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Trikudanathan G, Yazici C, Evans Phillips A, Forsmark CE. Diagnosis and Management of Acute Pancreatitis. Gastroenterology 2024:S0016-5085(24)04916-3. [PMID: 38759844 DOI: 10.1053/j.gastro.2024.02.052] [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] [Received: 09/04/2023] [Revised: 01/03/2024] [Accepted: 02/18/2024] [Indexed: 05/19/2024]
Abstract
Acute pancreatitis (AP) is increasing in incidence across the world, and in all age groups. Major changes in management have occurred in the last decade. Avoiding total parenteral nutrition and prophylactic antibiotics, avoiding overly aggressive fluid resuscitation, initiating early feeding, avoiding endoscopic retrograde cholangiopancreatography in the absence of concomitant cholangitis, same-admission cholecystectomy, and minimally invasive approaches to infected necrosis should now be standard of care. Increasing recognition of the risk of recurrence of AP, and progression to chronic pancreatitis, along with the unexpectedly high risk of diabetes and exocrine insufficiency after AP is the subject of large ongoing studies. In this review, we provide an update on important changes in management for this increasingly common disease.
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Affiliation(s)
- Guru Trikudanathan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota
| | - Cemal Yazici
- Division of Gastroenterology, Hepatology, and Nutrition, University of Illinois, Chicago, Illinois
| | - Anna Evans Phillips
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Chris E Forsmark
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida
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Kawka M, Lucas A, Riad AM, Hawkins D, de Madaria E, West H, Jakaityte I, Lee MJ, Kouli O, Ruanne R, Gujjuri RR, Brown S, Cambridge WA, Pandanaboyana S, Kamarajah SK, McLean KA. Quality of life instruments in acute and chronic pancreatitis: a consensus-based standards for the selection of health measurement instruments (COSMIN) approach. HPB (Oxford) 2024:S1365-182X(24)01260-7. [PMID: 38735815 DOI: 10.1016/j.hpb.2024.04.004] [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] [Received: 11/22/2023] [Revised: 04/07/2024] [Accepted: 04/18/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Pancreatitis is a common surgical emergency, associated with pain and poor quality of life for patients. However, assessment of patient-reported outcome measures in these patients is unclear. This study aimed to identify and evaluate the methodological quality of the health-related quality of life instruments used for patients with acute or chronic pancreatitis. METHODS Prospective studies that evaluated health-related quality of life in acute or chronic pancreatitis were identified from systematic review of MEDLINE, EMBASE, and Web of Science until 28th June 2023 (PROSPERO: CRD42021274743). Instrument characteristics were extracted, and methodological quality assessed using COSMIN (COnsensus-based Standards for the selection of health status Measurement Instruments) guidelines and GRADE approach. Narrative synthesis was conducted, with recommendations for use based on COSMIN criteria, evaluated according to World Health Organisation (WHO) quality of life domains. RESULTS From 3850 records screened, 41 quality of life instruments were identified across 138 studies included. The majority (69.8%, n = 26) were designed to assess general health-related quality of life, whereas the remainder were abdominal-specific (n = 5) or pancreas-specific (n = 10). Only ten instruments (24.3%) demonstrated sufficient content validity, incorporating items in ≥5 WHO quality of life domains. However, only nine instruments (21.9%) incorporated public and patient involvement. Only the Gastrointestinal Quality of Life Index and PAN-PROMISE met the criteria to be recommended for use based on COSMIN methodological assessment. CONCLUSION There is significant heterogeneity in instruments used to assess quality of life after pancreatitis, with almost all instruments considered insufficient. Robust, validated, and relevant instruments are needed to better understand and determine appropriate interventions to improve quality of life for these patients.
