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Sellers ZM, Giefer MJ, Wang F, Cress GA, Abu-El-Haija MA, Chugh A, Cohen RZ, Downs EM, Fishman DS, Freeman AJ, Gariepy CE, Gonska TY, Grover AS, Lindblad D, Liu QY, Maqbool A, Mark JA, McFerron BA, Mehta MS, Morinville VD, Ng K, Noel RA, Ooi CY, Perito ER, Phadke MY, Ruan W, Schwarzenberg SJ, Troendle DM, Wilschanski M, Zheng Y, Yuan Y, Lowe ME, Uc A. Impact of Elevated Serum Triglycerides on Children with Acute Recurrent or Chronic Pancreatitis from INSPPIRE-2. J Pediatr 2024:114298. [PMID: 39277078 DOI: 10.1016/j.jpeds.2024.114298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 09/03/2024] [Accepted: 09/09/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVE To determine if mild-moderate hypertriglyceridemia is associated with increased development of chronic pancreatitis or pancreatitis-associated complications in children with acute recurrent or chronic pancreatitis. STUDY DESIGN Longitudinal data from the INSPPIRE-2 (INternational Study group of Pediatric Pancreatitis: In search for a cuRE-2) cohort of children with acute recurrent or chronic pancreatitis (n=559) were analyzed. Subjects were divided into normal triglycerides (<150 mg/dL; 1.7 mmol/L), any hypertriglyceridemia (≥150 mg/dL; ≥1.7 mmol/L), mild-moderate hypertriglyceridemia (150-499 mg/dL; 1.7-5.6 mmol/L), moderate hypertriglyceridemia (500-999 mg/dL; 5.6-11.3 mmol/L), and severe hypertriglyceridemia groups (≥1,000 mg/dL; ≥11.3 mmol/L), based on highest serum triglyceride value. Laboratory, imaging, pancreatitis and hospital events, complications, and quality of life data were analyzed. RESULTS In children with acute recurrent or chronic pancreatitis and hypertriglyceridemia, there was no increase in the number of pancreatitis attacks per person-years, nor an increase in chronic pancreatitis prevalence. However, hypertriglyceridemia severity was associated with increased pancreatic inflammation, pancreatic cysts, pain, hospital days, number of hospitalizations, intensive care, and missed school days. CONCLUSIONS Mild-moderate hypertriglyceridemia in children with acute recurrent or chronic pancreatitis was not associated with increased pancreatitis frequency, nor increased development of chronic pancreatitis, but was associated with increased pancreatitis complications and disease burden. As a treatable condition, treatment of mild-moderate hypertriglyceridemia may be considered to reduce pancreatitis-associated complications and medical burden in children with acute recurrent or chronic pancreatitis.
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Affiliation(s)
- Zachary M Sellers
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, CA, USA.
| | - Matthew J Giefer
- The University of Queensland, Brisbane, QLD, AU and Ochsner Hospital for Children, New Orleans, LA, USA
| | - Fuchenchu Wang
- The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Maisam A Abu-El-Haija
- Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, OH, USA
| | - Ankur Chugh
- Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI, USA
| | - Reuven Z Cohen
- Emory University, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Elissa M Downs
- University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| | - Douglas S Fishman
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - A Jay Freeman
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Cheryl E Gariepy
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Tanja Y Gonska
- Department of Pediatrics, University of Toronto, and Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Amit S Grover
- Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Doug Lindblad
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Quin Y Liu
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Asim Maqbool
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jacob A Mark
- University of Colorado School of Medicine, Children's Hospital of Colorado, Aurora, CO, USA
| | - Brian A McFerron
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Megha S Mehta
- University of Texas Southwestern Medical Center and Children's Health, Dallas, TX, USA
| | | | - Kenneth Ng
- Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Chee Y Ooi
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales and Department of Gastroenterology, Sydney Children' Hospital Randwick, Sydney, NSW, Australia
| | - Emily R Perito
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Wenly Ruan
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | | | - David M Troendle
- University of Texas Southwestern Medical Center and Children's Health, Dallas, TX, USA
| | | | - Yuhua Zheng
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Ying Yuan
- The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Mark E Lowe
- Washington University School of Medicine, St. Louis, MO, USA
| | - Aliye Uc
- University of Iowa, Stead Family Children's Hospital, IA, USA
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Su XJ, Chen Y, Zhang QC, Peng XB, Liu YP, Wang L, Du YQ. Exosomes Derived From Cerulein-Stimulated Pancreatic Acinar Cells Mediate Peritoneal Macrophage M1 Polarization and Pyroptosis via an miR-24-3p/MARCH3/NLRP3 Axis in Acute Pancreatitis. Pancreas 2024; 53:e641-e651. [PMID: 38530976 DOI: 10.1097/mpa.0000000000002351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVES Acute pancreatitis (AP) has a high incidence of hospitalizations, morbidity, and mortality worldwide. A growing number of studies on AP pathogenesis are based on cerulein-induced experimental model, which simulates human AP in vivo. It has been demonstrated that both pancreatic acinar cells and peritoneal macrophages are involved in pancreatic inflammation and damage. However, their connection has not been well understood. METHODS A cerulein-induced AP model was established on the pancreatic acinar cell line AR42J. Rat macrophages were isolated from the peritoneal cavity. The effects of cerulein-induced pancreatic exosomes on the peritoneal macrophage and pancreas in vivo and in vitro were examined. The underlying molecular mechanism was investigated by exploring the regulatory role of downstream molecules. RESULTS We found that exosomes derived from cerulein-treated AR42J cells induced rat peritoneal macrophage M1 polarization and pyroptosis. miR-24-3p was upregulated in cerulein-stimulated exosomes, whereas the miR-24-3p inhibitor counteracted the effect of pancreatic exosomes on peritoneal macrophage M1 polarization and pyroptosis. Furthermore, miR-24-3p inhibited March3 expression, whereas MARCH3 mediated NLRP3 ubiquitination in rat peritoneal macrophages, which, in turn, contributed to the apoptosis, reactive oxygen species production, and inflammation in AR42J cells. CONCLUSIONS Exosomes derived from cerulein-stimulated pancreatic acinar cells mediate peritoneal macrophage M1 polarization and pyroptosis via an miR-24-3p/MARCH3/NLRP3 axis in AP.
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Affiliation(s)
- Xiao-Ju Su
- From the Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yan Chen
- From the Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Qi-Chen Zhang
- From the Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xiao-Bo Peng
- Department of Oncology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Ya-Ping Liu
- From the Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Lei Wang
- From the Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yi-Qi Du
- From the Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
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3
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Milano RV, Morneault-Gill K, Kamal HY, Barkin JA, Chadwick CB. Pancreatitis in cystic fibrosis: Presentation, medical and surgical management, and the impact of modulator therapies. Pediatr Pulmonol 2024; 59 Suppl 1:S53-S60. [PMID: 38501345 DOI: 10.1002/ppul.26958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/19/2024] [Accepted: 03/01/2024] [Indexed: 03/20/2024]
Abstract
Patients with Cystic Fibrosis (CF) are at increased risk of acute (AP) and chronic (CP) pancreatitis, and their complications. The extent of remaining healthy pancreatic parenchyma determines the risk of developing future episodes of pancreatitis, as well as pancreatic exocrine or endocrine insufficiency. Pancreatitis may be the presenting symptom of CF, and genetic testing is especially important in pediatrics. AP and recurrent AP are managed with intravenous fluid hydration and pain control, in addition to early refeeding and treatment of complications. With the use of modulator therapy in CF, pancreatic function may be restored to some extent. CP related pain is managed with analgesics and neuromodulators, with surgery if indicated in specific situations including TPIAT as a possible type of surgical intervention. Long-term sequelae of CP in patients with CF include exocrine pancreatic insufficiency treated with pancreatic enzyme replacement therapy, fat-soluble vitamin deficiencies and associated metabolic complications such as bone disease/osteoporosis, pancreatogenic diabetes, and less commonly, pancreatic cancer. We review the presentation and etiologies of pancreatitis in CF patients as well as the management of AP and CP primarily in children.
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Affiliation(s)
- Reza V Milano
- Department of Medicine, Division of Digestive Health and Liver Diseases, University of Miami, Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Kayla Morneault-Gill
- Department of Pediatrics, Division of Gastroenterology, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Hebat Y Kamal
- Department of Pediatrics, Division of Gastroenterology, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Jodie A Barkin
- Department of Medicine, Division of Digestive Health and Liver Diseases, University of Miami, Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Christina Baldwin Chadwick
- Department of Pediatrics, Division of Gastroenterology, University of Florida, College of Medicine, Gainesville, Florida, USA
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Maloof T, Rodrigues D, Li T, Rodrigues T, Lancki N, Keswani RN. Early Endoscopic Retrograde Cholangiopancreatography in Gallstone Pancreatitis Is Safe: Results From a Large Single-Center Retrospective Study. Pancreas 2024; 53:e657-e661. [PMID: 39137091 DOI: 10.1097/mpa.0000000000002352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
OBJECTIVES There is concern that performing early endoscopic retrograde cholangiopancreatography (ERCP) in the setting of gallstone pancreatitis (GSP) with choledocholithiasis can worsen underlying pancreatitis. This study was designed to assess outcomes of early versus delayed ERCP in patients with GSP with choledocholithiasis in the absence of cholangitis. MATERIALS AND METHODS In this single-center retrospective study, we identified 124 patients who underwent ERCP for choledocholithiasis in the setting of GSP without cholangitis between 2012 and 2022. Timing of ERCP was categorized as early (<48 hours after time of diagnosis) versus delayed (>48 hours). Data on patient demographics, complications, length of stay (LOS), and mortality were collected. RESULTS Cannulation success rates were similar for early and delayed ERCP (97% vs 100%). The adverse event rate for early ERCP was 15% compared to 29% for delayed ERCP. LOS for patients with predicted mild pancreatitis was shorter for early versus delayed ERCP (4.2 vs 7.1 days, P = 0.007). There were no deaths in either group. CONCLUSIONS There was a trend toward fewer adverse events and there was a shorter LOS among patients with GSP with choledocholithiasis undergoing early versus delayed ERCP. Early ERCP should be considered, particularly in patients with predicted mild pancreatitis.
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Affiliation(s)
- Tassiana Maloof
- From the Department of Medicine, Northwestern University Feinberg School of Medicine
| | | | - Thomas Li
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine
| | - Terrance Rodrigues
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine
| | - Nicola Lancki
- Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rajesh N Keswani
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine
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5
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Lan Y, Chen L, Yang Q, Zhu B, Lin Z. Association between wait time of central venous pressure and 28-day mortality in critically patients with acute pancreatitis: A restrospective cohort study. Medicine (Baltimore) 2024; 103:e39438. [PMID: 39213238 PMCID: PMC11365617 DOI: 10.1097/md.0000000000039438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/26/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024] Open
Abstract
Hemodynamic management is crucial in patients with acute pancreatitis. Central venous pressure (CVP) is widely used to assess volume status. Our aim was to determine the optimal time window for obtaining CVP measurements to prevent adverse outcomes in patients. This study utilized data from the Medical Information Mart for Intensive Care (MIMIC) IV database. The primary outcome under investigation was the 28-day mortality, while secondary outcomes included 90-day mortality and 1-year mortality. To categorize the study population, a CVP waiting time of 12 hours was employed as the grouping criterion, followed by the utilization of Cox regression analysis to compare the outcomes between the 2 groups. Our study included a total of 233 patients, among whom 154 cases (66.1%) underwent CVP measurements within 12 hours after admission to the Intensive Care Unit (ICU). Univariate and multivariate Cox regression analyses revealed a significantly increased risk of 28-day mortality in patients from the delayed CVP monitoring group compared to those who underwent early CVP measurements (HR = 2.87; 95% CI: 1.35-6.13; P = .006). Additionally, consistent results were observed for the risks of 90-day mortality (HR = 1.91; 95% CI: 1.09-3.35; P = .023) and 1-year mortality (HR = 1.84; 95% CI: 1.09-3.10; P = .023). In the ICU, an extended waiting time for CVP measurements in patients with acute pancreatitis was associated with an increased risk of 28-day mortality.
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Affiliation(s)
- Ying Lan
- Department of Critical Care Medicine, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Lvlin Chen
- Department of Critical Care Medicine, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Qilin Yang
- Department of Critical Care, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bin Zhu
- Hubei University of Science and Technology, Xianning, China
| | - Zhimei Lin
- Department of Hematology, Affiliated Hospital of Chengdu University, Chengdu, China
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Vu PQ, Thiriveedi M, Patel S, Metuku R. Case Report: Acute Pancreatitis in an Uncontrolled Diabetic Patient Presenting With a Skin Rash Later Found to Be Eruptive Xanthoma, a Dermatological Manifestation and Diagnostic Clue to Recognizing Hypertriglyceridemia as the Cause of Disease. Cureus 2024; 16:e64563. [PMID: 39144851 PMCID: PMC11323875 DOI: 10.7759/cureus.64563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 07/14/2024] [Indexed: 08/16/2024] Open
Abstract
Acute pancreatitis results from any insult that leads to inflammation of the organ. Hypertriglyceridemia is one of the risk factors associated with acute pancreatitis. The typical presentation is abdominal pain, nausea, and vomiting. We present a unique case in which the patient's condition was further complicated by diabetic ketoacidosis. Consequently, he presented somnolent to the emergency room, providing a limited history only pertaining to generalized weakness and a skin rash. The patient was found to have hypertriglyceridemia-induced pancreatitis, which was appropriately managed in the intensive care unit. The skin lesions were diagnosed as xanthomas, which are associated with hypertriglyceridemia and acute pancreatitis secondary to hypertriglyceridemia. The patient was discharged on fibrate therapy, dietary counseling, and strict monitoring by his primary care physician. This unique case highlights the importance of recognizing dermatological conditions and their associated diseases to allow for prompt diagnosis and treatment in the face of limited history.
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Affiliation(s)
- Paul Q Vu
- Internal Medicine, Alabama College of Osteopathic Medicine, Dothan, USA
| | | | | | - Rajesh Metuku
- Internal Medicine, Alabama College of Osteopathic Medicine, Dothan, USA
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7
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Aijaz P, Park JY, Yarlagadda H. COVID-19-Induced Hypertriglyceridemia Leading to Pancreatitis in a 51-Year-Old Female. Cureus 2024; 16:e64065. [PMID: 38979030 PMCID: PMC11229386 DOI: 10.7759/cureus.64065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2024] [Indexed: 07/10/2024] Open
Abstract
There are increasing reports of the effects of COVID-19 on the pancreas. Pancreatitis, as a result of hypertriglyceridemia, has also been reported. Hypothesized mechanisms include hemophagocytic lymphohistiocytosis (HLH) syndrome and acquired lipoprotein lipase (LPL) inhibitors. We present a 51-year-old female patient who presented with nausea, vomiting, and epigastric abdominal pain radiating to the back. On examination, she had generalized abdominal tenderness without guarding or rebound tenderness. Our workup revealed elevated lipase of 1150 units/L, triglycerides (TG) of 11340 mg/dL, and mild pancreatitis on an abdominal computed tomography (CT) scan. On day 2, she developed a new oxygen requirement and tested positive for COVID-19. She was treated with fluids and opiates for pancreatitis, plasmapheresis, and an insulin infusion to treat her hypertriglyceridemia. She was treated with remdesivir for an acute COVID-19 infection. Triglycerides decreased to <500 mg/dL with treatment, and she was discharged home on oral lipid-lowering agents. By discussing this case, we aim to shed light on the association between COVID-19 and hypertriglyceridemia, which can further lead to life-threatening complications such as acute pancreatitis. Further studies are needed to identify the exact mechanisms, preventive measures, and long-term effects of COVID-19 on triglycerides and the pancreas.
