Causes and Risk Factors of Pancreatitis

Metabolic Causes

Hypertriglyceridemia causes acute pancreatitis, particularly when triglyceride levels exceed 700-1000 mg/dL, and patients with severe hypertriglyceridemia (≥1,000 mg/dL) have a 14% incidence of acute pancreatitis 1
In severe hypertriglyceridemia (≥1,000 mg/dL), pharmacotherapy effectiveness is limited because these agents primarily reduce hepatic VLDL synthesis rather than clearing circulating chylomicrons 1

Azathioprine and 6-mercaptopurine cause pancreatitis in approximately 4% of treated IBD patients, typically occurring within the first 3-4 weeks of treatment in a dose-independent manner 2
5-ASA medications have a much lower risk of inducing pancreatitis compared to thiopurines 2
Patients with HLA-DQA102:01-HLA-DRB107:01 haplotype are more prone to develop thiopurine-induced pancreatitis 2

Post-ERCP pancreatitis is a recognized complication of endoscopic retrograde cholangiopancreatography 2
Duodenal Crohn's disease can cause pancreatitis through direct extension or fistulizing disease 2

Autoimmune pancreatitis, including IgG4-related pancreatitis, has been described in IBD patients 2
Various infections, including mumps, Coxsackie B4, and others, can trigger acute pancreatitis 3

Approximately 15-20% of cases remain idiopathic despite thorough evaluation, though this percentage should be minimized through vigorous investigation 3
Microlithiasis (microscopic gallstones) may be responsible for some previously labeled "idiopathic" cases and can be detected through bile sampling or endoscopic ultrasound 3
The diagnosis of idiopathic pancreatitis should not be accepted without obtaining at least two good quality ultrasound examinations, as the most sensitive test for missed gallstones remains a repeat ultrasound 3

Gallstones are the leading cause of acute pancreatitis in many countries and regions, accounting for 60-75% of all cases, according to the World Journal of Emergency Surgery guidelines 4
Alcohol consumption is the second most common cause overall, with incidence varying by region and associated with high alcohol intake, as reported by the World Journal of Emergency Surgery 4

In chronic pancreatitis, alcohol is the etiological factor in 60-70% of cases, as stated by Clinical Nutrition guidelines 5

Drug-induced pancreatitis, particularly from medications such as azathioprine/6-mercaptopurine, occurs in approximately 4% of treated patients, according to the Journal of Crohn's and Colitis 6
Autoimmune pancreatitis is another etiology, as reported by the Journal of Crohn's and Colitis 6
Pancreatic duct abnormalities, such as obstruction or pancreas divisum, are also a cause, as stated by Clinical Nutrition guidelines 5
Hereditary or tropical pancreatitis are additional etiologies, as reported by Clinical Nutrition guidelines 5

Abstinence from alcohol is essential for patients with alcoholic pancreatitis, as recommended by Clinical Nutrition guidelines 5

There is no established direct causal relationship between anticoagulants such as apixaban and acute pancreatitis, according to the European Society of Gastrointestinal Endoscopy 7, 8, 9
Endoscopic sphincterotomy is associated with a higher incidence of post-ERCP hemorrhage but a lower incidence of post-ERCP pancreatitis, as reported by the European Society of Gastrointestinal Endoscopy 9