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Hollemans RA, Timmerhuis HC, Besselink MG, Bouwense SAW, Bruno M, van Duijvendijk P, van Geenen EJ, Hadithi M, Hofker S, Van-Hooft JE, Kager LM, Manusama ER, Poley JW, Quispel R, Römkens T, van der Schelling GP, Schwartz MP, Spanier BWM, Stommel M, Tan A, Venneman NG, Vleggaar F, van Wanrooij RLJ, Bollen TL, Voermans RP, Verdonk RC, van Santvoort HC. Long-term follow-up study of necrotising pancreatitis: interventions, complications and quality of life. Gut 2024; 73:787-796. [PMID: 38267201 DOI: 10.1136/gutjnl-2023-329735] [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: 02/16/2023] [Accepted: 01/07/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To describe the long-term consequences of necrotising pancreatitis, including complications, the need for interventions and the quality of life. DESIGN Long-term follow-up of a prospective multicentre cohort of 373 necrotising pancreatitis patients (2005-2008) was performed. Patients were prospectively evaluated and received questionnaires. Readmissions (ie, for recurrent or chronic pancreatitis), interventions, pancreatic insufficiency and quality of life were compared between initial treatment groups: conservative, endoscopic/percutaneous drainage alone and necrosectomy. Associations of patient and disease characteristics during index admission with outcomes during follow-up were assessed. RESULTS During a median follow-up of 13.5 years (range 12-15.5 years), 97/373 patients (26%) were readmitted for recurrent pancreatitis. Endoscopic or percutaneous drainage was performed in 47/373 patients (13%), of whom 21/47 patients (45%) were initially treated conservatively. Pancreatic necrosectomy or pancreatic surgery was performed in 31/373 patients (8%), without differences between treatment groups. Endocrine insufficiency (126/373 patients; 34%) and exocrine insufficiency (90/373 patients; 38%), developed less often following conservative treatment (p<0.001 and p=0.016, respectively). Quality of life scores did not differ between groups. Pancreatic gland necrosis >50% during initial admission was associated with percutaneous/endoscopic drainage (OR 4.3 (95% CI 1.5 to 12.2)), pancreatic surgery (OR 3.2 (95% CI 1.1 to 9.5) and development of endocrine insufficiency (OR13.1 (95% CI 5.3 to 32.0) and exocrine insufficiency (OR6.1 (95% CI 2.4 to 15.5) during follow-up. CONCLUSION Acute necrotising pancreatitis carries a substantial disease burden during long-term follow-up in terms of recurrent disease, the necessity for interventions and development of pancreatic insufficiency, even when treated conservatively during the index admission. Extensive (>50%) pancreatic parenchymal necrosis seems to be an important predictor of interventions and complications during follow-up.
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Affiliation(s)
- Robbert A Hollemans
- Department of Surgery, St Antonius Hospital Location, Utrecht, Netherlands
- Department of Research and Development, St. Antonius Hospital, Nieuwegein, Netherlands
| | | | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands
| | - Stefan A W Bouwense
- Department of Surgery, Maastricht Universitair Medisch Centrum+, Maastricht, Netherlands
| | - Marco Bruno
- Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Erwin-Jan van Geenen
- Department of Gastroenterology and Hepatology, Radboudumc, Nijmegen, Netherlands
| | - Muhammed Hadithi
- Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, Netherlands
| | - Sybrand Hofker
- Department of Surgery, University Medical Centre, Groningen, Netherlands
| | - Jeanin E Van-Hooft
- Department of Gastroenterology & Hepatology, Leiden Universitair Medisch Centrum, Leiden, Netherlands
| | - Liesbeth M Kager
- Department of Gastroenterology & Hepatology, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
| | - Eric R Manusama
- Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, Netherlands
| | - Jan-Werner Poley
- Department of Gastroenterology and Hepatology, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Rutger Quispel
- Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft, Netherlands
| | - Tessa Römkens
- Department of Gastroenterology and Hepatology, Jeroen Bosch Ziekenhuis, Den Bosch, Netherlands
| | | | - Matthijs P Schwartz
- Department of Gastroenterology and Hepatology, Meander Medical Centre, Amersfoort, Netherlands
| | - Bernhard W M Spanier
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, Netherlands
| | | | - Adriaan Tan
- Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Niels G Venneman
- Department of Gastroenterology and Hepatology, Medical Spectrum Twente, Enschede, Netherlands
| | - Frank Vleggaar
- Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, Netherlands
| | - Roy L J van Wanrooij
- Department of Gastroenterology and Hepatology, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
| | - Thomas L Bollen
- Department of Radiology, St Antonius Hospital Location, Utrecht, Netherlands
| | - Rogier P Voermans
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Robert C Verdonk
- Department of Gastroenterology and Hepatology, St Antonius Hospital Location, Utrecht, Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, St Antonius Hospital Location, Utrecht, Netherlands
- Department of Surgery, University Medical Centre, Utrecht, Netherlands