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Affiliation(s)
- Parisa Aijaz
- Internal Medicine, Charleston Area Medical Center, Charleston, USA
| | - Ji Yoon Park
- Internal Medicine, Charleston Area Medical Center, Charleston, USA
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Jin DX, Lacson R, Eskian M, McNabb-Baltar J, Banks PA, Kayden SR, Raja AS, Khorasani R. Prospective Validation of a Prediction Model for the Diagnosis of Acute Pancreatitis. JAMA Netw Open 2024; 7:e2419014. [PMID: 38941094 PMCID: PMC11214112 DOI: 10.1001/jamanetworkopen.2024.19014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/26/2024] [Indexed: 06/29/2024] Open
Abstract
Importance While most patients with acute pancreatitis (AP) fulfill diagnostic criteria with characteristic abdominal pain and serum lipase levels of at least 3 times the upper limit of normal (reference range) at presentation, early imaging is often used for confirmation. A prior prediction model and corresponding point-based score were developed using nonimaging parameters to diagnose AP in patients presenting to the emergency department (ED). Objective To evaluate the performance of the prediction model to diagnose AP in a prospective patient cohort. Design, Setting, and Participants This prospective diagnostic study included consecutive adult patients presenting to the ED between January 1, 2020, and March 9, 2021, at 2 large academic medical centers in the northeastern US with serum lipase levels at least 3 times the upper limit of normal. Patients transferred from outside institutions or with malignant disease and established intra-abdominal metastases, acute trauma, or altered mentation were excluded. Data were analyzed from October 15 to October 23, 2023. Exposures Participants were assigned scores for initial serum lipase level, number of prior AP episodes, prior cholelithiasis, abdominal surgery within 2 months, presence of epigastric pain, pain of worsening severity, duration from pain onset to presentation, and pain level at ED presentation. Main Outcome and Measures A final diagnosis of AP, established by expert review of hospitalization records. Results Prospective scores in 349 participants (mean [SD] age, 53.0 [18.8] years; 184 women [52.7%]; 66 Black [18.9%]; 199 White [57.0%]) demonstrated an area under the receiver operating characteristics curve of 0.91. A score of at least 6 points achieved highest accuracy (F score, 82.0), corresponding to a sensitivity of 81.5%, specificity of 85.9%, positive predictive value of 82.6%, and negative predictive value of 85.1% for AP diagnosis. Early computed tomography or magnetic resonance imaging was performed more often in participants predicted to have AP (116 of 155 [74.8%] with a score ≥6 vs 111 of 194 [57.2%] with a score <6; P < .001). Early imaging revealed an alternative diagnosis in 8 of 116 participants (6.9%) with scores of at least 6 points, 1 of 93 (1.1%) with scores of at least 7 points, and 1 of 73 (1.4%) with scores of at least 8 points. Conclusions and Relevance In this multicenter diagnostic study, the prediction model demonstrated excellent AP diagnostic accuracy. Its application may be used to avoid unnecessary confirmatory imaging.
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Affiliation(s)
- David X. Jin
- Center for Pancreatic Disease, Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ronilda Lacson
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mahsa Eskian
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Julia McNabb-Baltar
- Center for Pancreatic Disease, Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Peter A. Banks
- Center for Pancreatic Disease, Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephanie R. Kayden
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ali S. Raja
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ramin Khorasani
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Spampinato MD, Caputo F, Guarino M, Iantomasi C, Luppi F, Benedetto M, Perna B, Portoraro A, Passaro A, Pellicano R, DE Giorgio R. Predicting in-hospital mortality in patients with acute pancreatitis in the ED: a direct, retrospective comparison of four clinical and radiological prognostic scores. Minerva Gastroenterol (Torino) 2024; 70:147-157. [PMID: 37199713 DOI: 10.23736/s2724-5985.23.03389-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND Acute pancreatitis can be a severe disease that significantly impacts patients' quality of life and outcome. The clinical course is variable and predictive scoring systems have a debated role in early prognosis. This study aims to compare the prognostic accuracy of Balthazar, BISAP, HAPS and SOFA scores in the prediction of in-hospital mortality in patients with acute pancreatitis. METHODS This is a retrospective, single-center cohort study conducted in the Emergency Department of a third-level university hospital. Patients aged >18 years admitted from 1st January 2018 to 31st December 2021 for the first episode of acute pancreatitis were included. RESULTS A total of 385 patients (mean age of 65.4 years and 1.8% in-hospital mortality) were studied. Balthazar, BISAP and SOFA scores were significantly higher in patients with in-hospital mortality and AUROCs were equal to 0.95 (95% CI 0.91-0.99, P<0.001), 0.96 (95% CI 0.89-1, P=0.001), 0.91 (95% CI 0.81-1, P=0.001) with no differences among them and absence of in-hospital mortality in patients with HAPS=0. CONCLUSIONS Our data support the concept that clinical prediction scores can be useful for risk stratification in the Emergency Department. However, no single score has shown superiority in predicting acute pancreatitis-related in-hospital mortality among tested tools.
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Affiliation(s)
- Michele D Spampinato
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- School of Emergency Medicine, University of Ferrara, Ferrara, Italy
| | - Fabio Caputo
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Matteo Guarino
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- School of Emergency Medicine, University of Ferrara, Ferrara, Italy
| | - Chiara Iantomasi
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- School of Emergency Medicine, University of Ferrara, Ferrara, Italy
| | - Francesco Luppi
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Marcello Benedetto
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- School of Emergency Medicine, University of Ferrara, Ferrara, Italy
| | - Benedetta Perna
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- School of Emergency Medicine, University of Ferrara, Ferrara, Italy
| | - Andrea Portoraro
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- School of Emergency Medicine, University of Ferrara, Ferrara, Italy
| | - Angelina Passaro
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Rinaldo Pellicano
- Unit of Gastroenterology, Molinette ‒ S. Giovanni Antica Sede Hospital, Turin, Italy -
| | - Roberto DE Giorgio
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- School of Emergency Medicine, University of Ferrara, Ferrara, Italy
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10
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Metri A, Bush N, Singh VK. Predicting the severity of acute pancreatitis: Current approaches and future directions. Surg Open Sci 2024; 19:109-117. [PMID: 38650599 PMCID: PMC11033200 DOI: 10.1016/j.sopen.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
Acute pancreatitis (AP) is a sudden-onset inflammatory disease of the pancreas. The severity of AP is classified into mild, moderate, and severe categories based on the presence and persistence of organ failure. Severe acute pancreatitis (SAP) can be associated with significant morbidity and mortality. It requires early recognition for appropriate timely management. Prognostic scores for predicting SAP incorporating many clinical, laboratory, and radiological parameters have been developed in the past. However, all of these prognostic scores have low positive predictive value for SAP and some of these scores require >24 h for assessment. There is a need to develop biomarkers that can accurately identify patients at risk for SAP early in the course of the presentation. In this review, we aim to provide a summary of the most commonly utilized prognostic scores for AP and discuss future directions.
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Affiliation(s)
- Aida Metri
- Department of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Nikhil Bush
- Department of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Vikesh K. Singh
- Department of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
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Muhammed A, Thomas C, Kalaiselvan V, Undela K. Risk of pancreatitis and pancreatic carcinoma for anti-diabetic medications: findings from real-world safety data analysis and systematic review and meta-analysis of randomized controlled trials. Expert Opin Drug Saf 2024; 23:731-742. [PMID: 37986140 DOI: 10.1080/14740338.2023.2284992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/25/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The existing evidence from pre- and post-marketing studies is conflicting on the risk of pancreatic events for anti-diabetic medications. RESEARCH DESIGN AND METHODS A retrospective case/non-case study was conducted by using spontaneous reports on pancreatic events for anti-diabetic medications from the FDA Adverse Event Reporting System (FAERS) and VigiBase. Proportional Reporting Ratio (PRR), Reporting Odds Ratio (ROR), and Information Component (IC) were calculated by a disproportionality analysis. Furthermore, PubMed, Google Scholar, Scopus, and ClinicalTrials.gov were systematically searched for randomized controlled trials (RCTs) on anti-diabetic drugs with pancreatic outcomes. RESULTS The FAERS data analysis found strong signals on incretin mimetics causing pancreatic events, with sitagliptin having the highest risk [PRR = 24.2, lower bound (LB) ROR = 24.4, IC025 = 4.4 for pancreatitis, and PRR = 15.4, LB ROR = 14.9, IC025 = 3.8 for pancreatic carcinoma]. Empagliflozin was the most pancreatitis-risk sodium-glucose co-transporter-2 inhibitor [PRR = 4.0, LB ROR = 3.5, IC025 = 1.8]. VigiBase reiterated these findings and identified some new signals for novel anti-diabetics. Meta-analysis revealed that the incidence of pancreatitis and pancreatic carcinoma with anti-diabetic medications was insignificant. However, compared to the placebo/active comparator, gliptins had a higher risk of acute pancreatitis (OR 1.44; 95% CI 1.03, 2.01; P = 0.03). CONCLUSION Evidence from the post-marketing safety data analysis identified a strong association between incretin mimetics and pancreatic events. Fewer events in RCTs may justify insignificant meta-analysis results.
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Affiliation(s)
- Asif Muhammed
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER) Guwahati, Kamrup, Assam, India
| | - Christy Thomas
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER) Guwahati, Kamrup, Assam, India
| | - Vivekanandan Kalaiselvan
- Pharmacovigilance Programme of India (PvPI), National Coordination Centre, Indian Pharmacopoeia Commission, Ghaziabad, Uttar Pradesh, India
| | - Krishna Undela
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER) Guwahati, Kamrup, Assam, India
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12
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Grancini V, Cogliati I, Gaglio A, Resi V, Orsi E. Case report: GLP1RA for the treatment of diabetes in liver transplanted people. Do they increase the risk of pancreatitis? Front Endocrinol (Lausanne) 2024; 15:1392371. [PMID: 38779453 PMCID: PMC11109377 DOI: 10.3389/fendo.2024.1392371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
The incidence of acute pancreatitis (AP) in liver transplanted people is reported to be 1.5-8%. On the other hand, the evidence for a causal relationship between glucagon-like peptide 1 receptor agonists (GLP1RAs) and pancreatitis in people with type 2 diabetes is still weak. In addition, there are currently no data on a possible increased risk of AP in liver-transplanted individuals with diabetes treated with GLP1RAs. In a population of liver-transplanted individuals with diabetes receiving GLP1RA-based therapy, we reported an incidence of AP of 3.0% (two subjects). No cases were reported in liver-transplanted individuals with diabetes receiving SGLT2 inhibitors, insulin or metformin, neither in kidney or lung-transplanted patients treated with GLP1RAs. In both patients with AP, the only additional risk factor for its development was a history of re-transplantation (liver or combined kidney/liver). For this reason, we suggest particular caution when considering GLP1RAs-based therapies in liver transplanted patients with multiple risk factors for AP, such as a history of repeated and complex abdominal surgery.
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Affiliation(s)
- Valeria Grancini
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico Milano, Milan, Italy
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13
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Matana Kaštelan Z, Brumini I, Poropat G, Tkalčić L, Grubešić T, Miletić D. Pancreatic Iodine Density and Fat Fraction on Dual-Energy Computed Tomography in Acute Pancreatitis. Diagnostics (Basel) 2024; 14:955. [PMID: 38732369 PMCID: PMC11083507 DOI: 10.3390/diagnostics14090955] [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: 03/28/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
The aim of our study was to investigate iodine density (ID) and fat fraction (FF) on dual-energy computed tomography (DECT) in patients with acute pancreatitis (AP). This retrospective study included 72 patients with clinically confirmed AP and 62 control subjects with DECT of the abdomen. Two radiologists assessed necrosis and measured attenuation values, ID, and FF in three pancreatic segments. We used receiver operating characteristic (ROC) analysis to determine the optimal threshold for ID for the differentiation between AP groups. The ID was significantly higher in interstitial edematous AP compared to necrotizing AP and the control group (both p < 0.05). The ROC curve analysis revealed the thresholds of ID for detecting pancreatic necrosis ≤ 2.2, ≤2.3, and ≤2.4 mg/mL (AUC between 0.880 and 0.893, p > 0.05) for the head, body, and tail, respectively. The FF was significantly higher for pancreatitis groups when compared with the control group in the head and body segments (both p < 0.001). In the tail, the difference was significant in necrotizing AP (p = 0.028). The ID values were independent of attenuation values correlated with the FF values in pancreatic tissue. Iodine density values allow for differentiation between morphologic types of AP.
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Affiliation(s)
- Zrinka Matana Kaštelan
- Department of Diagnostic and Interventional Radiology, Clinical Hospital Center Rijeka, Kresimirova 42, 51000 Rijeka, Croatia (D.M.)
| | - Ivan Brumini
- Department of Diagnostic and Interventional Radiology, Clinical Hospital Center Rijeka, Kresimirova 42, 51000 Rijeka, Croatia (D.M.)
- Department of Anatomy, Faculty of Medicine of the University of Rijeka, Brace Branchetta 20, 51000 Rijeka, Croatia
- Department of Radiological Technology, Faculty of Health Studies of the University of Rijeka, Ul. Viktora Cara Emina 5, 51000 Rijeka, Croatia
| | - Goran Poropat
- Department of Gastroenterology, Clinical Hospital Center Rijeka, Kresimirova 42, 51000 Rijeka, Croatia
- Department of Internal Medicine, Faculty of Medicine of the University of Rijeka, Brace Branchetta 20, 51000 Rijeka, Croatia
| | - Lovro Tkalčić
- Department of Diagnostic and Interventional Radiology, Clinical Hospital Center Rijeka, Kresimirova 42, 51000 Rijeka, Croatia (D.M.)
- Department of Radiological Technology, Faculty of Health Studies of the University of Rijeka, Ul. Viktora Cara Emina 5, 51000 Rijeka, Croatia
| | - Tiana Grubešić
- Department of Diagnostic and Interventional Radiology, Clinical Hospital Center Rijeka, Kresimirova 42, 51000 Rijeka, Croatia (D.M.)
- Department of Radiology, Faculty of Medicine of the University of Rijeka, Brace Branchetta 20, 51000 Rijeka, Croatia
| | - Damir Miletić
- Department of Diagnostic and Interventional Radiology, Clinical Hospital Center Rijeka, Kresimirova 42, 51000 Rijeka, Croatia (D.M.)
