51
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Di Mauro D, Wijesurendere CN, Attanasio A, Fulgenzi CAM, Elkhuffash I, Ricciardi E, Wajed S, Manzelli A. Outcome of acute pancreatitis in octogenarians: A retrospective study. JGH OPEN 2020; 4:461-465. [PMID: 32514454 PMCID: PMC7273716 DOI: 10.1002/jgh3.12279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 10/16/2019] [Accepted: 10/19/2019] [Indexed: 12/17/2022]
Abstract
Background and Aim Acute pancreatitis (AP) is a common disease, but data on outcomes in octogenarians are scarce in the literature. The aim of this study is to analyze results from patients aged 80 years old and over who were treated for AP at a single center. Methods Patients aged 80 years and older diagnosed with AP from April 2010 to October 2015 were considered. Demographics, American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), serum biochemistry at 24 and 48 h after admission, and revised Atlanta severity score were analyzed and correlated with hospital mortality rate and length of stay using the multiple regression and Kaplan–Meier tests. Results A total of 100 consecutive patients were included in the study. There were 52 women, and the mean age was 87.5 years (range 80–95). Gallstones were the most common cause of AP (69.7%). The ASA score was ≥III in 51 patients. Eight patients had severe, disease and all of them died in hospital. A CCI > 4 was associated with higher disease severity and mortality (P < 0.00001). The median hospital stay was 9 days (range 1–59). Longer hospital stay was associated with serum C‐reactive protein ≥242 mg/L (P = 0.01) and serum albumin ≤30 g/L (P = 0.01) at 48 h. Over a 5‐year period, 22% of patients were readmitted to hospital with recurrent AP. Gallstones were the main cause of disease (63.6%). Conclusions AP in octogenarians has low mortality. Higher death rate is associated with disease severity. In the presence of gallstone disease, cholecystectomy is recommended whenever possible as the risk of disease recurrence is significant.
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Affiliation(s)
- Davide Di Mauro
- Department of Upper GI Surgery Royal Devon and Exeter NHS Foundation Trust Exeter UK
| | | | - Andrea Attanasio
- Department of Upper GI Surgery Royal Devon and Exeter NHS Foundation Trust Exeter UK
| | - Claudia A M Fulgenzi
- Department of Upper GI Surgery Royal Devon and Exeter NHS Foundation Trust Exeter UK
| | | | - Edoardo Ricciardi
- Department of Upper GI Surgery Royal Devon and Exeter NHS Foundation Trust Exeter UK
| | - Shahjehan Wajed
- Department of Upper GI Surgery Royal Devon and Exeter NHS Foundation Trust Exeter UK
| | - Antonio Manzelli
- Department of Upper GI Surgery Royal Devon and Exeter NHS Foundation Trust Exeter UK
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52
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Butler RJ, Grieve DA. Index cholecystectomy rates in mild gallstone pancreatitis: a single-centre experience. ANZ J Surg 2020; 90:2011-2014. [PMID: 32338824 DOI: 10.1111/ans.15887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 02/03/2020] [Accepted: 03/12/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Gallstone pancreatitis (GSP) has evidence-based guidelines regarding management. Both the International Association of Pancreatology/American Pancreatology Association and American College of Gastroenterology recommend index admission cholecystectomy (IAC) in patients presenting with mild GSP. The aim of this study was to examine guideline adherence and GSP recurrence rate when IAC was not performed. A comparison between admitting specialty was also performed to examine the difference in compliance rates. METHODS A retrospective chart review was conducted on all patients who presented to the Sunshine Coast Hospital and Health Service with GSP from December 2013 to December 2016. Patient demographics, timing of surgery, admitting specialty, laboratory and imaging results were recorded. RESULTS A total of 95 patients were identified with a first presentation of mild GSP during the study period. Of whom, 66 (69.5%) underwent IAC and 29 (30.5%) were discharged prior to cholecystectomy with 10 of those patients receiving index admission endoscopic sphincterotomy. Five patients (17%) who did not receive IAC were readmitted with gallstone-related complications with the mean time to re-presentation of 12.8 days (range 7-21 days). Patients were more likely to receive IAC when admitted under surgery compared with gastroenterology (76% versus 20%, P < 0.001). CONCLUSION Two out of three patients presenting with mild GSP underwent IAC in accordance with evidence-based management guidelines. Patients should be admitted under a surgical service to prevent delay in definitive management.
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Affiliation(s)
- Reuban J Butler
- Department of General Surgery, Sunshine Coast University Hospital, Sunshine Coast Region, Queensland, Australia
| | - David A Grieve
- Department of General Surgery, Sunshine Coast University Hospital, Sunshine Coast Region, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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53
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Li M, Xing XK, Lu ZH, Guo F, Su W, Lin YJ, Wang DH. Comparison of Scoring Systems in Predicting Severity and Prognosis of Hypertriglyceridemia-Induced Acute Pancreatitis. Dig Dis Sci 2020; 65:1206-1211. [PMID: 31515723 DOI: 10.1007/s10620-019-05827-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/04/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND In China, hyperlipidemia is the second major reason of acute pancreatitis. AIMS Comparison of Scoring Systems in identification patients at risk for severe acute pancreatitis (SAP), pancreatic necrosis (PNec), and infected pancreatic necrosis (IPN) early in the course of hypertriglyceridemia-induced acute pancreatitis (HTG-AP). METHODS Predictive accuracy of scoring systems was measured by the area under the receiver operating characteristic curve (AUC) in a retrospective study. Pairwise AUC comparisons were performed to calculate the difference between scoring systems. RESULTS A total of 238 patients diagnosed with HTG-AP were included. Sixty patients (25.2%) were classified as SAP. Twenty-nine patients (12.2%) had evidence of PNec. Nine patients (3.8%) were diagnosed with IPN. One patient (0.4%) died during hospitalization. In predicting SAP in HTG-AP, the AUCs of APACHE-II, SOFA, SIRS, Ranson's, BISAP, and MMS were 0.77, 0.83, 0.73, 0.88, 0.83, and 0.85, respectively; in predicting PNec, were 0.75, 0.77, 0.75, 0.86, 0.80, and 0.75, respectively; and in predicting IPN, were 0.92, 0.86, 0.76, 0.85, 0.84, and 0.87, respectively. Pairwise AUC comparisons revealed that Ranson's, MMS, BISAP, and SOFA had higher accuracy than SIRS, Ranson's and MMS had higher accuracy than APACHE-II in predicting SAP; Ranson's had the same accuracy with BISAP, but higher than other four criteria in predicting PNec; APACHE-II had higher accuracy than SIRS in predicting IPN. CONCLUSIONS APACHE-II had high performance in predicting IPN, and all other score systems had medium performance in predicting SAP, PNec, and IPN in HTG-AP. Each score has its merit and weakness; BISAP may be the best criterion in predicting severity and prognosis of HTG-AP.