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Lan WP, Guo W, Zhou X, Li Z. Research trends on traditional Chinese medicine and acute pancreatitis: A bibliometric analysis from 2007 to mid-2023. Heliyon 2024; 10:e25659. [PMID: 38455538 PMCID: PMC10918020 DOI: 10.1016/j.heliyon.2024.e25659] [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: 09/27/2023] [Revised: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 03/09/2024] Open
Abstract
Traditional Chinese Medicine (TCM) is a unique medical system of historic significance, holding substantial influence within China and beyond. In recent years, the efficacy of TCM in treating acute pancreatitis has been substantiated. Despite over two decades of development in this domain, a bibliometric analysis illustrating TCM's role in acute pancreatitis remains scarce. OBJECTIVE This study aims to conduct a comprehensive analysis of findings in the field of acute pancreatitis and TCM using machine learning and text-analyzing methodologies. The intent is to provide scientific and intuitive support to researchers and clinicians. METHODS We searched the Web of Science Core Collection database for publications and related literature from 2007 to mid-2023. Tools such as Excel, Citespace V, and Vosviewer were utilized for bibliometric analysis. That included assessing published and cited counts, co-authorship mapping, co-citation analysis, burst detection, and keyword analysis. RESULTS The study revealed a fluctuating growth trend in the number of publications and citations since 2007. As many as 147 institutions from 13 countries, with a total of 756 authors, have published 202 papers in 76 academic journals. Sichuan University in China and Tang Wenfu have been recognized as the most influential national institution and author. The most frequently published journal is "Pancreas", while the most cited is the "World Journal of Gastroenterology". Commonly used single herbs in this field include Baicalin, Emodin, Rhubarb, and Salvia miltiorrhizae. Frequently used herbal formulations include Da chengqi decoction, Chaiqin chengqi decoction, and Qing yi decoction. Current research hotspots primarily surround concepts like hmgb1, nf-kappab, nfr2, oxidative stress, exosomes, nlrp3, pyroptosis, etc. Potential future research themes could relate to pharmacology, reducing hmgb1, inflammatory response, cell activation, Qing Yi-decoction, etc. This review holds significant guiding importance for clinical and scientific research into TCM treatment for acute pancreatitis in the future.
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Affiliation(s)
- Wang-peng Lan
- The Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Digestive System Diseases of Luzhou city, Affiliated Traditional Medicine Hospital of Southwest Medical University, Lu zhou, 646000, China
- Department of Spleen and Stomach Diseases, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Lu zhou, Sichuan, 646000, China
| | - Wen Guo
- The Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Digestive System Diseases of Luzhou city, Affiliated Traditional Medicine Hospital of Southwest Medical University, Lu zhou, 646000, China
- Department of Spleen and Stomach Diseases, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Lu zhou, Sichuan, 646000, China
| | - Xin Zhou
- The Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Digestive System Diseases of Luzhou city, Affiliated Traditional Medicine Hospital of Southwest Medical University, Lu zhou, 646000, China
- Department of Spleen and Stomach Diseases, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Lu zhou, Sichuan, 646000, China
| | - Zhi Li
- The Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Digestive System Diseases of Luzhou city, Affiliated Traditional Medicine Hospital of Southwest Medical University, Lu zhou, 646000, China
- Department of Spleen and Stomach Diseases, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Lu zhou, Sichuan, 646000, China
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Ammer-Herrmenau C, Antweiler KL, Asendorf T, Beyer G, Buchholz SM, Cameron S, Capurso G, Damm M, Dang L, Frost F, Gomes A, Hamm J, Henker R, Hoffmeister A, Meinhardt C, Nawacki L, Nunes V, Panyko A, Pardo C, Phillip V, Pukitis A, Rasch S, Riekstina D, Rinja E, Ruiz-Rebollo ML, Sirtl S, Weingarten M, Sandru V, Woitalla J, Ellenrieder V, Neesse A. Gut microbiota predicts severity and reveals novel metabolic signatures in acute pancreatitis. Gut 2024; 73:485-495. [PMID: 38129103 PMCID: PMC10894816 DOI: 10.1136/gutjnl-2023-330987] [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: 08/24/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Early disease prediction is challenging in acute pancreatitis (AP). Here, we prospectively investigate whether the microbiome predicts severity of AP (Pancreatitis-Microbiome As Predictor of Severity; P-MAPS) early at hospital admission. DESIGN Buccal and rectal microbial swabs were collected from 424 patients with AP within 72 hours of hospital admission in 15 European centres. All samples were sequenced by full-length 16S rRNA and metagenomic sequencing using Oxford Nanopore Technologies. Primary endpoint was the association of the orointestinal microbiome with the revised Atlanta classification (RAC). Secondary endpoints were mortality, length of hospital stay and severity (organ failure >48 hours and/or occurrence of pancreatic collections requiring