- Department of Radiology, Faculty of Medicine of the University of Rijeka, Brace Branchetta 20, 51000 Rijeka, Croatia
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Köksal AŞ, Tozlu M, Sezgin O, Oğuz D, Kalkan İH, Altıntaş E, Yaraş S, Bilgiç Y, Yıldırım AE, Barutçu S, Hakim GD, Soytürk M, Bengi G, Özşeker B, Yurci A, Koç DÖ, İrak K, Kasap E, Cindoruk M, Oruç N, Ünal NG, Şen İ, Gökden Y, Saruç M, Ünal H, Eminler AT, Toka B, Basır H, Sağlam O, Ergül B, Gül Ö, Büyüktorun İ, Özel M, Şair Ü, Kösem G, Nedirli F, Tahtacı M, Parlak E. Acute pancreatitis in Turkey: Results of a nationwide multicenter study. Pancreatology 2024; 24:327-334. [PMID: 37880021 DOI: 10.1016/j.pan.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/12/2023] [Accepted: 10/05/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Acute pancreatitis (AP) is the most common gastrointestinal disease requiring hospitalization, with significant mortality and morbidity. We aimed to evaluate the clinical characteristics of AP and physicians' compliance with international guidelines during its management. METHODS All patients with AP who were hospitalized at 17 tertiary centers in Turkey between April and October 2022 were evaluated in a prospective cohort study. Patients with insufficient data, COVID-19 and those aged below 18 years were excluded. The definitions were based on the 2012 revised Atlanta criteria. RESULTS The study included 2144 patients (median age:58, 52 % female). The most common etiologies were biliary (n = 1438, 67.1 %), idiopathic (n = 259, 12 %), hypertriglyceridemia (n = 128, 6 %) and alcohol (n = 90, 4.2 %). Disease severity was mild in 1567 (73.1 %), moderate in 521 (24.3 %), and severe in 58 (2.6 %) patients. Morphology was necrotizing in 4.7 % of the patients. The overall mortality rate was 1.6 %. PASS and BISAP had the highest accuracy in predicting severe pancreatitis on admission (AUC:0.85 and 0.81, respectively). CT was performed in 61 % of the patients, with the majority (90 %) being within 72 h after admission. Prophylactic NSAIDs were not administered in 44 % of the patients with post-ERCP pancreatitis (n = 86). Antibiotics were administered to 53.7 % of the patients, and 38 % of those received them prophylactically. CONCLUSIONS This prospective study provides an extensive report on clinical characteristics, management and outcomes of AP in real-world practice. Mortality remains high in severe cases and physicians' adherence to guidelines during management of the disease needs improvement in some aspects.
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Affiliation(s)
- Aydın Şeref Köksal
- Sakarya University, School of Medicine, Department of Gastroenterology, Turkey.
| | - Mukaddes Tozlu
- Sakarya University, School of Medicine, Department of Gastroenterology, Turkey
| | - Orhan Sezgin
- Mersin University, School of Medicine, Department of Gastroenterology, Turkey
| | - Dilek Oğuz
- Kırıkkale University, School of Medicine, Department of Gastroenterology, Turkey
| | - İsmail Hakkı Kalkan
- TOBB Economy and Technology University, Department of Gastroenterology, Turkey
| | - Engin Altıntaş
- Mersin University, School of Medicine, Department of Gastroenterology, Turkey
| | - Serkan Yaraş
- Mersin University, School of Medicine, Department of Gastroenterology, Turkey
| | - Yılmaz Bilgiç
- İnönü University, School of Medicine, Department of Gastroenterology, Turkey
| | | | - Sezgin Barutçu
- Gaziantep University, School of Medicine, Department of Gastroenterology, Turkey
| | - Gözde Derviş Hakim
- Sağlık Bilimleri University, Izmir School of Medicine, Department of Gastroenterology, Turkey
| | - Müjde Soytürk
- Dokuz Eylül University, School of Medicine, Department of Gastroenterology, Turkey
| | - Göksel Bengi
- Dokuz Eylül University, School of Medicine, Department of Gastroenterology, Turkey
| | - Burak Özşeker
- Muğla Sıtkı Koçman University, School of Medicine, Department of Gastroenterology, Turkey
| | - Alper Yurci
- Erciyes University, School of Medicine, Department of Gastroenterology, Turkey
| | - Deniz Öğütmen Koç
- Sağlık Bilimleri University, Gaziosmanpaşa Education and Research Hospital, Department of Gastroenterology, Turkey
| | - Kader İrak
- Sağlık Bilimleri University, Başakşehir Çam and Sakura City Hospital, Department of Gastroenterology, Turkey
| | - Elmas Kasap
- Manisa Celal Bayar University, School of Medicine, Department of Gastroenterology, Turkey
| | - Mehmet Cindoruk
- Ankara Gazi University, School of Medicine, Department of Gastroenterology, Turkey
| | - Nevin Oruç
- Ege University, School of Medicine, Department of Gastroenterology, Turkey
| | - Nalan Gülşen Ünal
- Ege University, School of Medicine, Department of Gastroenterology, Turkey
| | - İlker Şen
- Sağlık Bilimleri University, Şişli Hamidiye Etfal Education and Research Hospital, Department of Gastroenterology, Turkey
| | - Yasemin Gökden
- Sağlık Bilimleri University, Prof. Dr. Cemil Taşçıoğlu City Hosoital, Department of Gastroenterology, Turkey
| | - Murat Saruç
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Gastroenterology, Turkey
| | - Hakan Ünal
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Gastroenterology, Turkey
| | - Ahmet Tarık Eminler
- Sakarya University, School of Medicine, Department of Gastroenterology, Turkey
| | - Bilal Toka
- Sakarya University, School of Medicine, Department of Gastroenterology, Turkey
| | - Hakan Basır
- Mersin University, School of Medicine, Department of Gastroenterology, Turkey
| | - Osman Sağlam
- İnönü University, School of Medicine, Department of Gastroenterology, Turkey
| | - Bilal Ergül
- Kırıkkale University, School of Medicine, Department of Gastroenterology, Turkey
| | - Özlem Gül
- Kırıkkale University, School of Medicine, Department of Gastroenterology, Turkey
| | - İlker Büyüktorun
- Dokuz Eylül University, School of Medicine, Department of Gastroenterology, Turkey
| | - Mustafa Özel
- Erciyes University, School of Medicine, Department of Gastroenterology, Turkey
| | - Ümit Şair
- Sağlık Bilimleri University, Gaziosmanpaşa Education and Research Hospital, Department of Internal Medicine, Turkey
| | - Gizem Kösem
- Manisa Celal Bayar University, School of Medicine, Department of Internal Medicine, Turkey
| | - Ferda Nedirli
- Gazi University, School of Medicine, Department of Internal Medicine, Turkey
| | - Mustafa Tahtacı
- Ankara Yıldırım Beyazıt University, Department of Gastroenterology, Turkey
| | - Erkan Parlak
- Hacettepe University, School of Medicine, Department of Gastroenterology, Turkey
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15
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Hussen MS, Ibrahim AF, Tekle Y, Gebremariam S, Feto AD, Nida T, Mohammed H. Aetiology, clinical profile, management and outcome of acute pancreatitis at public hospitals in Addis Ababa, Ethiopia: a prospective observational study. Ann Med Surg (Lond) 2024; 86:2494-2502. [PMID: 38694301 PMCID: PMC11060299 DOI: 10.1097/ms9.0000000000001967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/19/2024] [Indexed: 05/04/2024] Open
Abstract
Background Acute pancreatitis (AP) is a rare gastrointestinal pathology that has recently become increasingly common owing to lifestyle changes. Its clinical presentation ranges from mild discomfort to organ failure and death. Previous studies in Ethiopia reported that AP is rare. However, lifestyle changes have recently increased. Therefore, this study aimed to assess the aetiology, clinical profile, management, and outcomes of AP. Methods This prospective observational study included 59 adults diagnosed with AP using the Revised Atlanta Classification between November 2021 and August 2022 at five public hospitals in Addis Ababa. The data were analyzed using SPSS 25. The mean ± standard deviation and adjusted odds ratio (AOR) at 95% CI were used. Results The mean age was 38.2 (SD±11.5 years), mostly aged 30-44, with 67% males and 89.8% patients presenting with new-onset AP. Abdominal pain and nausea were the most common presentations in 93.2% of patients. More than 52.5% of AP cases were caused by alcohol, followed by gallstones (28.8%), and gallstones (47.1%) underwent cholecystectomy during the index admission. One patient (1.7%) died. The length of hospital stay ranges from 1-47 days and increases with the severity of AP. Patients with recurrent AP had a 2.4 folds increase in complications compared to new-onset AP (AOR=2.4, 95% CI=1.38, 15.71). Conclusion Most AP cases were caused by alcohol consumption, followed by gallstones, smoking, and hypertriglyceridemia. One death in a 60-year-old male with an alcohol and smoking history was diagnosed and triaged as severe AP with persistent multiple organ failure; BISAP score 4, his Creatinine=2.55 mg/dl, haematocrit 72.6%; and left shift of WBC, was associated.
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Affiliation(s)
| | | | | | | | | | - Tamrat Nida
- Department of Medical Biochemistry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Hussen Mohammed
- School of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa
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16
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Earjala JK, Muthukumarasamy T, Govindaraj Raman SK, V C K, Micheal M, Nath VG, A AR, Aravindan U. Step-Up Management in Acute Pancreatitis: A Tertiary Care Center's Experience From Southern India. Cureus 2024; 16:e58971. [PMID: 38800167 PMCID: PMC11128138 DOI: 10.7759/cureus.58971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Background The clinical spectrum of acute pancreatitis (AP) ranges from mild disease to severe form associated with multiorgan failure, prolonged hospital stay, high morbidity, and mortality. Acute necrotizing pancreatitis (ANP) is a severe form of AP. This study evaluates AP's outcomes after applying principles of the step-up approach in a tertiary healthcare center in south India. Methodology This prospective observational study was carried out from January 2021 to December 2022. The study population includes patients admitted to our department with AP. Results Ninety patients were included in the study, most of them were middle-aged males with ethanol ingestion as the common etiology. Thirty-seven (41.1%) patients had mild AP, 25 (27.7%) had moderately severe AP, and 28 (31.1%) had severe AP. Organ failure at admission was noted in 36 (40%) patients. Twenty-three (25.5%) patients developed ANP. Infected necrosis was noted in 3 (3.33%) patients. Eighteen (20%) patients needed image-guided percutaneous drainage. Seven (38.8%) needed necrosectomy following percutaneous drainage. Mortality was observed in 8 (8.8%) patients. Specifically, mortality was noted in 6 (6.6%) patients who presented later in their disease course. Conclusions Percutaneous catheter drainage is a safe and effective therapy to tide over the initial phase of AP. It also serves as a bridging therapy till the patient is clinically fit for a necrosectomy. Severe AP cases presenting late in their course are associated with significant mortality even after step-up management. Standardized protocols for referral and management are essential to obtain a good clinical outcome.
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Affiliation(s)
- Joel Kumar Earjala
- Surgical Gastroenterology and GI Oncology, Thanjavur Medical College, Thanjavur, IND
| | | | | | | | - Mathews Micheal
- Surgical Gastroenterology and GI Oncology, Thanjavur Medical College, Thanjavur, IND
| | - Vivek G Nath
- Surgical Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, IND
- Surgical Gastroenterology and GI Oncology, Thanjavur Medical College, Thanjavur, IND
| | - Arun Raja A
- Surgical Gastroenterology and GI Oncology, Thanjavur Medical College, Thanjavur, IND
| | - U Aravindan
- Surgical Gastroenterology and GI Oncology, Thanjavur Medical College, Thanjavur, IND
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Sandoval C, Vera A, Birditt K, Godoy K, Carmine F, Caamaño J, Farías J. β-Carotene Supplementation Improves Pancreas Function during Moderate Ethanol Consumption: Initial Characterization from a Morphological Overview. Int J Mol Sci 2024; 25:1219. [PMID: 38279214 PMCID: PMC10815982 DOI: 10.3390/ijms25021219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/28/2024] Open
Abstract
Alcohol is believed to harm acinar cells, pancreatic ductal epithelium, and pancreatic stellate cells. After giving ethanol and/or β-carotene to C57BL/6 mice, our goal was to evaluate their biochemistry, histology, and morpho-quantitative features. There were six groups of C57BL/6 mice: 1. Group C (control), 2. Group LA (low-dose alcohol), 3. Group MA (moderate-dose alcohol), 4. Group B (β-carotene), 5. Group LA + B (low-dose alcohol combined with β-carotene), and 6. Group MA + B (moderate-dose alcohol combined with β-carotene). After the animals were euthanized on day 28, each specimen's pancreatic tissue was taken. Lipase, uric acid, and amylase were assessed using biochemical assessment. Furthermore, the examination of the pancreatic structure was conducted using Ammann's fibrosis scoring system. Finally, the morpho-quantitative characteristics of the pancreatic islets and acinar cells were determined. In the serum of the MA + B group, there were higher amounts of total amylase (825.953 ± 193.412 U/L) and lower amounts of lipase (47.139 ± 6.099 U/L) (p < 0.05). Furthermore, Ammann's fibrosis punctuation in the pancreas revealed significant variations between the groups (p < 0.001). Finally, the stereological analysis of pancreatic islets showed that the groups were different (p < 0.001). These findings suggest that antioxidant treatments might help decrease the negative effects of ethanol exposure in animal models.
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Affiliation(s)
- Cristian Sandoval
- Escuela de Tecnología Médica, Facultad de Salud, Universidad Santo Tomás, Los Carreras 753, Osorno 5310431, Chile;
- Departamento de Ingeniería Química, Facultad de Ingeniería y Ciencias, Universidad de La Frontera, Temuco 4811230, Chile
- Departamento de Medicina Interna, Facultad de Medicina, Universidad de La Frontera, Temuco 4811230, Chile
| | - Angeles Vera
- Carrera de Tecnología Médica, Facultad de Medicina, Universidad de La Frontera, Temuco 4811230, Chile;
| | - Katherine Birditt
- Physiology Development and Neuroscience Department, University of Cambridge, Cambridge CB2 1TN, UK;
| | - Karina Godoy
- Núcleo Científico y Tecnológico en Biorecursos (BIOREN), Universidad de La Frontera, Temuco 4811230, Chile;
| | - Florencia Carmine
- Carrera de Medicina, Facultad de Medicina, Universidad de La Frontera, Temuco 4811230, Chile;
| | - José Caamaño
- Departamento de Medicina Interna, Facultad de Medicina, Universidad de La Frontera, Temuco 4811230, Chile
- Laboratorio de Inmunohematología y Medicina Transfusional, Departamento de Medicina Interna, Facultad de Medicina, Universidad de La Frontera, Temuco 4811230, Chile
| | - Jorge Farías
- Departamento de Ingeniería Química, Facultad de Ingeniería y Ciencias, Universidad de La Frontera, Temuco 4811230, Chile
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18
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Narumi K, Okada T, Lin Y, Kikuchi S. Efficacy of nafamostat mesylate in the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography: a systematic review and meta-analysis of randomized controlled trials. Sci Rep 2023; 13:23012. [PMID: 38155200 PMCID: PMC10754829 DOI: 10.1038/s41598-023-50181-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 12/16/2023] [Indexed: 12/30/2023] Open
Abstract
We conducted a systematic review and meta-analysis to evaluate the effect of nafamostat on the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). PubMed, Web of Science, and Ichushi Web were searched for randomized controlled trials (RCTs) using nafamostat to prevent PEP. In subgroup analyses, we studied the preventive effects of nafamostat according to the severity of PEP, risk category, and dose. A random-effects model was adopted; heterogeneity between studies was examined using the chi-squared test and I2 statistics. This analysis uses the PRISMA statement as general guidance. 9 RCTs involving 3321 patients were included. The risk of PEP was lower in the nafamostat group than in the control group [4.4% vs. 8.3%, risk ratio (RR): 0.50, 95% confidence interval (CI): 0.36-0.68]. In subgroup analyses, the protective effects were evident in low-risk patients for PEP before ERCP (RR: 0.34, 95% CI: 0.21-0.55). The association between PEP and nafamostat was significant only in patients who developed mild PEP (RR: 0.49; 95% CI: 0.36-0.69). The benefits were independent of the dose. The prophylactic use of nafamostat resulted in a lower risk of PEP. The subgroup analyses suggested uncertain benefits for severe PEP or high-risk patients for PEP. This warrants further investigation through additional RCTs.