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Affiliation(s)
- Man Li
- Department of Critical Care Medicine, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Xiao-Kang Xing
- Department of Critical Care Medicine, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Zhi-Hua Lu
- Department of Critical Care Medicine, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Feng Guo
- Department of Critical Care Medicine, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, China.
| | - Wei Su
- Department of Critical Care Medicine, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Yong-Jun Lin
- Department of Critical Care Medicine, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Dong-Hai Wang
- Department of Critical Care Medicine, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, China
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54
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Hallensleben ND, Umans DS, Bouwense SAW, Verdonk RC, Romkens TEH, Witteman BJ, Schwartz MP, Spanier MB, Laheij R, van Santvoort HC, Besselink MG, van Hooft JE, Bruno MJ. The diagnostic work-up and outcomes of 'presumed' idiopathic acute pancreatitis: A post-hoc analysis of a multicentre observational cohort. United European Gastroenterol J 2020; 8:340-350. [PMID: 32213015 PMCID: PMC7184667 DOI: 10.1177/2050640619890462] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/28/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION After standard diagnostic work-up, the aetiology of acute pancreatitis remains unknown in 16-27% of cases, a condition referred to as idiopathic acute pancreatitis (IAP). Determining the aetiology of pancreatitis is essential, as it may direct treatment in the acute phase and guides interventions to prevent recurrent pancreatitis. METHODS Between 2008 and 2015, patients with acute pancreatitis were registered prospectively in 19 Dutch hospitals. Patients who had a negative initial diagnostic work-up with regard to the underlying aetiology of their pancreatitis were labelled 'presumed' IAP. The aim of this study was to assess the use of diagnostic modalities and their yield to establish an aetiology in 'presumed' IAP, and to assess recurrence rates both with and without treatment. RESULTS Out of the 1632 registered patients, 191 patients had a first episode of 'presumed' IAP, of whom 176 (92%) underwent additional diagnostic testing: CT (n = 124, diagnostic yield 8%), EUS (n = 62, yield 35%), MRI/MRCP (n = 56, yield 33%), repeat ultrasound (n = 97, yield 21%), IgG4 (n = 54, yield 9%) and ERCP (n = 15, yield 47%). In 64 of 176 patients (36%) an aetiological diagnosis was established, mostly biliary (n = 39). In 13 out of 176 of patients (7%) a neoplasm was diagnosed. If additional diagnostic workup revealed an aetiology, the recurrence rate was lower in the treated patients than in the patients without a definite aetiology (15% versus 43%, p = 0.014). CONCLUSION Additional diagnostic testing revealed an aetiology in one-third of 'presumed' IAP patients. The aetiology found was mostly biliary, but occasionally neoplasms were found. Identification of an aetiology with subsequent treatment reduced the rate of recurrence.
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Affiliation(s)
- Nora D Hallensleben
- Department of Gastroenterology, Erasmus
MC University Medical Centre, Rotterdam, the Netherlands
- Department of Research and Development,
St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Devica S Umans
- Department of Research and Development,
St. Antonius Hospital, Nieuwegein, the Netherlands
- Department of Gastroenterology,
Amsterdam UMC, Amsterdam, the Netherlands
| | - Stefan AW Bouwense
- Department of Surgery, Radboud
University Medical Centre, Nijmegen, the Netherlands
| | - Robert C Verdonk
- Department of Gastroenterology, St
Antonius Hospital, Nieuwegein, the Netherlands
| | - Tessa EH Romkens
- Department of Gastroenterology, Jeroen
Bosch Hospital, ‘s Hertogenbosch, the Netherlands
| | - Ben J Witteman
- Department of Gastroenterology, Gelderse
Vallei Hospital, Ede, the Netherlands
| | - Matthijs P Schwartz
- Department of Gastroenterology, Meander
Medical Centre, Amersfoort, the Netherlands
| | - Marcel B Spanier
- Department of Gastroenterology,
Rijnstate Hospital, Arnhem, the Netherlands
| | - Robert Laheij
- Department of Gastroenterology, St.
Elisabeth – Tweesteden Hospital, Tilburg, the Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, St. Antonius
Hospital, Nieuwegein, the Netherlands
- Department of Surgery, University
Medical Centre, Utrecht, the Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC,
Amsterdam, the Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology,
Amsterdam UMC, Amsterdam, the Netherlands
| | - Marco J Bruno
- Department of Gastroenterology, Erasmus
MC University Medical Centre, Rotterdam, the Netherlands
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55
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Umans DS, Hallensleben ND, Verdonk RC, Bouwense SAW, Fockens P, van Santvoort HC, Voermans RP, Besselink MG, Bruno MJ, van Hooft JE. Recurrence of idiopathic acute pancreatitis after cholecystectomy: systematic review and meta-analysis. Br J Surg 2019; 107:191-199. [PMID: 31875953 PMCID: PMC7003758 DOI: 10.1002/bjs.11429] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/26/2019] [Accepted: 10/04/2019] [Indexed: 12/12/2022]
Abstract
Background Occult biliary disease has been suggested as a frequent underlying cause of idiopathic acute pancreatitis (IAP). Cholecystectomy has been proposed as a strategy to prevent recurrent IAP. The aim of this systematic review was to determine the efficacy of cholecystectomy in reducing the risk of recurrent IAP. Methods PubMed, Embase and Cochrane Library databases were searched systematically for studies including patients with IAP treated by cholecystectomy, with data on recurrence of pancreatitis. Studies published before 1980 or including chronic pancreatitis and case reports were excluded. The primary outcome was recurrence rate. Quality was assessed using the Newcastle–Ottawa Scale. Meta‐analyses were undertaken to calculate risk ratios using a random‐effects model with the inverse‐variance method. Results Overall, ten studies were included, of which nine were used in pooled analyses. The study population consisted of 524 patients with 126 cholecystectomies. Of these 524 patients, 154 (29·4 (95 per cent c.i. 25·5 to 33·3) per cent) had recurrent disease. The recurrence rate was significantly lower after cholecystectomy than after conservative management (14 of 126 (11·1 per cent) versus 140 of 398 (35·2 per cent); risk ratio 0·44, 95 per cent c.i. 0·27 to 0·71). Even in patients in whom IAP was diagnosed after more extensive diagnostic testing, including endoscopic ultrasonography or magnetic resonance cholangiopancreatography, the recurrence rate appeared to be lower after cholecystectomy (4 of 36 (11 per cent) versus 42 of 108 (38·9 per cent); risk ratio 0·41, 0·16 to 1·07). Conclusion Cholecystectomy after an episode of IAP reduces the risk of recurrent pancreatitis. This implies that current diagnostics are insufficient to exclude a biliary cause.