intervention) as post hoc analysis. Multivariate analysis was conducted from normalised microbial and corresponding clinical data to build classifiers for predicting severity. For functional profiling, gene set enrichment analysis (GSEA) was performed and normalised enrichment scores calculated. RESULTS After data processing, 411 buccal and 391 rectal samples were analysed. The intestinal microbiome significantly differed for the RAC (Bray-Curtis, p value=0.009), mortality (Bray-Curtis, p value 0.006), length of hospital stay (Bray-Curtis, p=0.009) and severity (Bray-Curtis, p value=0.008). A classifier for severity with 16 different species and systemic inflammatory response syndrome achieved an area under the receiving operating characteristic (AUROC) of 85%, a positive predictive value of 67% and a negative predictive value of 94% outperforming established severity scores. GSEA revealed functional pathway units suggesting elevated short-chain fatty acid (SCFA) production in severe AP. CONCLUSIONS The orointestinal microbiome predicts clinical hallmark features of AP, and SCFAs may be used for future diagnostic and therapeutic concepts. TRIAL REGISTRATION NUMBER NCT04777812.
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Affiliation(s)
- Christoph Ammer-Herrmenau
- Department of Gastroenterology, gastrointestinal Oncology and Endocrinology, University Medical Centre Goettingen, Goettingen, Germany
| | - Kai L Antweiler
- Department of Medical Statistics, University Medical Centre Goettingen, Goettingen, Germany
| | - Thomas Asendorf
- Department of Medical Statistics, University Medical Centre Goettingen, Goettingen, Germany
| | - Georg Beyer
- Department of Medicine II, Ludwig Maximilians University Hospital, Munich, Germany
| | - Soeren M Buchholz
- Department of Gastroenterology, gastrointestinal Oncology and Endocrinology, University Medical Centre Goettingen, Goettingen, Germany
| | - Silke Cameron
- Department of Gastroenterology, gastrointestinal Oncology and Endocrinology, University Medical Centre Goettingen, Goettingen, Germany
| | - Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Centre, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Marko Damm
- Internal Medicine I, University Hospital Halle, Halle, Germany
| | - Linh Dang
- Department Medical Bioinformatics, University Medical Centre Goettingen, Goettingen, Germany
| | - Fabian Frost
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Antonio Gomes
- Department of General Surgery, Hospital Professor Doctor Fernando Fonseca, Amadora, Amadora, Portugal
| | - Jacob Hamm
- Department of Gastroenterology, gastrointestinal Oncology and Endocrinology, University Medical Centre Goettingen, Goettingen, Germany
| | - Robert Henker
- Medical Department II, Division of Gastroenterology, University Hospital Leipzig, Leipzig, Germany
| | - Albrecht Hoffmeister
- Medical Department II, Division of Gastroenterology, University Hospital Leipzig, Leipzig, Germany
| | - Christian Meinhardt
- University Clinic of Internal Medicine - Gastroenterology, University Hospital Oldenburg, Oldenburg, Germany
| | - Lukasz Nawacki
- Collegium Medicum, The Jan Kochanowski University in Kielce, Kielce, Poland
| | - Vitor Nunes
- Department of General Surgery, Hospital Professor Doctor Fernando Fonseca, Amadora, Amadora, Portugal
| | - Arpad Panyko
- 4th Department of Surgery, University Hospital Bratislava, Bratislava, Slovakia
| | - Cesareo Pardo
- Servicio de Aparato Digestivo, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Veit Phillip
- Department of Internal Medicine II, University Hospital rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Aldis Pukitis
- Center of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Sebastian Rasch
- Department of Internal Medicine II, University Hospital rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Diana Riekstina
- Center of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Ecaterina Rinja
- Clinical Emergency Hospital Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Simon Sirtl
- Department of Medicine II, Ludwig Maximilians University Hospital, Munich, Germany
| | - Mark Weingarten
- Department of Gastroenterology, gastrointestinal Oncology and Endocrinology, University Medical Centre Goettingen, Goettingen, Germany
| | - Vasile Sandru
- Clinical Emergency Hospital Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Julia Woitalla
- Department of Medicine II, University Hospital of Rostock, Rostock, Germany
| | - Volker Ellenrieder
- Department of Gastroenterology, gastrointestinal Oncology and Endocrinology, University Medical Centre Goettingen, Goettingen, Germany
| | - Albrecht Neesse
- Department of Gastroenterology, gastrointestinal Oncology and Endocrinology, University Medical Centre Goettingen, Goettingen, Germany