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Affiliation(s)
- Kazuaki Narumi
- Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Tomoki Okada
- Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Yingsong Lin
- Department of Public Health, Aichi Medical University School of Medicine, Yazakokarimata 1-1, Nagakute, Aichi, 480-1195, Japan.
| | - Shogo Kikuchi
- Department of Public Health, Aichi Medical University School of Medicine, Yazakokarimata 1-1, Nagakute, Aichi, 480-1195, Japan
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19
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Haddadin R, Tonna RF, Iqbal H, Valenta J, Iraninezhad H. A Rare Case of Sodium-Glucose Cotransporter-2 Inhibitor-Induced Acute Pancreatitis. Cureus 2023; 15:e49369. [PMID: 38146577 PMCID: PMC10749287 DOI: 10.7759/cureus.49369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 12/27/2023] Open
Abstract
Acute pancreatitis is an acute inflammatory process of the pancreas that requires hospital admission and treatment. There are many causes of pancreatitis, the most common being gallstone and alcohol-induced; other reasons include metabolic, infectious, and medication-induced. A new medication that has come to the market is empagliflozin, which is a sodium-glucose cotransporter-2 inhibitor that is common in managing type 2 diabetes mellitus and congestive heart failure. Although generally considered safe and effective, rare adverse effects have been reported. In this case, we present a 67-year-old female patient who presented with severe acute pancreatitis after two weeks of starting empagliflozin to treat her type 2 diabetes. This case report highlights the importance of considering rare adverse events associated with empagliflozin and the need for close monitoring of patients receiving this medication.
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Affiliation(s)
| | - Roger F Tonna
- Internal Medicine, MountainView Hospital, Las Vegas, USA
| | - Humzah Iqbal
- Internal Medicine, University of California San Francisco, Fresno, Fresno, USA
| | - Jordan Valenta
- Internal Medicine, MountainView Hospital, Las Vegas, USA
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Hu JX, Zhao CF, Wang SL, Tu XY, Huang WB, Chen JN, Xie Y, Chen CR. Acute pancreatitis: A review of diagnosis, severity prediction and prognosis assessment from imaging technology, scoring system and artificial intelligence. World J Gastroenterol 2023; 29:5268-5291. [PMID: 37899784 PMCID: PMC10600804 DOI: 10.3748/wjg.v29.i37.5268] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/31/2023] [Accepted: 09/14/2023] [Indexed: 09/25/2023] Open
Abstract
Acute pancreatitis (AP) is a potentially life-threatening inflammatory disease of the pancreas, with clinical management determined by the severity of the disease. Diagnosis, severity prediction, and prognosis assessment of AP typically involve the use of imaging technologies, such as computed tomography, magnetic resonance imaging, and ultrasound, and scoring systems, including Ranson, Acute Physiology and Chronic Health Evaluation II, and Bedside Index for Severity in AP scores. Computed tomography is considered the gold standard imaging modality for AP due to its high sensitivity and specificity, while magnetic resonance imaging and ultrasound can provide additional information on biliary obstruction and vascular complications. Scoring systems utilize clinical and laboratory parameters to classify AP patients into mild, moderate, or severe categories, guiding treatment decisions, such as intensive care unit admission, early enteral feeding, and antibiotic use. Despite the central role of imaging technologies and scoring systems in AP management, these methods have limitations in terms of accuracy, reproducibility, practicality and economics. Recent advancements of artificial intelligence (AI) provide new opportunities to enhance their performance by analyzing vast amounts of clinical and imaging data. AI algorithms can analyze large amounts of clinical and imaging data, identify scoring system patterns, and predict the clinical course of disease. AI-based models have shown promising results in predicting the severity and mortality of AP, but further validation and standardization are required before widespread clinical application. In addition, understanding the correlation between these three technologies will aid in developing new methods that can accurately, sensitively, and specifically be used in the diagnosis, severity prediction, and prognosis assessment of AP through complementary advantages.
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Affiliation(s)
- Jian-Xiong Hu
- Intensive Care Unit, The Affiliated Hospital of Putian University, Putian 351100, Fujian Province, China
| | - Cheng-Fei Zhao
- School of Pharmacy and Medical Technology, Putian University, Putian 351100, Fujian Province, China
- Key Laboratory of Pharmaceutical Analysis and Laboratory Medicine, Putian University, Putian 351100, Fujian Province, China
| | - Shu-Ling Wang
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Xiao-Yan Tu
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Wei-Bin Huang
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Jun-Nian Chen
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Ying Xie
- School of Mechanical, Electrical and Information Engineering, Putian University, Putian 351100, Fujian Province, China
| | - Cun-Rong Chen
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
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21
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Portincasa P, Di Ciaula A, Bonfrate L, Stella A, Garruti G, Lamont JT. Metabolic dysfunction-associated gallstone disease: expecting more from critical care manifestations. Intern Emerg Med 2023; 18:1897-1918. [PMID: 37455265 PMCID: PMC10543156 DOI: 10.1007/s11739-023-03355-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Abstract
About 20% of adults worldwide have gallstones which are solid conglomerates in the biliary tree made of cholesterol monohydrate crystals, mucin, calcium bilirubinate, and protein aggregates. About 20% of gallstone patients will definitively develop gallstone disease, a condition which consists of gallstone-related symptoms and/or complications requiring medical therapy, endoscopic procedures, and/or cholecystectomy. Gallstones represent one of the most prevalent digestive disorders in Western countries and patients with gallstone disease are one of the largest categories admitted to European hospitals. About 80% of gallstones in Western countries are made of cholesterol due to disturbed cholesterol homeostasis which involves the liver, the gallbladder and the intestine on a genetic background. The incidence of cholesterol gallstones is dramatically increasing in parallel with the global epidemic of insulin resistance, type 2 diabetes, expansion of visceral adiposity, obesity, and metabolic syndrome. In this context, gallstones can be largely considered a metabolic dysfunction-associated gallstone disease, a condition prone to specific and systemic preventive measures. In this review we discuss the key pathogenic and clinical aspects of gallstones, as the main clinical consequences of metabolic dysfunction-associated disease.
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Affiliation(s)
- Piero Portincasa
- Clinica Medica "A. Murri", Division of Internal Medicine, Department of Preventive and Regenerative Medicine and Ionian Area (DiMePrev-J), University of Bari Aldo Moro, p.zza Giulio Cesare 11, 70124, Bari, Italy.
| | - Agostino Di Ciaula
- Clinica Medica "A. Murri", Division of Internal Medicine, Department of Preventive and Regenerative Medicine and Ionian Area (DiMePrev-J), University of Bari Aldo Moro, p.zza Giulio Cesare 11, 70124, Bari, Italy
| | - Leonilde Bonfrate
- Clinica Medica "A. Murri", Division of Internal Medicine, Department of Preventive and Regenerative Medicine and Ionian Area (DiMePrev-J), University of Bari Aldo Moro, p.zza Giulio Cesare 11, 70124, Bari, Italy
| | - Alessandro Stella
- Laboratory of Medical Genetics, Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari, Italy
| | - Gabriella Garruti
- Section of Endocrinology, Department of Preventive and Regenerative Medicine and Ionian Area (DiMePrev-J), University of Bari Aldo Moro, Bari, Italy
| | - John Thomas Lamont
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA
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22
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Morinville VD, Husain SZ, Wang F, Cress GA, Abu-El-Haija M, Chugh A, Downs E, Ellery K, Fishman DS, Freeman AJ, Gariepy CE, Giefer M, Gonska T, Liu Q, Maqbool A, Mark J, Mcferron BA, Mehta M, Nathan JD, Ng K, Ooi CY, Perito E, Ruan W, Schwarzenberg SJ, Sellers ZM, Serrano J, Troendle DM, Wilschanski M, Zheng Y, Yuan Y, Lowe M, Uc A. Pediatric Drug-Associated Pancreatitis Reveals Concomitant Risk Factors and Poor Reliability of Causality Scoring: Report From INSPPIRE. J Pediatr Gastroenterol Nutr 2023; 77:540-546. [PMID: 37496124 PMCID: PMC10529270 DOI: 10.1097/mpg.0000000000003898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVES Drug-associated acute pancreatitis (DAP) studies typically focus on single acute pancreatitis (AP) cases. We aimed to analyze the (1) characteristics, (2) co-risk factors, and (3) reliability of the Naranjo scoring system for DAP using INSPPIRE-2 (the INternational Study group of Pediatric Pancreatitis: In search for a cuRE-2) cohort study of acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) in children. METHODS Data were obtained from ARP group with ≥1 episode of DAP and CP group with medication exposure ± DAP. Physicians could report multiple risk factors. Pancreatitis associated with Medication (Med) (ARP+CP) was compared to Non-Medication cases, and ARP-Med vs CP-Med groups. Naranjo score was calculated for each DAP episode. RESULTS Of 726 children, 392 had ARP and 334 had CP; 51 children (39 ARP and 12 CP) had ≥1 AP associated with a medication; 61% had ≥1 AP without concurrent medication exposure. The Med group had other risk factors present (where tested): 10 of 35 (28.6%) genetic, 1 of 48 (2.1%) autoimmune pancreatitis, 13 of 51 (25.5%) immune-mediated conditions, 11 of 50 (22.0%) obstructive/anatomic, and 28 of 51 (54.9%) systemic risk factors. In Med group, 24 of 51 (47%) had involvement of >1 medication, simultaneously or over different AP episodes. There were 20 ARP and 4 CP cases in "probable" category and 19 ARP and 7 CP in "possible" category by Naranjo scores. CONCLUSIONS Medications were involved in 51 of 726 (7%) of ARP or CP patients in INSPPIRE-2 cohort; other pancreatitis risk factors were present in most, suggesting a potential additive role of different risks. The Naranjo scoring system failed to identify any cases as "definitive," raising questions about its reliability for DAP.
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Affiliation(s)
| | | | - Fuchenchu Wang
- The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Gretchen A Cress
- The University of Iowa, Stead Family Children's Hospital, Iowa City, IA
| | - Maisam Abu-El-Haija
- The Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Ankur Chugh
- The Medical College of Wisconsin, Milwaukee, WI
| | - Elissa Downs
- The University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Kate Ellery
- The Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
| | - Douglas S Fishman
- The Division of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | | | | | | | - Tanja Gonska
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Quin Liu
- The Cedars-Sinai Medical Center, Los Angeles, CA
| | - Asim Maqbool
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jacob Mark
- the Children's Hospital Colorado, Aurora, CO
| | - Brian Arthur Mcferron
- The Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Megha Mehta
- The University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Ken Ng
- The John Hopkins Medical Center, Baltimore, MD
| | - Chee Y Ooi
- The School of Women's and Children's Health, Faculty of Medicine, University of New South Wales and Sydney Children's Hospital Randwick, Sydney, NSW, Australia
| | - Emily Perito
- The University of California San Francisco Medical Center, San Francisco, CA
| | - Wenly Ruan
- The Nationwide Children's Hospital, Columbus, OH
| | | | | | - Jose Serrano
- the Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Bethesda, MD
| | | | | | - Yuhua Zheng
- The Children's Hospital of Los Angeles, Los Angeles, CA
| | - Ying Yuan
- The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Mark Lowe
- The Washington University School of Medicine, St Louis, MO
| | - Aliye Uc
- The University of Iowa, Stead Family Children's Hospital, Iowa City, IA
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23
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Famili DT, Mistry A, Gerasimenko O, Gerasimenko J, Tribe RM, Kyrana E, Dhawan A, Goldberg MF, Voermans N, Willis T, Jungbluth H. Pancreatitis in RYR1-related disorders. Neuromuscul Disord 2023; 33:769-775. [PMID: 37783627 DOI: 10.1016/j.nmd.2023.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 10/04/2023]
Abstract
Mutations in RYR1 encoding the ryanodine receptor (RyR) skeletal muscle isoform (RyR1) are a common cause of inherited neuromuscular disorders. Despite its expression in a wide range of tissues, non-skeletal muscle manifestations associated with RYR1 mutations have only been rarely reported. Here, we report three patients with a diagnosis of Central Core Disease (CCD), King-Denborough Syndrome (KDS) and Malignant Hyperthermia Susceptibility (MHS), respectively, who in addition to their (putative) RYR1-related disorder also developed symptoms and signs of acute pancreatitis. In two patients, episodes were recurrent, with severe multisystem involvement and sequelae. RyR1-mediated calcium signalling plays an important role in normal pancreatic function but has also been critically implicated in the pathophysiology of acute pancreatitis, particularly in bile acid- and ethanol-induced forms. Findings from relevant animal models indicate that pancreatic damage in these conditions may be ameliorated through administration of the specific RyR1 antagonist dantrolene and other compounds modifying pancreatic metabolism including calcium signalling. These observations suggest that patients with RYR1 gain-of-function variants may be at increased risk of developing acute pancreatitis, a condition which should therefore be considered in the health surveillance of such individuals.
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Affiliation(s)
- Dennis T Famili
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Arti Mistry
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine (FoLSM), King's College London, London, United Kingdom
| | - Oleg Gerasimenko
- School of Biosciences, Cardiff University, Cardiff, United Kingdom
| | | | - Rachel M Tribe
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine (FoLSM), King's College London, London, United Kingdom
| | - Eirini Kyrana
- Department of Paediatric Hepatology, King's College Hospital, London, United Kingdom
| | - Anil Dhawan
- Department of Paediatric Hepatology, King's College Hospital, London, United Kingdom
| | | | - Nicol Voermans
- Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Tracey Willis
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Heinz Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom; Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, Faculty of Life Sciences and Medicine (FoLSM), King's College London, London, United Kingdom.
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24
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Bruno MJ. Endoscopy in Gallstone Pancreatitis. Gastrointest Endosc Clin N Am 2023; 33:701-707. [PMID: 37709405 DOI: 10.1016/j.giec.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
The root cause for biliary pancreatitis is a transient impediment of the outflow of secretion from the pancreatic duct due to gallstones and sludge obstructing the ampulla of Vater. Based on meta-analyses and recent studies, clear recommendations can be formulated when and when not to perform an ERC in patients with biliary pancreatitis. ERC is indicated urgently in patients with biliary pancreatitis and concomitant cholangitis. Urgent ERC is not indicated in patients with predicted mild or severe biliary pancreatitis without cholangitis, even when stones or sludge are proven on EUS imaging.