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Affiliation(s)
- D S Umans
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - N D Hallensleben
- Department of Gastroenterology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.,Department of Research and Development, St Antonius Hospital, Nieuwegein, the Netherlands
| | - R C Verdonk
- Department of Gastroenterology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - S A W Bouwense
- Department of Surgery, MUMC+, Maastricht, the Netherlands
| | - P Fockens
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - H C van Santvoort
- Department of Surgery, St Antonius Hospital, Nieuwegein, the Netherlands.,Department of Surgery, UMC Utrecht, Utrecht, the Netherlands
| | - R P Voermans
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M G Besselink
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M J Bruno
- Department of Gastroenterology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - J E van Hooft
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Wolfe D, Kanji S, Yazdi F, Skidmore B, Moher D, Hutton B. Methods for the early detection of drug-induced pancreatitis: a systematic review of the literature. BMJ Open 2019; 9:e027451. [PMID: 31694842 PMCID: PMC6858245 DOI: 10.1136/bmjopen-2018-027451] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 10/02/2019] [Accepted: 10/10/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES We systematically reviewed the literature to identify evidence-informed recommendations regarding the detection of drug-induced pancreatitis (DIP) and, secondarily, to describe clinical processes for the diagnosis of DIP. DESIGN Systematic review. DATA SOURCES Ovid MEDLINE, including Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Embase Classic+Embase, the Cochrane Library. ELIGIBILITY CRITERIA We included clinical practice guidelines, systematic reviews, narrative reviews and observational studies with a focus of establishing incidence, prevalence or diagnostic approaches for DIP. Clinical trials that diagnosed DIP as an outcome were also included. DATA EXTRACTION AND SYNTHESIS Two reviewers screened citations and performed data extraction. A narrative synthesis of the evidence was prepared. RESULTS Fifty-nine studies were included. Early published evidence suggested serial pancreatic ultrasound could detect subclinical pancreatitis; however, subsequent studies demonstrated no utility of serial ultrasound or serial monitoring of pancreatic enzymes in the early detection of DIP. Two small studies conducted in patients with a high baseline risk of acute pancreatitis concluded serial monitoring of pancreatic enzymes may be useful to guide early discontinuation of medications with known associations with pancreatitis. Early discontinuation of medication was not advised for lower-risk patients because some medications cause transient elevations of pancreatic enzymes that do not progress to acute pancreatitis. Eight of 52 studies (15%) reporting a clinical diagnostic process for DIP reported using currently accepted criteria for the diagnosis of acute pancreatitis. A variety of methods were used to assess drug-related causality. CONCLUSIONS There is minimal evidence to support the use of serial monitoring by ultrasound or pancreatic enzymes to detect cases of DIP. Serial monitoring may be useful to guide early discontinuation of DIP-associated drugs in high-risk patients, but not in lower-risk patients. Greater uptake of standardised diagnostic and causality criteria for DIP is needed. TRIAL REGISTRATION NUMBER CRD42017060473.
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Affiliation(s)
- Dianna Wolfe
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Salmaan Kanji
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Fatemeh Yazdi
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Becky Skidmore
- Independent Information Specialist, Ottawa, Ontario, Canada
| | - David Moher
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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57
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Jin M, Bai X, Chen X, Zhang H, Lu B, Li Y, Lai Y, Qian J, Yang H. A 16-year trend of etiology in acute pancreatitis: The increasing proportion of hypertriglyceridemia-associated acute pancreatitis and its adverse effect on prognosis. J Clin Lipidol 2019; 13:947-953.e1. [DOI: 10.1016/j.jacl.2019.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 08/17/2019] [Accepted: 09/09/2019] [Indexed: 12/14/2022]
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58
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Tan JH, Zhou L, Kan HP, Zhang GW. Parecoxib Improves the Outcomes of Acute Mild and Moderate Pancreatitis: A 3-Year Matched Cohort Study Based on a Prospective Database. Pancreas 2019; 48:1148-1154. [PMID: 31593014 DOI: 10.1097/mpa.0000000000001393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the role of parecoxib in patients with different severities of acute pancreatitis (AP). METHODS A total of 772 eligible patients with AP were divided into 4 groups: mild and moderately AP (MAP) treated with parecoxib (group A, n = 236), MAP without parecoxib treatment (group B, n = 453), severe AP (SAP) treated with parecoxib (group C, n = 28), and SAP without parecoxib treatment (group D, n = 55). Patients in group A were exactly matched with patients in group B by propensity score matching, similar to the matching between group C and group D. RESULTS The morbidity of abdominal infection in group A was significantly lower as compared with that in group B (P < 0.050). The progression of MAP to SAP significantly decreased in group A than group B (P < 0.050). No significant differences were observed between group C and group D. The risk factors independently related to the progression of MAP included alcoholic/high-fat dietary (P = 0.028) and parecoxib administration (P = 0.011). CONCLUSIONS Early administration of parecoxib could reduce the morbidity of complications among patients with MAP. Parecoxib may prevent the progression of MAP to SAP and improve its outcomes.
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Affiliation(s)
- Jie-Hui Tan
- From the Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
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59
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Al Lehibi A, Wani MA, Al Mtawa A, Ahmad S, Azhar T, Al Sayari K, Al Khathlan A, Al Eid A, Qutub A, Al Ghamdi A, Al Balkhi A. Acute Pancreatitis: An Exploratory, Cross-sectional, Single-center Study of the Epidemiological Features of the Disease in a Sample of Saudi Patients. J Epidemiol Glob Health 2019; 9:158-162. [PMID: 31529932 PMCID: PMC7310826 DOI: 10.2991/jegh.k.190524.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/20/2019] [Indexed: 01/22/2023] Open
Abstract
Epidemiological studies on Acute Pancreatitis (AP) are significantly scarce in the Saudi Arabian Literature. In this paper, we aim to explore the current trends of AP in a sample of Saudi patients. This is a cross-sectional study in which we reviewed AP-related admissions from 2014 to 2017. Data collected included demographics, clinical presentation, investigations, severity, complications, and the outcome at the end of hospitalization. During the study period, 107 patients were admitted due to AP. Fifty-seven (53%) were males. Biliary pancreatitis was the most common etiology found among our patients (39.3%; 95% CI: 30.5–48.7), followed by alcoholic pancreatitis (11.2%; 95% CI: 6.5–18.6) and hypertriglyceridemia (8%; 95% CI: 4.5–15.2). Pancreatic pseudocysts were the most common complication we found in this series (15%; 95% CI: 9.4–23). Of all the hospitalized patients in this study, eight patients (7.9%) died (95% CI: 3.8–14.1). The number of AP-related admissions and mortality rate appear to have increased as compared with the numbers in earlier national studies. The etiological groups have also changed. As compared with Western/Asian studies, however, there was almost no difference in the epidemiological patterns except for the mortality rate.
