acute diarrhoea that resists medical treatment must evoke the hypothesis of a coeliac disease and lead to a gastroscopy with duodenal biopsies. The interest of evoking the diagnosis is not only in order to obtain the rapid disappearance of the clinical signs after the introduction of a gluten-free diet but also to avoid an increase in the high risk of malignant lesions of the small intestine.