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Affiliation(s)
- Marco J Bruno
- Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Doctor Molewaterplein 40, Rotterdam 3015 GD, the Netherlands.
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25
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Toçoğlu AG, Köksal AŞ, Toka B, Mutlu F, Eminler AT, Uslan Mİ, Parlak E. Validation of the Revised Atlanta Criteria in determining the severity of acute pancreatitis. Eur J Gastroenterol Hepatol 2023; 35:1137-1142. [PMID: 37577807 DOI: 10.1097/meg.0000000000002621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
BACKGROUND/AIM Determining the severity of acute pancreatitis (AP) is crucial for patient management. The aim of our study was to assess the accuracy and limitations of the Revised Atlanta Criteria (RAC) in determining the severity of AP. MATERIALS AND METHODS The study was retrospectively conducted on AP patients admitted to the Gastroenterology Department of Sakarya University Faculty of Medicine. The severity, morphology and local complications of AP were evaluated according to the RAC. Laboratory parameters, clinical scores predicting disease severity and Computer Tomography Severity Index scores were assessed. RESULTS The study group included 113 patients. Ninety-eight (86.7%) had interstitial edematous, and 15 (13.3%) had necrotizing pancreatitis. AP pancreatitis was mild in 69 (61.1%), moderate in 33 (29.2%), and severe in 11 (9.7%). Compared to the moderate group, patients in the severe group had a higher hematocrit, creatinine, SIRS and BISAP scores at admission and more length of hospital stay, more ICU requirements, and higher mortality rates ( P < 0.05). Eleven patients had single or multiple persistent organ failure (POF). The mortality rate of patients who developed early POF (n = 6) was higher compared to the group of patients who developed late POF (n = 2) (83.3% and 40%, respectively). CONCLUSION Severity assessment using the RAC in patients with AP is consistent with laboratory parameters and scoring systems predicting severity. Severe pancreatitis cases who develop early POF may be classified separately.
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Affiliation(s)
- Aysel Gürkan Toçoğlu
- Department of Internal Medicine, Sakarya University Training and Research Hospital
| | - Aydin Şeref Köksal
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine, Sakarya University
| | - Bilal Toka
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine, Sakarya University
| | - Fuldem Mutlu
- Department of Radiology, Faculty of Medicine, Sakarya University, Sakarya
| | - Ahmet Tarik Eminler
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine, Sakarya University
| | - Mustafa İhsan Uslan
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine, Sakarya University
| | - Erkan Parlak
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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26
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Awan RU, Iyer A, Khan UA, Majeed H, Nabeel A, Zaidi SH, Sheikh AB, Shahjahan RD, Yazdanyar A, Sagheer S. Insights Into Clinical Outcomes of Acute Pancreatitis With Concomitant Acute Myocardial Infarction Using the National Inpatient Sample Database. Am J Cardiol 2023; 203:295-300. [PMID: 37517123 DOI: 10.1016/j.amjcard.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/14/2023] [Accepted: 07/05/2023] [Indexed: 08/01/2023]
Abstract
Acute pancreatitis (AP) and acute coronary syndrome (ACS) are common conditions, occasionally sharing overlapping symptoms, posing various clinical challenges. This study aims to investigate the demographics, outcomes, and risk factors of patients admitted with AP and ACS using the National Inpatient Sample database. The database from 2016 to 2019 was analyzed, identifying patients with a primary diagnosis of AP and dividing them into 2 groups: those with ACS and those without (non-ACS). Of the 112,874 patients with AP, 5,210 (0.46%) had ACS. The patients with AP with concomitant ACS were older, predominantly male, and had a higher prevalence of co-morbidities. Inpatient mortality was significantly higher in the AP with concomitant ACS cohort compared with the AP without ACS cohort (8.4% vs 0.5%, adjusted odds ratio 9.94, 95% confidence interval 7.79 to 12.67, p <0.05). In conclusion, patients with AP and ACS experienced worse clinical outcomes.
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Affiliation(s)
- Rehmat Ullah Awan
- Division of Medicine, Ochsner Rush Medical Center, Meridian, Mississippi.
| | - Aditya Iyer
- Department of Medicine, St Michael Medical center, Silverdale WA
| | - Umair A Khan
- Divisions of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Harris Majeed
- Divisions of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Ambreen Nabeel
- Division of Medicine, Ochsner Rush Medical Center, Meridian, Mississippi
| | - Syeda Humna Zaidi
- Division of Medicine, Poplar Bluff Regional Medical Center, Poplar Bluff, Missouri
| | - Abu Baker Sheikh
- Divisions of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | | | - Ali Yazdanyar
- Division of Emergency Medicine and Hospital Medicine, Lehigh Valley Hospital, Cedar Crest, Allentown, Pennsylvania
| | - Shazib Sagheer
- Divisions of Cardiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico; Division of Interventional Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey
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27
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Alvi AT, Santiago LE, Lopez-Medal M. Acute Pancreatitis-Induced Thrombosis of Celiac Artery: An Unusual Complication of Acute Pancreatitis. Cureus 2023; 15:e46249. [PMID: 37908938 PMCID: PMC10614078 DOI: 10.7759/cureus.46249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Acute pancreatitis can lead to both local and systemic complications, including pseudocysts, biliary obstruction, duodenal obstruction, sepsis, necrosis, vascular complications, and multiorgan failure. Vascular complications following acute pancreatitis are associated with a high risk of morbidity and mortality due to their thrombotic and hemorrhagic effects. When thrombosis is present, it usually involves the splanchnic venous system, but it is rarely seen in the arterial system. Celiac artery thrombosis is rare with only a few cases reported in the literature. In this case, we present a 65-year-old Hispanic female who presented to the emergency department with abdominal pain and nausea, with computed tomography angiography (CTA) of the abdomen revealing acute pancreatitis with thrombosis of the celiac artery, which was managed with anticoagulation.
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Affiliation(s)
- Ali Tariq Alvi
- Internal Medicine, HCA Florida Westside Hospital, Plantation, USA
- Internal Medicine, HCA Florida Northwest Hospital, Margate, USA
| | - Luis E Santiago
- Internal Medicine, HCA Florida Westside Hospital, Plantation, USA
- Internal Medicine, HCA Florida Northwest Hospital, Margate, USA
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28
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Hayes AJ, Zheng X, O'Kelly J, Neyton LPA, Bochkina NA, Uings I, Liddle J, Baillie JK, Just G, Binnie M, Homer NZM, Murray TBJ, Baily J, McGuire K, Skouras C, Garden OJ, Webster SP, Iredale JP, Howie SEM, Mole DJ. Kynurenine monooxygenase regulates inflammation during critical illness and recovery in experimental acute pancreatitis. Cell Rep 2023; 42:112763. [PMID: 37478012 DOI: 10.1016/j.celrep.2023.112763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/14/2022] [Accepted: 06/21/2023] [Indexed: 07/23/2023] Open
Abstract
Kynurenine monooxygenase (KMO) blockade protects against multiple organ failure caused by acute pancreatitis (AP), but the link between KMO and systemic inflammation has eluded discovery until now. Here, we show that the KMO product 3-hydroxykynurenine primes innate immune signaling to exacerbate systemic inflammation during experimental AP. We find a tissue-specific role for KMO, where mice lacking Kmo solely in hepatocytes have elevated plasma 3-hydroxykynurenine levels that prime inflammatory gene transcription. 3-Hydroxykynurenine synergizes with interleukin-1β to cause cellular apoptosis. Critically, mice with elevated 3-hydroxykynurenine succumb fatally earlier and more readily to experimental AP. Therapeutically, blockade with the highly selective KMO inhibitor GSK898 rescues the phenotype, reducing 3-hydroxykynurenine and protecting against critical illness and death. Together, our findings establish KMO and 3-hydroxykynurenine as regulators of inflammation and the innate immune response to sterile inflammation. During critical illness, excess morbidity and death from multiple organ failure can be rescued by systemic KMO blockade.
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Affiliation(s)
- Alastair J Hayes
- University of Edinburgh Centre for Inflammation Research, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, UK; Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Xiaozhong Zheng
- University of Edinburgh Centre for Inflammation Research, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, UK
| | - James O'Kelly
- University of Edinburgh Centre for Inflammation Research, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, UK; Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Lucile P A Neyton
- University of Edinburgh Centre for Inflammation Research, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, UK; The Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Natalia A Bochkina
- School of Mathematics and Maxwell Institute, University of Edinburgh, Edinburgh, UK
| | - Iain Uings
- GlaxoSmithKline, Gunnels Wood Road, Stevenage, Hertfordshire, UK
| | - John Liddle
- GlaxoSmithKline, Gunnels Wood Road, Stevenage, Hertfordshire, UK
| | | | - George Just
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, University of Edinburgh, Edinburgh, UK
| | - Margaret Binnie
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, University of Edinburgh, Edinburgh, UK
| | - Natalie Z M Homer
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, University of Edinburgh, Edinburgh, UK
| | | | - James Baily
- Charles River Laboratories, East Lothian, UK
| | - Kris McGuire
- University of Edinburgh Centre for Inflammation Research, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, UK
| | | | - O James Garden
- Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Scott P Webster
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | | | - Sarah E M Howie
- University of Edinburgh Centre for Inflammation Research, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, UK
| | - Damian J Mole
- University of Edinburgh Centre for Inflammation Research, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, UK; Clinical Surgery, University of Edinburgh, Edinburgh, UK.
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29
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Collen LV, Mitchell PD, Fox VL, Grover AS. Pancreatitis-Associated Medication Use in Hospitalized Pediatric and Young Adult Patients With Acute Pancreatitis. J Pediatr Gastroenterol Nutr 2023; 77:260-266. [PMID: 37477886 DOI: 10.1097/mpg.0000000000003829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
OBJECTIVE The objective of this study is (1) to describe the prevalence of pancreatitis-associated medication (PAM) use at admission and discharge in pediatric and young adult patients hospitalized with acute pancreatitis (AP) and (2) to describe the prevalence of PAM use at admission in patients classified as having idiopathic AP. STUDY DESIGN A single-center retrospective study of patients <21 years who were hospitalized with AP or acute recurrent pancreatitis from March 2015 to July 2017 was performed. Charts were reviewed for demographic data, etiology of pancreatitis, comorbidities, and use of PAMs at admission and discharge. PAMs were defined and scored based on an evidence-based classification system, with class I PAMs having strongest evidence for causation. Standard descriptive statistics were used to report prevalence data. RESULTS Our cohort was comprised of 119 patients; 50% of patients were using a PAM at admission and 67% were taking a PAM at discharge, reflecting a significant change (P = 0.0009); 44% of patients classified as having idiopathic pancreatitis were taking a PAM on admission, reflecting a possibly missed role of medication in their presentation. Comorbidities significantly associated with PAM use included seizure disorder (P = 0.005) and oncologic disease (P = 0.005). The most commonly used class I PAMs were omeprazole, trimethoprim-sulfamethazole, valproic acid, and 6-mercaptopurine. The increase in prevalence of PAM use at discharge compared to admission was partially driven by addition of omeprazole to the outpatient medication regimen during the hospital stay (P = 0.07). CONCLUSION Medications likely play an under-recognized role in pediatric AP. The practice of using proton pump inhibitors in management of AP warrants further study.
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Affiliation(s)
- Lauren V Collen
- From the Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Paul D Mitchell
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA
| | - Victor L Fox
- From the Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Amit S Grover
- From the Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, MA
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Dahiya DS, Jahagirdar V, Chandan S, Gangwani MK, Merza N, Ali H, Deliwala S, Aziz M, Ramai D, Pinnam BSM, Bapaye J, Cheng CI, Inamdar S, Sharma NR, Al-Haddad M. Acute pancreatitis in liver transplant hospitalizations: Identifying national trends, clinical outcomes and healthcare burden in the United States. World J Hepatol 2023; 15:797-812. [PMID: 37397932 PMCID: PMC10308289 DOI: 10.4254/wjh.v15.i6.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/19/2023] [Accepted: 05/06/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Acute pancreatitis (AP) in liver transplant (LT) recipients may lead to poor clinical outcomes and development of severe complications.
AIM We aimed to assess national trends, clinical outcomes, and the healthcare burden of LT hospitalizations with AP in the United States (US).
METHODS The National Inpatient Sample was utilized to identify all adult (≥ 18 years old) LT hospitalizations with AP in the US from 2007–2019. Non-LT AP hospitalizations served as controls for comparative analysis. National trends of hospitalization characteristics, clinical outcomes, complications, and healthcare burden for LT hospitalizations with AP were highlighted. Hospitalization characteristics, clinical outcomes, complications, and healthcare burden were also compared between the LT and non-LT cohorts. Furthermore, predictors of inpatient mortality for LT hospitalizations with AP were identified. All P values ≤ 0.05 were considered statistically significant.
RESULTS The total number of LT hospitalizations with AP increased from 305 in 2007 to 610 in 2019. There was a rising trend of Hispanic (16.5% in 2007 to 21.1% in 2018, P-trend = 0.0009) and Asian (4.3% in 2007 to 7.4% in 2019, p-trend = 0.0002) LT hospitalizations with AP, while a decline was noted for Blacks (11% in 2007 to 8.3% in 2019, P-trend = 0.0004). Furthermore, LT hospitalizations with AP had an increasing comorbidity burden as the Charlson Comorbidity Index (CCI) score ≥ 3 increased from 41.64% in 2007 to 62.30% in 2019 (P-trend < 0.0001). We did not find statistically significant trends in inpatient mortality, mean length of stay (LOS), and mean total healthcare charge (THC) for LT hospitalizations with AP despite rising trends of complications such as sepsis, acute kidney failure (AKF), acute respiratory failure (ARF), abdominal abscesses, portal vein thrombosis (PVT), and venous thromboembolism (VTE). Between 2007–2019, 6863 LT hospitalizations with AP were compared to 5649980 non-LT AP hospitalizations. LT hospitalizations with AP were slightly older (53.5 vs 52.6 years, P = 0.017) and had a higher proportion of patients with CCI ≥ 3 (51.5% vs 19.8%, P < 0.0001) compared to the non-LT cohort. Additionally, LT hospitalizations with AP had a higher proportion of Whites (67.9% vs 64.6%, P < 0.0001) and Asians (4% vs 2.3%, P < 0.0001), while the non-LT cohort had a higher proportion of Blacks and Hispanics. Interestingly, LT hospitalizations with AP had lower inpatient mortality (1.37% vs 2.16%, P = 0.0479) compared to the non-LT cohort despite having a higher mean age, CCI scores, and complications such as AKF, PVT, VTE, and the need for blood transfusion. However, LT hospitalizations with AP had a higher mean THC ($59596 vs $50466, P = 0.0429) than the non-LT cohort.
CONCLUSION In the US, LT hospitalizations with AP were on the rise, particularly for Hispanics and Asians. However, LT hospitalizations with AP had lower inpatient mortality compared to non-LT AP hospitalizations.