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Affiliation(s)
- Abed Al Lehibi
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammad Abdullah Wani
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah Al Mtawa
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Shameem Ahmad
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Tauseef Azhar
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khalid Al Sayari
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah Al Khathlan
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmad Al Eid
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Adel Qutub
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmad Al Ghamdi
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Areej Al Balkhi
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
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Pereira R, Eslick G, Cox M. Endoscopic Ultrasound for Routine Assessment in Idiopathic Acute Pancreatitis. J Gastrointest Surg 2019; 23:1694-1700. [PMID: 31197695 DOI: 10.1007/s11605-019-04272-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/17/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acute pancreatitis (AP) is one of the most common general acute surgical presentations. Current recommendations are that idiopathic acute pancreatitis (IAP) should account for no more than 20% of AP cases. Some studies suggest gallbladder microlithiasis is the aetiology in up to 75% of IAP patients. Endoscopic ultrasound (EUS) has been reported to be effective in the detection of microlithiasis and choledocholithiasis as well as pancreatic parenchymal, ductal and ampullary disorders. The aims of this study were to evaluate the usefulness of EUS in establishing aetiology in IAP patients and to assess if there is a role for EUS in the selection criteria for laparoscopic cholecystectomy to treat a potential biliary cause in IAP patients. METHODS A systematic review following PRISMA guideline was performed to gather data on patients with IAP undergoing EUS for further investigation. Three databases (MEDLINE, PubMed, and EMBASE) were searched to 28 July 2018. RESULTS Our systematic review included 28 studies, comprising 1850 patients with an initial diagnosis of IAP prior to having EUS. Diagnosis of a potential aetiology or associated pancreatic pathology was established in 1095 (62%, p < 0.001) of cases. A biliary aetiology (microlithiasis or choledocholithiasis) was found in 37%. Chronic pancreatitis and associated pancreatic findings (dilated pancreatic duct, pancreatic duct stricture or stone) were found in 21%. Pancreatic neoplasms were found in 6%. Of the patients who had identifiable biliary pathology on EUS that proceeded to cholecystectomy, 2% had a recurrence of AP during a mean follow-up period of 20.5 months. CONCLUSIONS There is a likely role for the routine use of EUS in the assessment of patients with IAP. The routine use of EUS may decrease the proportion of cases with a diagnosis of IAP. EUS may provide better selection criteria for laparoscopic cholecystectomy in patients with an initial diagnosis of IAP.
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Affiliation(s)
- Ryan Pereira
- The Whiteley-Martin Research Unit, Discipline of Surgery, The University of Sydney, Clinical Sciences Building, Nepean Hospital, P. O. Box 67, Penrith, NSW, 2751, Australia.,Department of Surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Guy Eslick
- The Whiteley-Martin Research Unit, Discipline of Surgery, The University of Sydney, Clinical Sciences Building, Nepean Hospital, P. O. Box 67, Penrith, NSW, 2751, Australia
| | - Michael Cox
- The Whiteley-Martin Research Unit, Discipline of Surgery, The University of Sydney, Clinical Sciences Building, Nepean Hospital, P. O. Box 67, Penrith, NSW, 2751, Australia. .,Department of Surgery, Nepean Hospital, Sydney, NSW, Australia.
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Abstract
OBJECTIVE Despite the fact that pediatric pancreatitis is an uncommon disease, its prevalence has increased in recent years. Nevertheless, until 4 years ago, the lack of nutritional guidelines for pediatric pancreatitis was evident, with all recommendations being based on clinical practice guidelines (CPGs) for adults. The aim of the present study was to review and critically appraise guidelines for the medical nutrition therapy (MNT) of pediatric pancreatitis. METHODS A comprehensive search was performed in electronic databases (PubMed, Scopus, National Institute for Health and Care Excellence), the International Guidelines Network, BMJ best practice, and the Scottish Intercollegiate Guidelines Network to identify CPGs on the MNT of pediatric pancreatitis. The validated AGREE II tool was used for guidelines appraisal by a team of 3 independent multidisciplinary reviewers. RESULTS A total of 4 CPGs were retrieved with pediatric pancreatitis MNT information. Out of the 4 advising bodies in total, the joint society paper published by the ESPGHAN/NASPGHAN received the highest score in almost all domains, whereas the Belgian consensus obtained the lowest score in all domains but stakeholder involvement, and was not recommended by 2 out of 3 reviewers. CONCLUSIONS Pediatric pancreatitis guidelines appear heterogenous in quality, rigour, and transparency. Our study points out existing gaps and biases in the CPGs, and delineates the need for improving the domains identified as being of low-quality.
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Serrano JPR, de Moura DTH, Bernardo WM, Ribeiro IB, Franzini TP, de Moura ETH, Brunaldi VO, Salesse MT, Sakai P, De Moura EGH. Nonsteroidal anti-inflammatory drugs versus placebo for post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis. Endosc Int Open 2019; 7:E477-E486. [PMID: 30957004 PMCID: PMC6445649 DOI: 10.1055/a-0862-0215] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 01/29/2019] [Indexed: 02/08/2023] Open
Abstract
Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is the primary therapeutic procedure for treatment of diseases that affect the biliary tree and pancreatic duct. While the therapeutic success rate of ERCP is high, the procedure can cause complications, such as acute pancreatitis (PEP), bleeding, and perforation. This meta-analysis aimed to assess the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) in preventing PEP following (ERCP). Materials and methods We searched databases, such as MEDLINE, Embase, and Cochrane Central Library. Only randomized controlled trials (RCTs) that compared the efficacy of NSAIDs and placebo for the prevention of PEP were included. Outcomes assessed included incidence of PEP, severity of pancreatitis, route of administration, and type of NSAIDs. Results Twenty-one RCTs were considered eligible with a total of 6854 patients analyzed. Overall, 3427 patients used NSAIDs before ERCP and 3427 did not use the drugs (control group). In the end, 250 cases of acute pancreatitis post-ERCP were diagnosed in the NSAIDs group and 407 cases in the placebo group. Risk for PEP was lower in the NSAID group (risk difference (RD): -0.05; 95 % confidence interval (CI): -0.07 to - 0.03; number need to treat (NNT), 20; P < 0.05). Use of NSAIDs effectively prevented mild pancreatitis compared with use of placebo (2.5 % vs. 4.1 %; 95 % CI, -0.05 to - 0.01; NNT, 33; P < 0.05), but the information on moderate and severe PEP could not be completely elucidated. Only rectal administration reduced incidence of PEP (6.8 % vs. 13 %; 95 % CI, -0.10 to - 0.04; NNT, 20; P < 0.05). Furthermore, only diclofenac or indomethacin use was effective in preventing PEP. Conclusions Rectal administration of diclofenac and indomethacin significantly reduced risk of developing mild PEP. Further RCTs are needed to compare efficacy between NSAID administration pathways in prevention of PEP after ERCP.