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Mao WJ, Zhou J, Zhang GF, Chen FX, Zhang JZ, Li BQ, Ke L, Li WQ. Early systemic anticoagulation reduces hospital readmission in acute necrotizing pancreatitis patients: A retrospective cohort study. Hepatobiliary Pancreat Dis Int 2024; 23:77-82. [PMID: 37087368 DOI: 10.1016/j.hbpd.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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 04/07/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Early systemic anticoagulation (SAC) is a common practice in acute necrotizing pancreatitis (ANP), and its impact on in-hospital clinical outcomes had been assessed. However, whether it affects long-term outcomes is unknown. This study aimed to evaluate the effect of SAC on 90-day readmission and other long-term outcomes in ANP patients. METHODS During January 2013 and December 2018, ANP patients admitted within 7 days from the onset of abdominal pain were screened. The primary outcome was 90-day readmission after discharge. Cox proportional-hazards regression model and mediation analysis were used to define the relationship between early SAC and 90-day readmission. RESULTS A total of 241 ANP patients were enrolled, of whom 143 received early SAC during their hospitalization and 98 did not. Patients who received early SAC experienced a lower incidence of splanchnic venous thrombosis (SVT) [risk ratio (RR) = 0.40, 95% CI: 0.26-0.60, P < 0.01] and lower 90-day readmission with an RR of 0.61 (95% CI: 0.41-0.91, P = 0.02) than those who did not. For the quality of life, patients who received early SAC had a significantly higher score in the subscale of vitality (P = 0.03) while the other subscales were all comparable between the two groups. Multivariable Cox regression model showed that early SAC was an independent protective factor for 90-day readmission after adjusting for potential confounders with a hazard ratio of 0.57 (95% CI: 0.34-0.96, P = 0.04). Mediation analysis showed that SVT mediated 37.0% of the early SAC-90-day readmission causality. CONCLUSIONS The application of early SAC may reduce the risk of 90-day readmission in the survivors of ANP patients, and reduced SVT incidence might be the primary contributor.
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Affiliation(s)
- Wen-Jian Mao
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China; Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - Jing Zhou
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China; Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - Guo-Fu Zhang
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China; Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - Fa-Xi Chen
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China; Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - Jing-Zhu Zhang
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China
| | - Bai-Qiang Li
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China; Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - Lu Ke
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China; Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China; National Institute of Healthcare Data Science, Nanjing University, Nanjing 210010, China
| | - Wei-Qin Li
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China; Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China; National Institute of Healthcare Data Science, Nanjing University, Nanjing 210010, China.
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7
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Shen Y, Hu C, Li L, Chen Z, Chen W, Lin Z, Zhu P, Tan Q, Huang W, Sun X, Deng L, Xia Q. What should be measured and reported in clinical trials for the treatment of patients with acute pancreatitis? A study protocol for establishing a core outcome set. BMJ Open 2023; 13:e075859. [PMID: 38070929 PMCID: PMC10729096 DOI: 10.1136/bmjopen-2023-075859] [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: 05/21/2023] [Accepted: 10/27/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Acute pancreatitis (AP) is characterised by inflammation of the exocrine pancreas, which potentially leads to local complications and organ failure resulting in significant morbidity and mortality. A long-term follow-up by an experienced team is needed. Currently, a variety of outcome measures are used in clinical trials for patients with AP. However, due to heterogeneous and selective outcome reporting across trials of interventions, it is hard to combine or compare the trial results compromising systematic evaluations of effectiveness and safety. A core outcome set is demanded to standardise reporting for the management of AP in clinical trials, so as to conduct systematic reviews and to improve the quality of the existing evidence base on the management of AP. We designed a study to establish a core outcome set (COS) on what indicators should be measured and reported in clinical trials of patients with AP (COS-AP). METHODS AND ANALYSIS This study protocol outlines the following five phases: Phase I will be a systematic review of randomised control trials and semistructured interviews with patients to initially establish a preliminary list of potential outcomes. Phase II will be the recruitment of key stakeholders' groups comprising experts in pancreatic disease, clinical researchers, methodologists, journal editors and patients. Phase III will be two rounds of the Delphi surveys with key stakeholder groups. Phase IV will be a consensus on the outcomes that should be included in a final COS-AP. Phase V will be dissemination of COS-AP. ETHICS AND DISSEMINATION Ethical approval for this study was obtained from the Biomedical Research Ethics Committee (BREC) of West China Hospital of Sichuan University (2020 No.691). The findings will be disseminated in peer-reviewed journals and meetings. TRIAL REGISTRATION This study was registered with Core Outcome Measures in Effectiveness Trials (COMET) database as study 2573.