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Affiliation(s)
- Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI 48601, United States
| | - Vinay Jahagirdar
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64110, United States
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, NE 68131, United States
| | - Manesh Kumar Gangwani
- Department of Internal Medicine, The University of Toledo, Toledo, OH 43606, United States
| | - Nooraldin Merza
- Department of Internal Medicine, The University of Toledo, Toledo, OH 43606, United States
| | - Hassam Ali
- Department of Internal Medicine, East Carolina University, Greenville, NC 27858, United States
| | - Smit Deliwala
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, The University of Toledo, Toledo, OH 43606, United States
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, The University of Utah School of Medicine, Salt Lake City, UT 84112, United States
| | - Bhanu Siva Mohan Pinnam
- Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, IL 60612, United States
| | - Jay Bapaye
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY 14621, United States
| | - Chin-I Cheng
- Department of Statistics, Actuarial and Data Science, Central Michigan University, Mt. Pleasant, MI 48859, United States
| | - Sumant Inamdar
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
| | - Neil R Sharma
- Interventional Oncology and Surgical Endoscopy Programs, Parkview Cancer Institute, Fort Wayne, IN 46845, United States
| | - Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN 46202, United States
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Ceci L, Han Y, Krutsinger K, Baiocchi L, Wu N, Kundu D, Kyritsi K, Zhou T, Gaudio E, Francis H, Alpini G, Kennedy L. Gallstone and Gallbladder Disease: Biliary Tract and Cholangiopathies. Compr Physiol 2023; 13:4909-4943. [PMID: 37358507 DOI: 10.1002/cphy.c220028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Cholestatic liver diseases are named primarily due to the blockage of bile flow and buildup of bile acids in the liver. Cholestasis can occur in cholangiopathies, fatty liver diseases, and during COVID-19 infection. Most literature evaluates damage occurring to the intrahepatic biliary tree during cholestasis; however, there may be associations between liver damage and gallbladder damage. Gallbladder damage can manifest as acute or chronic inflammation, perforation, polyps, cancer, and most commonly gallstones. Considering the gallbladder is an extension of the intrahepatic biliary network, and both tissues are lined by biliary epithelial cells that share common mechanisms and properties, it is worth further evaluation to understand the association between bile duct and gallbladder damage. In this comprehensive article, we discuss background information of the biliary tree and gallbladder, from function, damage, and therapeutic approaches. We then discuss published findings that identify gallbladder disorders in various liver diseases. Lastly, we provide the clinical aspect of gallbladder disorders in liver diseases and ways to enhance diagnostic and therapeutic approaches for congruent diagnosis. © 2023 American Physiological Society. Compr Physiol 13:4909-4943, 2023.
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Affiliation(s)
- Ludovica Ceci
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy
| | - Yuyan Han
- School of Biological Sciences, University of Northern Colorado, Greeley, Colorado, USA
| | - Kelsey Krutsinger
- School of Biological Sciences, University of Northern Colorado, Greeley, Colorado, USA
| | | | - Nan Wu
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Debjyoti Kundu
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Konstantina Kyritsi
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tianhao Zhou
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Eugenio Gaudio
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy
| | - Heather Francis
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Research, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Gianfranco Alpini
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Research, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Lindsey Kennedy
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Research, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
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Kosti A, Borakati A, Varma A, Gupta A, Mustafa A, Hakeem A, Quddus A, Sahl AB, Beniwal A, Adesuyi A, Krzak AM, Brooks A, Frampton A, Gadhvi A, Talbot A, Elnogoomi A, Mahgoub A, Naqvi A, Pervez A, Bodla AS, Taha A, Tawfik A, Prabhu A, Puri A, Belgaumkar A, Gupta A, McCrorie A, Findlay A, Healey A, De Prendergast A, Farrugia A, Dosis A, Adiamah A, Sallam A, Wong A, Bradley A, Martin A, Collins A, Awan A, Bond A, Koh A, Kourdouli A, Patel AG, Dhannoon A, Khalil A, Banerjee A, Khan A, Elserafy A, Alamassi A, Owen A, Benjafield A, Zuccarrelli A, Luhmann A, Jones A, Kennedy-Dalby A, Smith AM, Kaul A, Kumar A, White A, Baker A, Minicozzi A, Bardoli A, Golpe AL, Manzelli A, Sivakumar A, Saha A, Shajpal A, Lango A, Cotton A, Nair A, Brown A, Menon A, Tandon A, Afza A, Hassan A, Shamali A, Khalid A, Regan A, Piramanayagam B, Oyewole B, Ibrahim B, Murphy B, Clayton B, Jenkins B, Kumar B, Rybinski B, Khor BY, Davidson BR, Lees B, Blacklock C, Johnstone C, Salinas CH, Boven C, Wolstenholme C, Chin C, Gilmore C, Sharp C, Walker C, Harris C, Khanna C, Ferguson C, Kyriakides C, Bee C, Currow C, Parmar C, Collins C, Halloran C, Smart CJ, Neophytou C, Delaney C, Anele C, Heugh C, Choh CTP, Kenington C, Wyatt C, Borg CM, Mole D, Arumugam D, Gunia D, Porter D, Berry D, Griffith D, Hou D, Longbotham D, Mitton D, Strachan D, Di Mauro D, Worku D, Heaphy D, Dunne D, Yeung D, Arambepola D, Leswas DA, Pournaras DJ, Damaskos D, Saleh D, Osilli D, Pearman D, Whitelaw D, Haq EU, Mack E, Spurring E, Jamieson E, Lenzi E, Gemmill E, Gammeri E, Bota E, Britton E, Farrow E, Lloyd E, Moran E, Itobi E, Craig E, Tanaka E, Chohda E, Muhammad FU, Youssef F, Roslan F, Amir F, Froghi F, Di Franco F, Abbadessa F, DiMaggio F, Gurung G, Faulkner G, Choa G, Kerans G, Davis GN, Galanopoulos G, Karagiannidis G, McCabe G, Mohammadi-Zaniani G, Nawaz G, Van Boxel G, Bond-Smith G, Tierney GM, Muthukumarasamy G, Grey G, Wong G, Finch G, Khan H, Bourne H, Javanmard-Emamghissi H, Murray H, Rottenburg H, Wright H, Khalil H, Spiers HVM, Bashiti H, Shanti H, Ebied H, Ng HJ, Hamid HKS, Kim H, Wilson I, Rajendran I, Gerogiannis I, Patel I, El-Abbassy I, Burridge I, Caldwll J, Jackman J, Clark J, Duncan J, Milburn J, O’Kelly J, Olivier J, Rink J, Royle J, Rai J, Latif J, Ahmad J, Maliyil J, Carr J, Coles J, McGarry J, Apollos J, Lim J, Gray J, Thomas J, Bennett J, Findlay J, Spearman J, Young J, Lund JN, Meilak J, Alfred J, Welsh J, Chan JH, Martin J, Patel K, Ko KYK, Isand K, Razi K, Sarathy K, Powezka K, Foster K, Peleki K, Bevan K, Fox K, Edwards K, Larsen K, Spellar K, Oh KE, Kong K, Brown K, Roberts KJ, Seymour K, Beatson K, Etherson K, Willis K, Mann K, Nizami K, Rajput K, Lavery L, Sawdon L, Nip L, Al-Hamed L, Fagan L, Watton L, Saint-Grant AL, Convie L, Girard LP, Huppler L, Marsh L, Seretny L, Newton L, Buksh M, Sallam M, Mathew M, Prasanth MN, Nayar M, Wijeyaratne M, Hollyman M, Ransome M, Popa M, Galea M, Taylor M, Gismondi M, Michel M, Wadley M, Al-Azzawi M, Claxton M, Kuzman M, Bonomaully M, Newman M, Bhandari M, Courtney M, Jones M, Rarity M, Wilson M, Ebraheem M, Elnaghi M, Mohamed MSN, Al-Hijaji M, Al-Rashedy M, Qayum MK, Zourob M, Gaber M, Rao M, Islam MA, Rashid MU, Zafar M, Naqvi M, Ahmad MN, Telfah M, Merali N, Hanbali N, Gulnaz N, Kumar N, Husain N, Angamuthu N, Murali N, Kirmani N, Assaf N, Doshi N, Shah NS, Basra N, Menezes N, Dai N, Schuijtvlot N, Kansal N, Chidumije N, Yassin N, Babalola O, Oyende O, Williams O, Pawlik O, O'Connor O, Jalil OA, Ryska O, Vaz O, Sarmah P, Jayawardena P, Patel P, Hart P, Cromwell P, Manby P, Marriott P, Needham P, Ghaneh P, Rao PKD, Eves P, Coe PO, May-Miller P, Szatmary P, Ireland P, Seta P, Ravi P, Janardhanan P, Patil P, Mistry P, Heer P, Patel P, Nunes Q, Ain Q, Clifford R, Brindle R, Lee RXN, Lim RQH, Rahman R, Kumar RM, Lunevicius R, Mukherjee R, Lahiri R, Behmida R, Rajebhosale R, Levy R, Chhabra R, Oliphant R, Freeman R, Jones RM, Elkalbash R, Brignall R, Bell R, Byrom R, Laing RW, Patel R, Buhain R, Clark R, Sutton R, Presa R, Lawther R, Patel R, Zakeri R, Mashar R, Wei R, Baron R, Tasleem S, Kadambot SS, Azam S, Wajed S, Ali S, Body S, Saeed S, Bandyopadhyay S, Mohamed S, Pandanaboyana S, Hassasing S, Dyer S, Small S, Seeralakandapalan S, Arumugam S, Chakravartty S, Ong SL, Ooi SZY, Nazir S, Zafar S, Shirazi S, Bharucha S, Majid S, Ahmed S, Rajamanickam SK, Albalkiny S, Ng S, Chowdhury S, Yahia S, Handa S, Fallis S, Fisher S, Jones S, Phillips S, Mitra S, Aroori S, Thanki S, Rozwadowski S, Tucker S, Conroy S, Barman S, Bhat S, McCallion S, Knight SR, Tezas S, van Laarhoven S, Cowie S, Rao S, Sellahewa S, Bhatti S, Kaistha S, Moug SJ, Argyropoulos S, Virupaksha S, Difford T, Shikh-Bahaei T, Saafan T, Lo T, Magro T, Gala T, Katbeh T, Athwal T, Lo T, Fraser T, Anyomih T, Chase TJG, Walker T, Ward T, Gallagher TK, Richardson T, Wiggins T, Ali U, Patnam V, Kanakala V, Beynon V, Hudson VE, Morrison-Jones V, Korwar V, Massella V, Parekh V, Ng V, Toh WH, Toh W, Hawkins W, Cambridge W, Harrison W, Tan YY, Aal YA, Malam Y, Toumi Z, Khaddar ZA, Bleything Z. PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK. BJS Open 2023; 7:zrad008. [PMID: 37161673 PMCID: PMC10170253 DOI: 10.1093/bjsopen/zrad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/01/2022] [Accepted: 01/04/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. METHODS All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. RESULTS A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. CONCLUSION Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions.
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Gurakar M, Faghih M, Akshintala VS, Bhullar FA, Kanthasamy K, Khashab MA, Kamal A, Zaheer A, He J, Afghani E, Singh VK. Factors Associated With Serial Lipase Measurement in Hospitalized Patients With Acute Pancreatitis. Pancreas 2023; 52:e293-e297. [PMID: 37816173 DOI: 10.1097/mpa.0000000000002255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
OBJECTIVES To determine the factors associated with serial lipase measurement in patients with acute pancreatitis (AP). METHODS Patients admitted to Johns Hopkins Health System between September 2019 and August 2020 with lipase ≥3 times upper limit normal were prospectively identified. Acute pancreatitis was defined using revised Atlanta criteria. Serial lipase measurement was defined as >2 lipase measurements on consecutive days within 7 days of presentation. RESULTS There were 294 patients with AP with mean age 52.4 ± 16 years (SD), and 155 (52.7%) were male. A total of 227 (77.2%) were admitted to a medical service. There were 111 (37.7%) who underwent serial lipase measurements. There were 89 (30.8%), 36 (12.2%), 6 (1%), and 40 (13.6%) patients with systemic inflammatory response syndrome at time of initial lipase measurement, persistent organ failure, necrosis on admission, and intensive care unit admission. Serial lipase measurements were more likely to be obtained in patients admitted to surgical services (odds ratio, 4.3; 95% confidence interval, 1.4-13.2; P = 0.01) and nontertiary hospitals (odds ratio, 1.8; 95% confidence interval, 1.0-2.9; P = 0.04). CONCLUSION More than one-third of AP patients undergo serial lipase measurements. This practice is more likely to occur on surgical services and in nontertiary hospitals.
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Affiliation(s)
| | - Mahya Faghih
- Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Furqan A Bhullar
- Division of Internal Medicine, St Joseph's University Medical Center, Paterson, NJ
| | | | | | | | | | - Jin He
- Division of Surgical Oncology, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD
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Nohomovich B, Shah A, Hughes N. Severe, Complicated Pancreatitis With an Unclear Etiology. Cureus 2023; 15:e39011. [PMID: 37323321 PMCID: PMC10264160 DOI: 10.7759/cureus.39011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 06/17/2023] Open
Abstract
Acute pancreatitis is an inflammatory process. There can be many causes of pancreatitis, which include alcohol or gallstones but can also be due to hypercalcemia, infections, or hypertriglyceridemia. Most cases of pancreatitis are mild and without complications. Severe cases of pancreatitis can cause complications, including organ failure. Pseudocysts are a rare complication of pancreatitis and may require management. We present a patient with severe acute pancreatitis with organ failure admitted to the intensive care unit, stabilized, and required subsequent management of a pseudocyst with cystogastrostomy with a lumen-apposing metal stent. The patient subsequently improved and is doing well today. Herein, we present an acute severe pancreatitis case report with an extensive workup complicated by pseudocyst development. We review pancreatitis causes, including rare causes and management.
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Affiliation(s)
- Brian Nohomovich
- Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
| | - Ali Shah
- Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
| | - Neil Hughes
- Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
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Traboulsi C, Gligorijevic N. A Rare Case of Acute Necrotizing Pancreatitis Infected With Prevotella Species. Cureus 2023; 15:e36145. [PMID: 37065282 PMCID: PMC10101509 DOI: 10.7759/cureus.36145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/15/2023] Open
Abstract
Acute pancreatitis is one of the leading causes of gastrointestinal-related hospitalizations in the United States. One of the complications of acute pancreatitis is infected pancreatic necrosis. We present a rare case of acute necrotizing pancreatitis infected with Prevotella species in a young patient. We demonstrate the importance of early suspicion of complicated acute pancreatitis and the need for early intervention to prevent hospital re-admission and improve the morbidity and mortality associated with infected pancreatic necrosis.