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Affiliation(s)
- Juan Pablo Román Serrano
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – HC/FMUSP, Gastrointestinal Endoscopy Unit, São Paulo, Brazil
| | - Diogo Turiani Hourneaux de Moura
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – HC/FMUSP, Gastrointestinal Endoscopy Unit, São Paulo, Brazil
| | - Wanderley Marques Bernardo
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – HC/FMUSP, Gastrointestinal Endoscopy Unit, São Paulo, Brazil
| | - Igor Braga Ribeiro
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – HC/FMUSP, Gastrointestinal Endoscopy Unit, São Paulo, Brazil,Corresponding author Igor Braga Ribeiro, MD 255 – Instituto Central – Prédio dos Ambulatórios – PinheirosAv. Dr. Enéas de Carvalho AguiarCEP: 05403-000 – São Paulo, SPBrazil+551130697579
| | - Tomazo Prince Franzini
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – HC/FMUSP, Gastrointestinal Endoscopy Unit, São Paulo, Brazil
| | - Eduardo Turiani Hourneaux de Moura
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – HC/FMUSP, Gastrointestinal Endoscopy Unit, São Paulo, Brazil
| | - Vitor Ottoboni Brunaldi
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – HC/FMUSP, Gastrointestinal Endoscopy Unit, São Paulo, Brazil
| | | | - Paulo Sakai
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – HC/FMUSP, Gastrointestinal Endoscopy Unit, São Paulo, Brazil
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Wang YY, Qian ZY, Jin WW, Chen K, Xu XD, Mou YP, Zhang W. Acute pancreatitis with abdominal bloating and distension, normal lipase and amylase: A case report. Medicine (Baltimore) 2019; 98:e15138. [PMID: 30985682 PMCID: PMC6485828 DOI: 10.1097/md.0000000000015138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Acute pancreatitis is an inflammatory disorder of the pancreas, and its correct diagnosis is an area of interest for clinicians. In accordance with the revised Atlanta classification, acute pancreatitis can be diagnosed if at least 2 of the following 3 criteria are fulfilled: abdominal pain; serum lipase (or amylase) activity at least 3 times the upper limit of normal; or characteristic findings of acute pancreatitis on contrast-enhanced computed tomography (CT) or, less often, magnetic resonance imaging or transabdominal ultrasonography. Diagnostic imaging is essential in patients with no or slight enzyme elevation. If enzymes are normal in cases with abdominal distension, there is clinical doubt about the diagnosis of acute pancreatitis, so an early CT scan should be obtained and other life-threatening disorders excluded. PATIENT CONCERNS A 50-year-old male presented with a 1-day history of abdominal bloating and distension. On physical examination, abdominal bulging and mild epigastric tenderness were detected. Laboratory evaluation showed normal amylase and lipase. There was no abnormality on abdominal ultrasound or CT of the abdomen and pelvis. On the fourth day of admission, CT of the abdomen and pelvis showed a hypodense lesion in the pancreas surrounded by a moderate amount of peripancreatic fluid. DIAGNOSES In accordance with the revised Atlanta classification, acute pancreatitis was diagnosed, based on the presence of abdominal pain, and the results of the CT scan of the abdomen and pelvis. INTERVENTIONS The patient was treated with fasting, gastrointestinal decompression bowel rest, intravenous rehydration, and somatostatin. OUTCOMES After 2 days of treatment, his abdominal distension was significantly relieved, and the patient was discharged on the seventh day of admission. At the 3-month follow-up, the patient had no recurrence of pancreatitis. LESSONS This case of abdominal distension could not be explained by common causes, such as ascites, bowel edema, hematoma, bowel distension, or ileus, which led us to suspect pancreatitis.
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Does Etiology of Pancreatitis Matter? Differences in Outcomes Among Patients With Post-Endoscopic Retrograde Cholangiopancreatography, Acute Biliary, and Alcoholic Pancreatitis. Pancreas 2019; 48:574-578. [PMID: 30946237 DOI: 10.1097/mpa.0000000000001283] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We compared outcomes of acute alcoholic pancreatitis (AAP), acute biliary pancreatitis (ABP), and post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). METHODS This was a retrospective cohort study conducted at a tertiary care center between June 2007 and June 2012. RESULTS A total of 300 (68%) patients were diagnosed with AAP, 88 (20%) with ABP, and 55 (12%) with PEP. Longer length of hospital stay (LOHS) was more common in ABP (23%) as compared with AAP (10%) and PEP (7%, P = 0.025). Pseudocyst (P = 0.048), organ failure (OF) (P = 0.01), need for interventions (P ≤ 0.001), and mortality (P = 0.002) occurred more in ABP as compared with other groups. Systemic inflammatory response syndrome was associated with LOHS of more than 10 days (P = 0.01) and multi-OF (P = 0.05). Chronic pancreatitis was associated more with pseudocyst (P < 0.001) and mortality (P = 0.03). Serum urea nitrogen of greater than 25 g/dL predicted LOHS of more than 10 days (P = 0.02), OF (P < 0.001), multi-OF (P < 0.001), and persistent OF (P < 0.001). CONCLUSIONS Acute biliary pancreatitis is a more severe disease compared with PEP and AAP. Chronic pancreatitis, systemic inflammatory response syndrome, and high serum urea nitrogen are important predictors of morbidity.
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Zilio MB, Eyff TF, Azeredo-Da-Silva ALF, Bersch VP, Osvaldt AB. A systematic review and meta-analysis of the aetiology of acute pancreatitis. HPB (Oxford) 2019; 21:259-267. [PMID: 30249509 DOI: 10.1016/j.hpb.2018.08.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/05/2018] [Accepted: 08/11/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gallstones and alcohol are currently the most frequent aetiologies of acute pancreatitis (AP). The aim of this study is to quantify these aetiologies worldwide, by geographic region and by diagnostic method. METHODS A systematic review of observational studies published from January 2006 to October 2017 was performed. The studies provided objective criteria for establishing the diagnosis and aetiology of AP for at least biliary and alcoholic causes. A random-effects meta-analysis was used to assess the frequency of biliary (ABP), alcoholic (AAP) and idiopathic AP (IAP) worldwide and to perform 6 subgroup analyses: 2 compared diagnostic methods for AP aetiology and the other 4 compared geographic regions. RESULTS Forty-six studies representing 2,341,007 patients of AP in 36 countries were included. The global estimate of proportion (95% CI) of aetiologies was 42 (39-44)% for ABP, 21 (17-25)% for AAP and 18 (15-22)% for IAP. In studies that used discharge code diagnoses and in those from the US, IAP was the most frequent aetiology. ABP was more frequent in Latin America than in other regions. CONCLUSION Gallstones represent the main aetiology of AP globally, and this aetiology is twice as frequent as the second most common aetiology.