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Affiliation(s)
- Yuxin Shen
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Chen Hu
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ling Li
- Chinese Evidence-Based Medicine Centre, Cochrane China Centre and MAGIC China Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhiyao Chen
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Weiwei Chen
- Department of Gastroenterology, Subei People's Hospital, Yangzhou University, Yangzhou, Jiangsu, China
| | - Ziqi Lin
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ping Zhu
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qingyuan Tan
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Wei Huang
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xin Sun
- Chinese Evidence-Based Medicine Centre, Cochrane China Centre and MAGIC China Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lihui Deng
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qing Xia
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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8
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Jeon CY, Adeniran E, Stewart C, Papachristou GI, Pisegna JR, Kuc AA, Buxbaum JL, Pandol SJ, Yadav D. Female patients delay seeking medical care with alcohol-associated acute pancreatitis. Pancreatology 2023; 23:761-766. [PMID: 37567847 DOI: 10.1016/j.pan.2023.08.001] [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: 06/13/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND/OBJECTIVE Alcohol consumption is increasing in women, who more frequently report abdominal symptoms compared to men. We aimed to examine differences in presentation of acute pancreatitis [AP] in male and female patients hospitalized with alcohol-associated AP. METHODS We analyzed 138 patients enrolled in an ongoing case-crossover study of alcohol-associated AP conducted across 5 medical centers in the U.S. Patients meeting the Revised Atlanta Classification of AP and who scored 3 or higher on the AUDIT-C instrument were invited to participate in the study and were interviewed while hospitalized with AP. Sex differences in the timing and type of pancreas-associated pain, alcohol consumption, clinical presentation, and quality of life were examined by Chi-squared tests, Wilcoxon rank sum tests and t-tests. RESULTS Female patients reported significantly longer interval from onset of pain to deciding to seek medical attention (median 40 h, interquartile range [IQR] 14, 74) as compared to males (14 h, IQR 4, 50; p = 0.005). While male patients were more likely to have been admitted to the intensive care unit [ICU] (21%) as compared to female patients (7%; p = 0.04), the incidence of SIRS or severe AP did not differ by sex. Quality of life measures as reported through the PROMIS-29 instrument were equally suboptimal in both sexes. Anxiety disorders were diagnosed more frequently among females (61%) than in males (41%, p = 0.009). CONCLUSION In a large case series of alcohol-associated AP, we found that female patients delayed seeking medical care compared to males. However, there were no differences in the type, location and intensity of abdominal pain.