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Acehan F, Tez M, Kalkan C, Akdogan M, Altiparmak E, Doganay M, Surel AA, Ates I. Revisiting the Ranson score in acute pancreatitis: Is the drop in hematocrit a worrisome sign? JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2023; 30:315-324. [PMID: 35703004 DOI: 10.1002/jhbp.1200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/07/2022] [Accepted: 05/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Ranson score has 11 parameters that are complex and laborious to implement. In this study, we aimed to create a revised Ranson score by modifying the parameters in Ranson. METHODS A total of 938 patients diagnosed with acute pancreatitis (AP) between 2014 and 2021 were included in the study. The parameters of the Ranson score were included in the univariate and multivariate analyses. According to the results, some of these parameters were modified, and then the revised Ranson score was created. RESULTS The revised Ranson system was created with nine parameters by modifying the hematocrit parameter at 48 hours and excluding the aspartate aminotransferase parameter from the scoring system. For in-hospital mortality, the area under the curve value of the revised Ranson was 0.959 (95% CI: 0.931-0.986), and it was significantly higher compared to the three scoring systems evaluated. At a cut-off value of 3.5, the revised Ranson had a sensitivity and specificity of 91.7% and 89.1%, respectively, for mortality. CONCLUSION The revised Ranson scoring system had better predictive ability for all clinical outcomes compared to the original Ranson in our large sample of 938 patients. However, the revised version should be further validated by prospective and multicenter studies.
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Affiliation(s)
- Fatih Acehan
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey
| | - Mesut Tez
- Department of General Surgery, Ankara City Hospital, Ankara, Turkey
| | - Cagdas Kalkan
- Department of Gastroenterology, Ankara City Hospital, Ankara, Turkey
| | - Meral Akdogan
- Department of Gastroenterology, Ankara City Hospital, Ankara, Turkey
| | - Emin Altiparmak
- Department of Gastroenterology, Ankara City Hospital, Ankara, Turkey
| | - Mutlu Doganay
- Department of General Surgery, Ankara City Hospital, Ankara, Turkey
| | - Aziz Ahmet Surel
- Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ihsan Ates
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey
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Bioinformatic Analyses of Peripheral Blood Transcriptome Identify Altered Neutrophil-Related Pathway and Different Transcriptomic Profiles for Acute Pancreatitis in Patients with and without Chylomicronemia Syndrome. Biomolecules 2023; 13:biom13020284. [PMID: 36830652 PMCID: PMC9953624 DOI: 10.3390/biom13020284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
Acute pancreatitis (AP) is a serious inflammatory condition of the pancreas that can be associated with chylomicronemia syndrome (CS). Currently, no study has explored the differences between non-CS-associated AP and CS-associated AP in terms of gene expression. Transcriptomic profiles of blood samples from patients with AP were retrieved from GSE194331 (non-CS-associated) and GSE149607 (CS-associated). GSE31568 was used to examine the linkage between non-CS-associated AP and the expression of micro RNAs (miRNAs). Differentially expressed genes (DEGs) were identified, a gene regulatory network was constructed, and hub genes were defined. Subsequently, single-sample gene set enrichment analysis (ssGSEA) scores of hub genes were calculated to represent their regulatory-level activity. A total of 1851 shared DEGs were identified between non-CS-associated and CS-associated AP. Neutrophils were significantly enriched in both conditions. In non-CS-associated AP, miRNAs including hsa-miR-21, hsa-miR-146a, and hsa-miR-106a demonstrated a lower expression level as compared with the healthy control. Furthermore, the expression patterns and regulatory activities were largely opposite between non-CS-associated and CS-associated AP, with significantly lower estimated neutrophils in the latter case. In summary, we found that the regulation of neutrophils was altered in AP. There was a different gene expression pattern and lower estimated neutrophil infiltration in CS-associated AP. Whether these findings are clinically significant requires further investigation.
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Han F, Shi XL, Pan JJ, Wu KY, Zhu QT, Yuan CC, Xiao WM, Ding YB, Yu XP, Jiao XP, Hu LH, Lu GT, Li WQ. Elevated serum HbA1c level, rather than previous history of diabetes, predicts the disease severity and clinical outcomes of acute pancreatitis. BMJ Open Diabetes Res Care 2023; 11:e003070. [PMID: 36746527 PMCID: PMC9906177 DOI: 10.1136/bmjdrc-2022-003070] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 08/16/2022] [Accepted: 01/01/2023] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The aim of our study is to explore the value of serum glycosylated hemoglobin A1c (HbA1c) in disease severity and clinical outcomes of acute pancreatitis (AP). RESEARCH DESIGN AND METHODS Patients with AP were included from January 2013 to December 2020, retrospectively, dividing into normal serum HbA1c level (N-HbA1c) group and high serum HbA1c level (H-HbA1c) group according to the criteria HbA1c <6.5%. We compared patient characteristics, biochemical parameters, disease severity, and clinical outcomes of patients with AP in two groups. Besides, we evaluated the efficacy of serum HbA1c to predict organ failure (OF) in AP patients by receiver operating curve (ROC). RESULTS We included 441 patients with AP, including 247 patients in N-HbA1c group and 194 patients in H-HbA1c group. Serum HbA1c level was positively correlated with Atlanta classification, systemic inflammatory response syndrome, local complication, and OF (all p<0.05). Ranson, BISAP (bedside index of severity in acute pancreatitis), and CT severity index scores in patients with H-HbA1c were markedly higher than those in patients with N-HbA1c (all p<0.01). ROC showed that the best critical point for predicting the development of OF in AP with serum HbA1c is 7.05% (area under the ROC curve=0.79). Logistic regression analysis showed H-HbA1c was the independent risk factor for the development of OF in AP. Interestingly, in patients with presence history of diabetes and HbA1c <6.5%, the severity of AP was significantly lower than that in H-HbA1c group. Besides, there was no significant difference between with and without history of diabetes in N-HbA1c group. CONCLUSIONS Generally known, diabetes is closely related to the development of AP, and strict control of blood glucose can improve the related complications. Thus, the level of glycemic control before the onset of AP (HbA1c as an indicator) is the key to poor prognosis of AP, rather than basic history of diabetes. Elevated serum HbA1c level can become the potential indicator for predicting the disease severity of AP.
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Affiliation(s)
- Fei Han
- Pancreatic Center, Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
- Yangzhou Key Laboratory of Pancreatic Disease, Institute of Digestive Diseases, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Xiao-Lei Shi
- Pancreatic Center, Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
- Yangzhou Key Laboratory of Pancreatic Disease, Institute of Digestive Diseases, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Jia-Jia Pan
- Yangzhou Key Laboratory of Pancreatic Disease, Institute of Digestive Diseases, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Ke-Yan Wu
- Pancreatic Center, Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
- Yangzhou Key Laboratory of Pancreatic Disease, Institute of Digestive Diseases, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Qing-Tian Zhu
- Pancreatic Center, Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
- Yangzhou Key Laboratory of Pancreatic Disease, Institute of Digestive Diseases, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Chen-Chen Yuan
- Pancreatic Center, Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
- Yangzhou Key Laboratory of Pancreatic Disease, Institute of Digestive Diseases, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Wei-Ming Xiao
- Pancreatic Center, Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
- Yangzhou Key Laboratory of Pancreatic Disease, Institute of Digestive Diseases, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Yan-Bing Ding
- Pancreatic Center, Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
- Yangzhou Key Laboratory of Pancreatic Disease, Institute of Digestive Diseases, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Xiao-Ping Yu
- Department of Ultrasound, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
- Department of Physical Examination Center, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Xiu-Ping Jiao
- Department of Physical Examination Center, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Liang-Hao Hu
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Guo-Tao Lu
- Pancreatic Center, Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
- Yangzhou Key Laboratory of Pancreatic Disease, Institute of Digestive Diseases, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Wei-Qin Li
- Department of Critical Care Medicine, Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, China
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Muñoz D, Medina R, Botache WF, Arrieta RE. Pancreatitis aguda: puntos clave. Revisión argumentativa de la literatura. REVISTA COLOMBIANA DE CIRUGÍA 2023. [DOI: 10.30944/20117582.2206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Introducción. La pancreatitis aguda es una condición gastrointestinal común que se asocia a una importante morbimortalidad. Se estima que su incidencia es de 34 por cada 100.000 habitantes, afecta principalmente a adultos a partir de la sexta década de la vida y en nuestra región es debida en la mayoría de los casos a cálculos biliares.
Métodos. Se hizo una revisión de los aspectos fundamentales de esta patología, común y potencialmente mortal.
Resultados. El diagnóstico requiere del hallazgo de manifestaciones clínicas, aumento de las enzimas pancreáticas en suero y, en ocasiones, el uso de imágenes diagnósticas. Se puede clasificar en leve, moderada y severa, lo cual es fundamental para determinar la necesidad de tratamiento y vigilancia en una unidad de cuidados intensivos.
Conclusión. En la actualidad los pilares de manejo de la pancreatitis aguda son la terapia temprana con líquidos, tratamiento del dolor, inicio precoz de la vía oral y resolución del factor etiológico desencadenante. En presencia de complicaciones o un curso severo de enfermedad, pueden requerirse manejo antibiótico e intervenciones invasivas.
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Lee SH, Choe JW, Cheon YK, Choi M, Jung MK, Jang DK, Jo JH, Lee JM, Kim EJ, Han SY, Choi YH, Seo HI, Lee DH, Lee HS. Revised Clinical Practice Guidelines of the Korean Pancreatobiliary Association for Acute Pancreatitis. Gut Liver 2023; 17:34-48. [PMID: 35975642 PMCID: PMC9840919 DOI: 10.5009/gnl220108] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 02/01/2023] Open
Abstract
Acute pancreatitis can range from a mild, self-limiting disease requiring no more than supportive care, to severe disease with life-threatening complications. With the goal of providing a recommendation framework for clinicians to manage acute pancreatitis, and to contribute to improvements in national health care, the Korean Pancreatobiliary Association (KPBA) established the Korean guidelines for acute pancreatitis management in 2013. However, many challenging issues exist which often lead to differences in clinical practices. In addition, with newly obtained evidence regarding acute pancreatitis, there have been great changes in recent knowledge and information regarding this disorder. Therefore, the KPBA committee underwent an extensive revision of the guidelines. The revised guidelines were developed using the Delphi method, and the main topics of the guidelines include the following: diagnosis, severity assessment, initial treatment, nutritional support, convalescent treatment, and the treatment of local complications and necrotizing pancreatitis. Specific recommendations are presented, along with the evidence levels and recommendation grades.
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Affiliation(s)
- Sang Hyub Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Wan Choe
- Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Young Koog Cheon
- Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Miyoung Choi
- Division of Health Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Min Kyu Jung
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Dong Kee Jang
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hyun Jo
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Min Lee
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Eui Joo Kim
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Sung Yong Han
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Young Hoon Choi
- Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung-Il Seo
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hong Sik Lee
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea,Corresponding AuthorHong Sik Lee, ORCIDhttps://orcid.org/0000-0001-9726-5416, E-mail
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Bangolo AI, Akhter M, Auda A, Akram R, Nagesh VK, Athem D, Thomas R, Tibalan L, Trivedi M, Mushtaq S, Singh N, Bagale P, Arana GV, Khan T, Sharma S, Mynedi S, Patel DD, Saini M, Chinthakuntla MR, Ahmed K, Gad M, Gondhi SDDR, Arana G, Gurumoorthy RB, Weissman S. A Case Report of Acute Severe Necrotizing Pancreatitis following the Johnson & Johnson Vaccine against the Novel SARS-CoV-2. Case Rep Infect Dis 2023; 2023:9965435. [PMID: 37008512 PMCID: PMC10060063 DOI: 10.1155/2023/9965435] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/26/2023] [Accepted: 03/16/2023] [Indexed: 04/04/2023] Open
Abstract
Acute pancreatitis is an inflammatory condition, which is a leading gastrointestinal cause of hospitalization in the United States. Several conditions are associated with acute pancreatitis. More recently, there have been a few cases reported of acute pancreatitis following the Pfizer-BioNTech COVID-19 mRNA vaccine. To our knowledge, no cases of acute pancreatitis have been yet reported following the Johnson & Johnson's Janssen COVID-19 vaccine (J& J vaccine). Herein we report a 34-year-old male with no significant past medical history admitted with acute necrotizing pancreatitis, the day following the receipt of the J&J vaccine. Based on the Naranjo and the modified Naranjo scale, the patient met the requirements for probable drug induced pancreatitis. This case report has the objective to raise awareness of a potentially severe side effect of the J&J vaccine. We hope to use this case to support screening all patients for previous history of acute pancreatitis before administration of the J& J vaccine.
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Affiliation(s)
- Ayrton I. Bangolo
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ, USA
| | - Mahabuba Akhter
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ, USA
| | - Auda Auda
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ, USA
| | - Rahina Akram
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ, USA
| | - Vignesh K. Nagesh
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ, USA
| | - Donnee Athem
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ, USA
| | - Reenu Thomas
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ, USA
| | - Ligaya Tibalan
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ, USA
| | - Mansi Trivedi
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ, USA
| | - Saima Mushtaq
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ, USA
| | - Neha Singh
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ, USA
| | - Pracheta Bagale
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ, USA
| | - Georgemar V. Arana
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ, USA
| | - Tayyaba Khan
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ, USA
| | - Shelja Sharma
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ, USA
| | - Swetha Mynedi
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ, USA
| | - Dhara D. Patel
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ, USA
| | - Mandeep Saini
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ, USA
| | | | - Kareem Ahmed
- Department of Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Mary Gad
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ, USA
| | | | - Georgemar Arana
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ, USA
| | | | - Simcha Weissman
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ, USA
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Etheridge JC, Castillo-Angeles M, Sinyard RD, Jarman MP, Havens JM. Impact of hospital characteristics on best-practice adherence for gallstone pancreatitis: a nationwide analysis. Surg Endosc 2023; 37:127-133. [PMID: 35854127 DOI: 10.1007/s00464-022-09444-y] [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: 01/10/2022] [Accepted: 07/04/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Current guidelines recommend cholecystectomy during the index admission for gallstone pancreatitis, and a growing body of evidence indicates that patients benefit from cholecystectomy within the first 48 h of admission. We examined the impact of hospital characteristics on adherence to these data-driven practices. METHODS We queried the National Inpatient Sample for patients admitted for gallstone pancreatitis between October 2015 and December 2018. Patients who underwent same-admission cholecystectomy were identified by procedure codes. Cholecystectomies within the first two days were classified as early cholecystectomies. Multivariable logistic regression was used to determine the association between hospital characteristics and adherence to these practices. RESULTS Of 163,390 admissions for gallstone pancreatitis, only 90,790 (55.6%) underwent cholecystectomy before discharge. Mean time from admission to cholecystectomy was 2.9 days; 27.0% of patients (44,005) underwent early cholecystectomy. Odds of same-admission cholecystectomy were highest in large hospitals (OR 1.21, 95% CI 1.13-1.28), urban teaching centers (OR 1.33, 95% CI 1.21-1.46), and the South (OR 1.70, 95% CI 1.57-1.83). Odds of early cholecystectomy did not vary with hospital size, urban-rural status, or teaching status but were highest in the West (OR 1.98, 95% CI 1.80-2.18). CONCLUSION Best-practice adherence for cholecystectomy in gallstone pancreatitis remains low despite an abundance of evidence and clinical practice guidelines. Active interventions are needed to improve delivery of surgical care for this patient population. Implementation efforts should focus on small hospitals, rural areas, and health systems in the Northeast region.