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Affiliation(s)
- Mariana B Zilio
- Department of Digestive Surgery, Hospital Moinhos de Vento Pancreas Group, Porto Alegre, Brazil.
| | - Tatiana F Eyff
- Department of Digestive Surgery, Hospital Moinhos de Vento Pancreas Group, Porto Alegre, Brazil
| | - André L F Azeredo-Da-Silva
- Internal Medicine Service, Hospital de Clinicas de Porto Alegre (HCPA), EBM Academy, Porto Alegre, Brazil
| | - Vivian P Bersch
- Group of Pancreas and Biliary Tract, Digestive Surgery Service, Hospital de Clinicas de Porto Alegre (HCPA), Hospital Moinhos de Vento Pancreas Group, Porto Alegre, Brazil
| | - Alessandro B Osvaldt
- Group of Pancreas and Biliary Tract, Digestive Surgery Service, Hospital de Clinicas de Porto Alegre (HCPA), Hospital Moinhos de Vento Pancreas Group, Porto Alegre, Brazil; Department of Surgery, Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Koziel D, Gluszek-Osuch M, Suliga E, Zak M, Gluszek S. Elderly persons with acute pancreatitis - specifics of the clinical course of the disease. Clin Interv Aging 2018; 14:33-41. [PMID: 30613137 PMCID: PMC6306050 DOI: 10.2147/cia.s188520] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background As may readily be inferred from clinical observations, there is an increasing prevalence of severe acute pancreatitis (SAP) in the elderly, even though the precise nature of the relationship between a patient's age and severity of the disease has not been unequivocally determined to date. This study aimed therefore to investigate the incidence, clinical course, and mortality rate among the elderly patients suffering from acute pancreatitis (AP), as compared to younger ones. Methods A prospective study, lasting a single calendar year, covered patients with AP successively admitted to hospitals. The final assessment comprised 963 patients. The patients were subsequently divided into three groups corresponding to the three grades of disease severity, based on the Revised Atlanta Classification for Acute Pancreatitis. The actual cause of the disease, its clinical course, results of radiological ultrasonography, computed tomography, and laboratory tests, as well as the duration of hospital stay were assessed in due consideration of patients' age (groups aged 65-79 years and ≥80 years vs <65 years). Results Cholelithiasis was determined as the main cause of AP among the older patients (54.08% and 58.12% vs 22.46%; P<0.000). Among the oldest patients (≥80 years), its course was often significantly more severe, in comparison with the ones under 65 years of age: 14.53% vs 6.31% (P<0.00); a phenomenon not observed in the age range 65-79 years, nor among the younger patients (7.69% vs 6.31%; P>0.05). Moderate AP occurred significantly more often in the younger patients compared to those aged ≥80 years (16% vs 8.55%; P<0.00), although without any significant differences observed between the group aged 65-79 years and the younger patients (13.27% vs 8.55%). SAP more frequently ended in death among the oldest patients - 11.97% vs 2.31% (P<0.000) than in the group aged 65-79 years (4.59%), as compared to the younger groups (P>0.05). Conclusion An appreciably higher susceptibility of older patients aged ≥80 years to AP, with cholelithiasis being the main cause that results in high mortality rate, is presently acknowledged a serious diagnostic and therapeutic management challenge to a national healthcare system.
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Affiliation(s)
- Dorota Koziel
- Faculty of Medicine and Health Sciences, The Jan Kochanowski University, Kielce, Poland,
| | - Martyna Gluszek-Osuch
- Faculty of Medicine and Health Sciences, The Jan Kochanowski University, Kielce, Poland,
| | - Edyta Suliga
- Faculty of Medicine and Health Sciences, The Jan Kochanowski University, Kielce, Poland,
| | - Marek Zak
- Faculty of Medicine and Health Sciences, The Jan Kochanowski University, Kielce, Poland,
| | - Stanislaw Gluszek
- Faculty of Medicine and Health Sciences, The Jan Kochanowski University, Kielce, Poland, .,Clinic General Oncological and Endocrinological Surgery, Regional Hospital, Kielce, Poland
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Waller A, Long B, Koyfman A, Gottlieb M. Acute Pancreatitis: Updates for Emergency Clinicians. J Emerg Med 2018; 55:769-779. [PMID: 30268599 DOI: 10.1016/j.jemermed.2018.08.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 08/03/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Acute pancreatitis is a frequent reason for patient presentation to the emergency department (ED) and the most common gastrointestinal disease resulting in admission. Emergency clinicians are often responsible for the diagnosis and initial management of acute pancreatitis. OBJECTIVE This review article provides emergency clinicians with a focused overview of the diagnosis and management of pancreatitis. DISCUSSION Pancreatitis is an inflammatory process within the pancreas. While the disease is often mild, severe forms can have a mortality rate of up to 30%. The diagnosis of pancreatitis requires two of the following three criteria: epigastric abdominal pain, an elevated lipase, and imaging findings of pancreatic inflammation. The most common etiologies include gallbladder disease and alcohol use. After the diagnosis has been made, it is important to identify underlying etiologies requiring specific intervention, as well as obtain a right upper quadrant ultrasound. The initial management of choice is fluid resuscitation and pain control. Recent data have suggested that more cautious fluid resuscitation in the first 24 h might be more appropriate for some patients. Intravenous opiates are generally safe if used judiciously. Appropriate disposition is a multifactorial decision, which can be facilitated by using Ranson criteria or the Bedside Index of Severity in Acute Pancreatitis score. Complications, though rare, can be severe. CONCLUSIONS Pancreatitis is a potentially deadly disease that commonly presents to most emergency departments. It is important for clinicians to be aware of the current evidence regarding the diagnosis, treatment, and disposition of these patients.
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Affiliation(s)
- Anna Waller
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
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Epidemiology and Etiology of Acute Pancreatitis in Urban and Suburban Areas in Shanghai: A Retrospective Study. Gastroenterol Res Pract 2018; 2018:1420590. [PMID: 30158961 PMCID: PMC6109519 DOI: 10.1155/2018/1420590] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/14/2018] [Accepted: 05/24/2018] [Indexed: 01/30/2023] Open
Abstract
Aim To investigate the epidemiology, etiology, and severity of acute pancreatitis (AP) in urban and suburban areas of Shanghai in 2011 and 2016. Methods A retrospective study of patients admitted to Shanghai General Hospital (urban and suburban campuses) with AP in 2011 and 2016 was undertaken. Patients were divided into acute biliary pancreatitis (ABP), hypertriglyceridemic pancreatitis (HTGP), alcoholic pancreatitis, and pancreatitis of other causes according to etiology. Severity of AP was divided into mild AP (MAP), moderately severe AP (MSAP), and severe AP (SAP). Results AP patients in the suburban area increased more rapidly than those in the urban area. The mean onset age of AP in the urban area in 2016 was older than that in the suburban area (p < 0.05). The suburban patients in 2016 have significantly younger mean onset age than those in 2011 (p < 0.05). HTGP incidence in suburban patients increased from 2011 to 2016, which changed little in the urban area. Urban females were more likely to develop HTGP than suburban ones in 2011, which reversed in 2016. As to the male patients, the incidence of HTGP increased in both urban and suburban areas. Nonelderly (<60 years old) patients had higher HTGP incidence than elderly ones in both 2011 and 2016. The descending trend of SAP in the suburban area was more obvious than that in the urban area. The length of hospitalization decreased from 2011 to 2016, especially in SAP patients. Conclusions AP patients increased more rapidly in the suburban area of Shanghai with younger onset age. The incidence of HTGP increased significantly in the suburban area, reminding of the prevention and screening of HTG.
