Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, P.O. Box 100496, Gainesville, FL, USA.
REMEDY, Emergency Department, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK.
Dig Dis Sci. 2020 Jan;65(1):292-300. doi: 10.1007/s10620-019-05803-3. Epub 2019 Aug 29.
Codeine has a spasmodic effect on sphincter of Oddi and is suspected to cause acute pancreatitis in patients with a history of cholecystectomy.
To assess the association between codeine use and acute pancreatitis in patients with a previous cholecystectomy.
We conducted a retrospective nested case-control study using the 2005-2015 MarketScan Commercial Claims and Encounters Database. The cohort included patients aged 18-64; cohort entry began 365 days after cholecystectomy. Odds ratios (ORs) and 95% CIs for acute pancreatitis hospitalization were estimated comparing use of codeine with non-use of codeine. In a secondary analysis, use of codeine was compared with an active comparator: use of non-steroidal anti-inflammatory drugs (NSAIDs).
Of the 664,083 patients included in the cohort, 1707 patients were hospitalized for acute pancreatitis (incidence 1.1 per 1000 person-years) and were matched to 17,063 controls. Compared with non-use of codeine, use of codeine was associated with an increased risk of acute pancreatitis (OR 2.67; 95% CI 1.63, 4.36), particularly elevated in the first 15 days of codeine use (OR 5.37; 95% CI 2.70, 10.68). Compared with use of NSAIDs, use of codeine was also associated with an increased risk of acute pancreatitis (OR 2.64; 95% CI 1.54, 4.52).
Codeine is associated with an increased risk of acute pancreatitis in patients who have previously undergone cholecystectomy; greater clinician awareness of this association is needed.
可待因对 Oddi 括约肌具有痉挛作用，并且怀疑在有胆囊切除术病史的患者中引起急性胰腺炎。
评估先前有胆囊切除术的患者中使用可待因与急性胰腺炎之间的关联。
我们使用 2005-2015 年 MarketScan 商业索赔和就诊数据库进行了回顾性巢式病例对照研究。该队列包括年龄在 18-64 岁之间的患者；队列入组始于胆囊切除术后 365 天。使用可待因与未使用可待因的情况下，比较急性胰腺炎住院的比值比（OR）和 95%置信区间（CI）。在二次分析中，将可待因的使用与活性对照物（非甾体抗炎药（NSAIDs））进行了比较。
在队列中纳入的 664,083 例患者中，有 1707 例患者因急性胰腺炎住院（发生率为每 1000 人年 1.1 例），并与 17,063 例对照相匹配。与未使用可待因相比，使用可待因与急性胰腺炎的风险增加相关（OR 2.67；95%CI 1.63, 4.36），尤其是在使用可待因的前 15 天内（OR 5.37；95%CI 2.70, 10.68）。与使用 NSAIDs 相比，使用可待因也与急性胰腺炎的风险增加相关（OR 2.64；95%CI 1.54, 4.52）。
在先前接受过胆囊切除术的患者中，可待因与急性胰腺炎的风险增加有关；需要临床医生对此关联有更高的认识。