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Affiliation(s)
- James C Etheridge
- Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. .,Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Manuel Castillo-Angeles
- Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert D Sinyard
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Molly P Jarman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Joaquim M Havens
- Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
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Gupta V, Narang SS, Gill CS, Selhi PK, Gupta M. Red Cell Distribution Width and Ratio of Red Cell Distribution Width-to-Total Serum Calcium as Predictors of Outcome of Acute Pancreatitis. Int J Appl Basic Med Res 2023; 13:5-9. [PMID: 37266525 PMCID: PMC10230523 DOI: 10.4103/ijabmr.ijabmr_286_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/26/2022] [Accepted: 12/27/2022] [Indexed: 04/01/2023] Open
Abstract
Background Current severity assessment scores of acute pancreatitis (AP) include multiple variables, the results of which are available only after 48 h of admission. Red cell distribution width (RDW) and total serum calcium (TSC) are simple routine parameters related to inflammatory status and results of which are readily available. Aim The aim of this study was to evaluate RDW and RDW: TSC within 24 h of hospital admission as predictors of outcome (severity and mortality) and intervention (medical/percutaneous drainage/surgical) required by patients of AP. Materials and Methods All the patients diagnosed with AP at a tertiary care hospital were enrolled for the study. Values of RDW and TSC along with data regarding the treatment given were collected. Diagnosis and severity were defined according to the revised Atlanta classification 2012. Results and Interpretation Cutoff value for RDW (area under the receiver operating characteristic curve [AUROC]: 0.997; P = 0.000) to predict the severity of AP was 16.25% (sensitivity - 100% and specificity - 97.1%,) (sensitivity - 100% and specificity - 97.1%, positive predictive value - 92.31%, negative predictive value - 100%, and Youden Index - 0.971), while that of RDW:TSC (AUROC: 1; P = 0.000) was 2.42 (sensitivity - 100%; specificity - 100%, positive predictive value - 100%, negative predictive value - 100%, and Youden Index - 1.00). Similarly, the cutoff value for RDW (AUROC: 0.947; P = 0.000) to predict mortality in AP was 17.20% (sensitivity - 100%; specificity - 87.4%, positive predictive value - 38.89%, negative predictive value - 100%, and Youden Index - 0.874) and that of RDW-to-TSC ratio (AUROC: 0.975; P = 0.000) was 2.9 (sensitivity - 100%; specificity - 96.6%, positive predictive value - 70%, negative predictive value - 100%, and Youden Index - 0.966). Conclusion Our study found that RDW and RDW: TSC were quick, convenient, economic, sensitive, and dependable prognostic predictors of severity and mortality in patients with AP.
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Affiliation(s)
- Varun Gupta
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Savjot Singh Narang
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Chiranjiv Singh Gill
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Pavneet Kaur Selhi
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Manvi Gupta
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Sbeit W, Abukaes H, Said Ahmad H, Sbeit M, Kalisky I, Katz L, Mari A, Khoury T. The possible association of proton pump inhibitor use with acute cholangitis in patients with choledocholithiasis: a multi-center study. Scand J Gastroenterol 2023; 58:83-87. [PMID: 35930433 DOI: 10.1080/00365521.2022.2106150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gallstone disease is common worldwide and can lead to severe complications, including cholangitis; thus, it is important to identify modifiable risk factors for cholangitis. Proton pump inhibitors (PPIs) are commonly prescribed to treat gastroenterological disorders. We aimed to explore whether PPI use is associated with an increased risk of acute cholangitis in patients with gallstone disease. METHODS This retrospective multicenter study included all patients arriving to the hospital over a 10-year period with various presentations of choledocholithiasis. We compared active PPI use in two groups: those with cholangitis (group A) vs. without cholangitis (group B). RESULTS Overall, 811 patients were included, 161 in group A and 650 in group B. The average age ± standard deviation (SD) in groups A and B was 74.5 ± 20.6 vs. 61.6 ± 20.9 years, respectively. PPI use in group A was higher vs. group B (42.9% vs. 29.1%, p = 0.001). On univariate analysis, male gender (OR 1.47, 95% confidence interval (CI) 1.04-2.08), age (OR 1.04, 95% CI 1.03-1.05), ischemic heart disease (IHD) (OR 1.68, 95% CI 1.07-2.64), hyperlipidemia (OR 1.59, 95% CI 1.11-2.29), hypertension (OR 1.81, 95% CI 1.28-2.57) and PPI use (OR 1.83, 95% CI 1.28-2.61), all were associated with acute cholangitis. On multivariate analysis, only PPI use kept its association after adjustment for age (OR 1.64, 95% CI 1.2-3.7). CONCLUSIONS Active PPI use was associated with a higher rate of cholangitis among patients with choledocholithiasis. We advocate considering this risk before prescribing PPIs to patients with gallstones. TRIAL REGISTRATION NUMBER NHR-0263-20 received on 14/01/2021 date 'retrospectively registered'.
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Affiliation(s)
- Wisam Sbeit
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Hani Abukaes
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Helal Said Ahmad
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.,Gastroenterology and Endoscopy Unit, Nazareth Hospital, EMMS, Nazareth, Israel
| | - Moeen Sbeit
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Itai Kalisky
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Institute of Gastroenterology and Hepatology, Hadassah University Medical Center, Jerusalem, Israel
| | - Lior Katz
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Institute of Gastroenterology and Hepatology, Hadassah University Medical Center, Jerusalem, Israel
| | - Amir Mari
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.,Gastroenterology and Endoscopy Unit, Nazareth Hospital, EMMS, Nazareth, Israel
| | - Tawfik Khoury
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Effects of Berberine against Pancreatitis and Pancreatic Cancer. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27238630. [PMID: 36500723 PMCID: PMC9738201 DOI: 10.3390/molecules27238630] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
The pancreas is a glandular organ with endocrine and exocrine functions necessary for the maintenance of blood glucose homeostasis and secretion of digestive enzymes. Pancreatitis is characterized by inflammation of the pancreas leading to temporary or permanent pancreatic dysfunction. Inflammation and fibrosis caused by chronic pancreatitis exacerbate malignant transformation and significantly increase the risk of developing pancreatic cancer, the world's most aggressive cancer with a 5-year survival rate less than 10%. Berberine (BBR) is a naturally occurring plant-derived polyphenol present in a variety of herbal remedies used in traditional medicine to treat ulcers, infections, jaundice, and inflammation. The current review summarizes the existing in vitro and in vivo evidence on the effects of BBR against pancreatitis and pancreatic cancer with a focus on the signalling mechanisms underlying the effects of BBR.
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He S, Ikner TP, Taylor BV, Aguiar T, Thakur NP, Chakravorty S. Mirtazapine-associated acute pancreatitis in a patient with insomnia and co-occurring psychiatric disorders. J Natl Med Assoc 2022; 114:617-620. [PMID: 36114064 DOI: 10.1016/j.jnma.2022.08.001] [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: 02/01/2022] [Revised: 07/21/2022] [Accepted: 08/24/2022] [Indexed: 12/15/2022]
Abstract
We report the case of an African American patient who developed drug-associated acute pancreatitis without hypertriglyceridemia, after being treated with mirtazapine for major depressive disorder (MDD). Acute pancreatitis is characterized by rapid inflammation and autodigestion of the pancreas, which may become life-threatening. Although heavy alcohol use and gallstones are the most common causes of acute pancreatitis, some medications are also known to cause drug-induced acute pancreatitis. This report describes a 47-year-old African American female with a history of MDD, insomnia, posttraumatic stress disorder (PTSD), and alcohol use disorder, who was prescribed mirtazapine. A literature search implicated mirtazapine as a rare cause of drug-induced acute pancreatitis. Some reports have suggested that mirtazapine-associated acute pancreatitis may be due to hypertriglyceridemia. This case report instead presents with a normal lipid panel, which is consistent with the majority of prior reports, and it is noteworthy for introducing an alternative mechanism. The Naranjo Adverse Drug Reaction (ADR) Probability Scale calculated an ADR of 5, indicating mirtazapine as the probable cause of the patient's drug-associated acute pancreatitis.
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Affiliation(s)
- Sean He
- Saint Louis University School of Medicine, Saint Louis, MO 63104, USA.
| | - Taylor P Ikner
- University of Pennsylvania College of Liberal and Professional Studies, USA
| | | | - Taylor Aguiar
- Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Nina P Thakur
- University of New England College of Osteopathic Medicine, Biddleford, ME 04005, USA
| | - Subhajit Chakravorty
- Cpl. Michael J Crescenz VA Medical Center, Philadelphia, PA 19104, USA; Perelman School of Medicine, Philadelphia, PA 19104, USA
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Tozlu M, Karaca B, Acar S, Toka B, Karacaer C, Eminler AT, Köksal AS. Higher Complications During the Waiting Period for Interval Cholecystectomy in Patients With Mild Biliary Pancreatitis. Surg Laparosc Endosc Percutan Tech 2022; 32:655-660. [PMID: 36468890 DOI: 10.1097/sle.0000000000001094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/06/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Although current guidelines recommend cholecystectomy during the same admission in patients with mild acute biliary pancreatitis (ABP), it involves a waiting list most of the time. We aimed to assess the risk of complications and determine predictors during the waiting period for cholecystectomy after the first episode of ABP. METHODS A prospective observational study was conducted in patients with mild ABP. Follow-ups were done by phone calls or using electronic health records for a maximum of 6 months after discharge or until cholecystectomy. RESULTS A total of 194 patients were included in the study. Although all patients were referred to surgeons, only 81 (41.8%) underwent cholecystectomy within 6 months after discharge. During the observation period, gallstone-related biliary events (GRBEs) developed in 68 (35.1%) patients, which included biliary colic, recurrent ABP, acute cholecystitis, choledocholithiasis, gallbladder perforation, cholangitis, and liver abscess. The overall readmission rate was 25.2%, with 44.8% occurred within 4 weeks after discharge. The odds ratio of any complication was 1.58 (95% CI, 1.42 to 1.76, P =0.028) and 1.59 (95% CI, 1.42 to 1.78, P =0.009) in the patients who did not have surgery within 2 to 7 days and 8 to 15 days, respectively. A 4-fold increased risk of readmission was detected (95% CI, 1.16 to 13.70, P =0.019) if cholecystectomy was not performed within 31 to 90 days. The patients who developed complications had significantly higher C-reactive protein at admission, longer waiting time, and had 3 or more gallstones on imaging. CONCLUSIONS Interval cholecystectomy was associated with a high risk of complications during the waiting period in patients with mild ABP.
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Affiliation(s)
| | - Busra Karaca
- Internal Medicine, Sakarya University Faculty of Medicine, Sakarya
| | | | - Bilal Toka
- Department of Gastroenterology, Silivri Anadolu Hospital, Istanbul, Turkey
| | - Cengiz Karacaer
- Internal Medicine, Sakarya University Faculty of Medicine, Sakarya
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Chan KS, Shelat VG. Diagnosis, severity stratification and management of adult acute pancreatitis-current evidence and controversies. World J Gastrointest Surg 2022; 14:1179-1197. [PMID: 36504520 PMCID: PMC9727576 DOI: 10.4240/wjgs.v14.i11.1179] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/08/2022] [Accepted: 10/25/2022] [Indexed: 02/07/2023] Open
Abstract
Acute pancreatitis (AP) is a disease spectrum ranging from mild to severe with an unpredictable natural course. Majority of cases (80%) are mild and self-limiting. However, severe AP (SAP) has a mortality risk of up to 30%. Establishing aetiology and risk stratification are essential pillars of clinical care. Idiopathic AP is a diagnosis of exclusion which should only be used after extended investigations fail to identify a cause. Tenets of management of mild AP include pain control and management of aetiology to prevent recurrence. In SAP, patients should be resuscitated with goal-directed fluid therapy using crystalloids and admitted to critical care unit. Routine prophylactic antibiotics have limited clinical benefit and should not be given in SAP. Patients able to tolerate oral intake should be given early enteral nutrition rather than nil by mouth or parenteral nutrition. If unable to tolerate per-orally, nasogastric feeding may be attempted and routine post-pyloric feeding has limited evidence of clinical benefit. Endoscopic retrograde cholangiopancreatogram should be selectively performed in patients with biliary obstruction or suspicion of acute cholangitis. Delayed step-up strategy including percutaneous retroperitoneal drainage, endoscopic debridement, or minimal-access necrosectomy are sufficient in most SAP patients. Patients should be monitored for diabetes mellitus and pseudocyst.
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Affiliation(s)
- Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
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Chetwood JD, Volovets A, Sivam S, Koh C. Surgical considerations in cystic fibrosis: what every general surgeon needs to know. ANZ J Surg 2022; 92:2425-2432. [PMID: 35920692 PMCID: PMC9804981 DOI: 10.1111/ans.17948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/12/2022] [Indexed: 01/09/2023]
Abstract
Cystic fibrosis (CF) is a complex multiorgan disease, which often affects the gastrointestinal tract. With improved CF specific therapies and multidisciplinary management, patients with CF are now living longer with a median life expectancy of around 50 years. This increased life expectancy has resulted in corresponding increase in presentations of the CF patient with comorbid surgical conditions that were never important considerations. Investigations and management of these conditions, such as distal intestinal obstruction syndrome and colorectal cancer warrant good clinical understanding of the unique challenges that CF patients present including chronic immunosuppression, impaired respiratory function and their multi-organ dysfunction. The purpose of this review is to provide general surgeons with a contemporary update on the CF related surgical issues as they are likely to become increasingly involved in the care of these complex patients and form an integral part of the multidisciplinary team.
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Affiliation(s)
- John D. Chetwood
- AW Morrow Gastroenterology and Liver CentreRoyal Prince Alfred HospitalSydneyNew South WalesAustralia,Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia
| | - Anastasia Volovets
- AW Morrow Gastroenterology and Liver CentreRoyal Prince Alfred HospitalSydneyNew South WalesAustralia,Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia
| | - Sheila Sivam
- Department of Respiratory and Sleep MedicineRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Cherry Koh
- Surgical Outcomes Research Centre (SOuRCe)Royal Prince Alfred HospitalSydneyNew South WalesAustralia
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Dixit VK, Sahu MK, Venkatesh V, Bhargav VY, Kumar V, Pateriya MB, Venkataraman J. Gastrointestinal Emergencies and the Role of Endoscopy. JOURNAL OF DIGESTIVE ENDOSCOPY 2022. [DOI: 10.1055/s-0042-1755303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AbstractMany gastrointestinal (GI) disorders present to the emergency room with acute clinical presentations, some even life threatening. Common emergencies encountered that require urgent endoscopic interventions include GI hemorrhage (variceal and nonvariceal), foreign body ingestion, obstructive jaundice, postprocedure-related complications such as postpolypectomy bleed or perforation, etc. A major advantage of emergency endoscopy is that it is cost effective and, on many occasions, can be life-saving. The present review will highlight a practical approach on various endoscopic modalities and their use in the GI emergencies.
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Affiliation(s)
- Vinod Kumar Dixit
- Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Manoj Kumar Sahu
- Department of Gastroenterology and Hepatobiliary Sciences, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (SOA) University, Bhubaneswar, Odisha, India
| | - Vybhav Venkatesh
- Department of Gastroenterology and Hepatobiliary Sciences, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (SOA) University, Bhubaneswar, Odisha, India
| | - Varanasi Yugandhar Bhargav
- Department of Hepatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Vinod Kumar
- Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Mayank Bhushan Pateriya
- Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Jayanthi Venkataraman
- Department of Hepatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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