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Abstract
OBJECTIVES This research was applied to case-control studies of the association between pancreatitis and SPINK1 gene to assess the joint evidence for the association, the influence of individual studies, and evidence for publication bias. METHODS MEDLINE and Embase were searched to identify longitudinal studies evaluating pancreatitis and SPINK1. Odds ratios (ORs) and 95% confidence interval (CI) were pooled using random-effect models and calculated using Carlin method. Publication bias was assessed using Egger et al's approach (A famous statistic method by Egger et al). Sensitivity, heterogeneity, and trim and fill analyses were conducted. RESULTS Based on the results, we found that (1) the results support for the association between pancreatitis and SPINK1, when analyzed totally and by subdivision (total [OR, 7.771; 95% CI, 5.232-11.543; P < 0.000]; European [OR,6.400; 95% CI, 4.346-9.426; P < 0.000]; Asian [OR, 11.823; 95% CI, 4.612-30.310; P < 0.000]; American [OR, 3.777; 95% CI, 1.596-8.939; P = 0.002]; mixed: [OR, 13.566; 95% CI, 2.322-79.252, P = 0.004]); (2) no evidence indicates that this association is accounted for by any one study, and no evidence indicates any publication bias exists. CONCLUSIONS The results indicated that SPINK1 gene, particularly the N34S mutation, has a genetic association with the development of pancreatitis.
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van Dijk SM, Hallensleben NDL, van Santvoort HC, Fockens P, van Goor H, Bruno MJ, Besselink MG. Acute pancreatitis: recent advances through randomised trials. Gut 2017; 66:2024-2032. [PMID: 28838972 DOI: 10.1136/gutjnl-2016-313595] [Citation(s) in RCA: 241] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/05/2017] [Accepted: 07/07/2017] [Indexed: 12/19/2022]
Abstract
Acute pancreatitis is one of the most common GI conditions requiring acute hospitalisation and has a rising incidence. In recent years, important insights on the management of acute pancreatitis have been obtained through numerous randomised controlled trials. Based on this evidence, the treatment of acute pancreatitis has gradually developed towards a tailored, multidisciplinary effort, with distinctive roles for gastroenterologists, radiologists and surgeons. This review summarises how to diagnose, classify and manage patients with acute pancreatitis, emphasising the evidence obtained through randomised controlled trials.
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Affiliation(s)
- Sven M van Dijk
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Academic Medical Center, Amsterdam, The Netherlands
| | - Nora D L Hallensleben
- Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Paul Fockens
- Department of Gastroenterology & Hepatology, Amsterdam Gastroenterology and Metabolism, Academic Medical Center, Amsterdam, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Academic Medical Center, Amsterdam, The Netherlands
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Cumulative Radiation Exposure in Pancreatic Drainage: Could it be Improved? Pancreas 2017; 46:e72-e73. [PMID: 28902798 DOI: 10.1097/mpa.0000000000000900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Reid GP, Williams EW, Francis DK, Lee MG. Acute pancreatitis: A 7 year retrospective cohort study of the epidemiology, aetiology and outcome from a tertiary hospital in Jamaica. Ann Med Surg (Lond) 2017; 20:103-108. [PMID: 28808565 PMCID: PMC5537196 DOI: 10.1016/j.amsu.2017.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is a significant cause of acute abdominal pain, morbidity and hospitalisation. There was previously a dearth of studies exploring the incidence, risk factors and outcome of AP in the Caribbean region. MATERIALS AND METHODS All patients with a diagnosis of AP admitted to the University Hospital of the West Indies (UHWI) between 2006 and 2012 were reviewed. The epidemiological profile, risk factors, clinical presentation and outcomes of patients with AP were retrospectively studied. RESULTS There were 70 females and 21 males with a median age of 44 years (range 2-86). The median age of males was significantly higher than that of females (p = 0.041). The incidence of AP was 74 per 100,000 admissions per year. Vomiting and abdominal tenderness were noted in the majority of patients. The most common aetiology was biliary disease (71.4%), idiopathic (12%), post-ERCP (6.6%) and alcohol (5.5%). Alcoholic pancreatitis was only seen in males whereas idiopathic and post-ERCP pancreatitis only occurred in females. The mean duration of hospitalisation was 9.51 ± 8.28 days. Disease severity was mild in 61.1%, moderately severe in 26.7%, and severe in 12.2% of patients. Factors associated with more severe disease included overweight/obesity, idiopathic aetiology and post-ERCP status. The case fatality rate was 2%. CONCLUSION The incidence of AP was 74/100,000 hospital admissions annually. There was an unusual female preponderance, with biliary pancreatitis being the most common type occurring at an equal frequency among males and females. Only 12.2% of the total cases seen were severe. The case fatality rate was 2%. Local health policy should target timely interventions for biliary pancreatitis and should also address the local factors affecting disease severity.
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Affiliation(s)
- Gail P Reid
- Emergency Medicine Division, Department of Surgery, Radiology, Anaesthesia & Intensive Care, The University Hospital of the West Indies, Mona, Jamaica
| | - Eric W Williams
- Emergency Medicine Division, Department of Surgery, Radiology, Anaesthesia & Intensive Care, The University Hospital of the West Indies, Mona, Jamaica
| | - Damian K Francis
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
| | - Michael G Lee
- Department of Medicine, The University Hospital of the West Indies, Mona, Jamaica
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McNicholas DP, Kelly ME, Das JP, Bowden D, Murphy JM, Malone C. Disappearing portal venous gas in acute pancreatitis and small bowel ischemia. Radiol Case Rep 2017; 12:269-272. [PMID: 28491167 PMCID: PMC5417629 DOI: 10.1016/j.radcr.2017.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 01/02/2017] [Indexed: 12/18/2022] Open
Abstract
We report an usual case of hepatic portal venous gas (HPVG) in the setting of acute pancreatitis and small bowel ischemia. Interestingly, the HPVG disappeared within 2 hours of the original computed tomography scan, despite the patient having small bowel ischemia. The patient had a complicated clinical course, dying 62 days postadmission. This case highlights that HPVG in setting of acute pancreatitis and small bowel ischemia has a very high morbidity and mortality, requiring early detection and aggressive surgical management.
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Affiliation(s)
- Daniel P McNicholas
- Department of Surgery, University Hospital Galway, Saolta University Healthcare Group, Newcastle Road, Galway City, Galway, Ireland
| | - Michael E Kelly
- Department of Surgery, University Hospital Galway, Saolta University Healthcare Group, Newcastle Road, Galway City, Galway, Ireland
| | - Jeeban P Das
- Department of Radiology, University Hospital Galway, Saolta University Healthcare Group, Newcastle Road, Galway City, Galway, Ireland
| | - Dermot Bowden
- Department of Surgery, University Hospital Galway, Saolta University Healthcare Group, Newcastle Road, Galway City, Galway, Ireland
| | - Joe M Murphy
- Department of Radiology, University Hospital Galway, Saolta University Healthcare Group, Newcastle Road, Galway City, Galway, Ireland
| | - Carmel Malone
- Department of Surgery, University Hospital Galway, Saolta University Healthcare Group, Newcastle Road, Galway City, Galway, Ireland
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Oz HS. Multiorgan chronic inflammatory hepatobiliary pancreatic murine model deficient in tumor necrosis factor receptors 1 and 2. World J Gastroenterol 2016; 22:4988-4998. [PMID: 27275091 PMCID: PMC4886374 DOI: 10.3748/wjg.v22.i21.4988] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/07/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To provoke persistent/chronic multiorgan inflammatory response and to contribute to stones formation followed by fibrosis in hepatobiliary and pancreatic tissues.
METHODS: Tumor necrosis factor receptors 1 and 2 (TNFR1/R2) deficient mice reared in-house were given dibutyltin dichloride (DBTC) twice within 10 d by oral gavage delivery. Sham control animals received vehicle treatment and naïve animals remained untreated throughout the study. Animals were monitored daily for symptoms of pain and discomfort. The abdominal and hindpaw hypersensitivity were assessed with von Frey microfilaments. Exploratory behaviors were recorded at the baseline, after initiation of treatment, and before study termination. Histopathological changes were examined postmortem in tissues. Collagen accumulation and fibrosis were confirmed with Sirius Red staining.
RESULTS: Animals lost weight after oral administration of DBTC and developed persistent inflammatory abdominal and hindpaw hypersensitivity compared to sham-treated controls (P < 0.0001). These pain related secondary mechanical hypersensitivity responses increased more than 2-fold in DBTC-treated animals. The drastically diminished rearing and grooming rates persisted after DBTC administration throughout the study. Gross as well as micropathology at one month confirmed that animals treated with DBTC developed chronic hepatobiliary injuries evidenced with activation of stellate cells, multifocal necrosis, fatty degeneration of hepatocytes, periportal infiltration of inflammatory cells, and prominent biliary ductal dilation. The severity of hepatitis was scored 3.7 ± 0.2 (severe) in DBTC-treated animals vs score 0 (normal) in sham-treated animals. Fibrotic thickening was extensive around portal ducts, in hepatic parenchyma as well as in lobular pancreatic structures and confirmed with Sirius Red histopathology. In addition, pancreatic microarchitecture was presented with distortion of islets, and parenchyma, infiltration of inflammatory cells, degeneration, vacuolization, and necrosis of acinar cells and distention of pancreatic ducts. Extent of pancreatic damage and pancreatitis were scored 3.6 ± 0.4 (severe) for DBTC-treated in contrast to score 0 (normal) in sham-treated animals. The gall bladder became expanded with ductal distention, and occasional bile stones were detected along with microscopic hepatic lesions. DBTC-treated animals developed splenic hypertrophy with increased weight and length (P < 0.01) along with thymic atrophy (P < 0.001). Finally, colitic lesions and colitis were prominent in DBTC-treated animals and scored 3.4 ± 0.3 (moderately severe) vs 0 (normal) for the sham-treated animals.
CONCLUSION: This is the first report of chronic inflammatory multiorgan hepatobiliary pancreatitis, along with fibrosis and calculi formation induced reliably utilizing oral DBTC administration in TNFR1/R2 deficient mice.
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MESH Headings
- Abdominal Pain/chemically induced
- Abdominal Pain/genetics
- Abdominal Pain/metabolism
- Animals
- Behavior, Animal
- Bile Ducts/metabolism
- Bile Ducts/pathology
- Chemical and Drug Induced Liver Injury/etiology
- Chemical and Drug Induced Liver Injury/genetics
- Chemical and Drug Induced Liver Injury/metabolism
- Chemical and Drug Induced Liver Injury/psychology
- Cholangitis/chemically induced
- Cholangitis/genetics
- Cholangitis/metabolism
- Cholangitis/psychology
- Colitis/chemically induced
- Colitis/genetics
- Colitis/metabolism
- Exploratory Behavior
- Genetic Predisposition to Disease
- Grooming
- Hepatic Stellate Cells/metabolism
- Hepatic Stellate Cells/pathology
- Hyperalgesia/chemically induced
- Hyperalgesia/genetics
- Hyperalgesia/metabolism
- Lithiasis/chemically induced
- Lithiasis/genetics
- Lithiasis/metabolism
- Lithiasis/psychology
- Liver/metabolism
- Liver/pathology
- Liver Cirrhosis, Experimental/chemically induced
- Liver Cirrhosis, Experimental/genetics
- Liver Cirrhosis, Experimental/metabolism
- Liver Cirrhosis, Experimental/psychology
- Mice, Knockout
- Organotin Compounds
- Pain Perception
- Pancreas/metabolism
- Pancreas/pathology
- Pancreatic Stellate Cells/metabolism
- Pancreatic Stellate Cells/pathology
- Pancreatitis/genetics
- Pancreatitis/metabolism
- Pancreatitis/psychology
- Phenotype
- Receptors, Tumor Necrosis Factor, Type I/deficiency
- Receptors, Tumor Necrosis Factor, Type I/genetics
- Receptors, Tumor Necrosis Factor, Type II/deficiency
- Receptors, Tumor Necrosis Factor, Type II/genetics
- Spleen/metabolism
- Spleen/pathology
- Weight Loss
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75
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Zhang YF, Deng HL, Fu J, Zhang Y, Wei JQ. Pancreatitis in hand-foot-and-mouth disease caused by enterovirus 71. World J Gastroenterol 2016; 22:2149-2152. [PMID: 26877620 PMCID: PMC4726688 DOI: 10.3748/wjg.v22.i6.2149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 11/18/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
Some viruses, including certain members of the enterovirus genus, have been reported to cause pancreatitis, especially Coxsackie virus. However, no case of human enterovirus 71 (EV71) associated with pancreatitis has been reported so far. We here report a case of EV71-induced hand-foot-and-mouth disease (HFMD) presenting with pancreatitis in a 2-year-old girl. This is the first report of a patient with acute pancreatitis in HFMD caused by EV71. We treated the patient conservatively with nasogastric suction, intravenous fluid and antivirals. The patient’s symptoms improved after 8 d, and recovered without complications. We conclude that EV71 can cause acute pancreatitis in HFMD, which should be considered in differential diagnosis, especially in cases of idiopathic pancreatitis.
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76
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Nesvaderani M, Eslick GD, Faraj S, Vagg D, Cox MR. Study of the early management of acute pancreatitis. ANZ J Surg 2015; 87:805-809. [DOI: 10.1111/ans.13330] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2015] [Indexed: 12/17/2022]
Affiliation(s)
- Maryam Nesvaderani
- The Whiteley-Martin Research Centre, Discipline of Surgery, Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
| | - Guy D. Eslick
- The Whiteley-Martin Research Centre, Discipline of Surgery, Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
| | - Shadi Faraj
- The Whiteley-Martin Research Centre, Discipline of Surgery, Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
| | - Daniel Vagg
- The Whiteley-Martin Research Centre, Discipline of Surgery, Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
| | - Michael R. Cox
- The Whiteley-Martin Research Centre, Discipline of Surgery, Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
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