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Affiliation(s)
- Christie Y Jeon
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
| | - Esther Adeniran
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Connor Stewart
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Georgios I Papachristou
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Joseph R Pisegna
- Division of Gastroenterology, Hepatology and Parenteral Nutrition, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Alma A Kuc
- Division of Gastroenterology, Hepatology and Parenteral Nutrition, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - James L Buxbaum
- Division of Gastroenterology, Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Stephen J Pandol
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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9
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Kee Jang D, Kyu Lee J, Yung Jung C, Ho Kim K, Ra Kang H, Sun Lee Y, Hwa Yoon J, Ro Joo K, Kyu Chae M, Hyeon Baek Y, Seo BK, Hyub Lee S, Lim C. Electroacupuncture for abdominal pain relief in patients with acute pancreatitis: A three-arm randomized controlled trial. JOURNAL OF INTEGRATIVE MEDICINE 2023; 21:537-542. [PMID: 37973472 DOI: 10.1016/j.joim.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/07/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Electroacupuncture (EA) may reduce the severity of acute pancreatitis (AP) and provide additional pain relief in patients with chronic pancreatitis. However, the ability of EA to relieve pain in patients with AP has not been well documented. OBJECTIVE This study was undertaken to compare the pain-relieving effects of EA and conventional treatment in patients with AP. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS This study was conducted using a randomized, controlled, three-arm, parallel-group and multi-center design. Patients diagnosed with AP were randomly and equally assigned to EA1, EA2 or control groups. All participants received conventional standard-of-care therapy for AP. Local EA alone was administered in EA1, and local plus distal EA was given in EA2. Local EA included two abdominal acupoints, while distal EA included twelve peripheral acupoints. EA groups underwent one session of EA daily for 4 days (days 1-4), or until pain was resolved or discharged. MAIN OUTCOME MEASURES The primary outcome measure was the change in the visual analogue scale (VAS; 0-100) pain score between baseline and day 5. RESULTS Eighty-nine participants were randomized into EA1, EA2 and control groups, and 88 (EA1, 30; EA2, 29; control, 29) were included in the full-analysis set. VAS score change (median [interquartile range]) on day 5 was (12.3 ± 22.5) in the EA1 group, (10.3 ± 21.5) in the EA2 group, and (8.9 ± 15.2) in the control group. There were not significant differences in the change in VAS score among treatments (P = 0.983). However, time to food intake was significantly shorter in the EA group (EA1 + EA2) than in the control group (median 2.0 days vs 3.0 days), with a hazard ratio of 0.581 (P = 0.022; 95% CI, 0.366-0.924). No significant adverse events occurred. CONCLUSION EA treatment did not significantly reduce pain after 4 days of treatment in patients with AP-associated abdominal pain but significantly reduced time to first food intake. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT03173222. Please cite this article as: Jang DK, Lee JK, Jung CY, Kim KH, Kang HR, Lee YS, Yoon JH, Joo KR, Chae MK, Baek YH, Seo BK, Lee SH, Lim C. Electroacupuncture for abdominal pain relief in patients with acute pancreatitis: A three-arm randomized controlled trial. J Integr Med. 2023; 21(6): 537-542.
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Affiliation(s)
- Dong Kee Jang
- Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Republic of Korea
| | - Jun Kyu Lee
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Republic of Korea.
| | - Chan Yung Jung
- Department of Acupuncture and Moxibustion, Dongguk University Ilsan Oriental Hospital, College of Korean Medicine, Dongguk University, Goyang 10326, Republic of Korea
| | - Kyung Ho Kim
- Department of Acupuncture and Moxibustion, Dongguk University Ilsan Oriental Hospital, College of Korean Medicine, Dongguk University, Goyang 10326, Republic of Korea
| | - Ha Ra Kang
- Department of Korean Medicine, Dongguk University, Goyang 10326, Republic of Korea
| | - Yeon Sun Lee
- Department of Korean Medicine, Dongguk University, Goyang 10326, Republic of Korea
| | - Jong Hwa Yoon
- Department of Acupuncture and Moxibustion, College of Korean Medicine, Dongguk University, Gyeongju 38067, Republic of Korea
| | - Kwang Ro Joo
- Department of Gastroenterology, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
| | - Min Kyu Chae
- Department of Gastroenterology, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
| | - Yong Hyeon Baek
- Department of Acupuncture and Moxibustion, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul 05278, Republic of Korea
| | - Byung-Kwan Seo
- Department of Acupuncture and Moxibustion, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul 05278, Republic of Korea
| | - Sang Hyub Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Chiyeon Lim
- Department of Biostatistics, College of Medicine, Dongguk University, Goyang 10326, Republic of Korea
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10
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Farquhar R, Matthews S, Baxter N, Rayers G, Ratnayake CBB, Robertson FP, Nandhra S, Lim WB, Witham M, Pandanaboyana S. Sarcopenia and Sarcopenic Obesity on Body Composition Analysis is a Significant Predictor of Mortality in Severe Acute Pancreatitis: A Longitudinal Observational Study. World J Surg 2023; 47:2825-2833. [PMID: 37541981 PMCID: PMC10545625 DOI: 10.1007/s00268-023-07122-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND The prevalence and impact of sarcopenia and sarcopenic obesity noted on body composition analysis in severe acute pancreatitis (SAP) is unknown. This study investigates the prevalence of sarcopenia at different timepoints and its effect on post-pancreatitis complications and mortality. METHODS A prospective database of SAP admissions with organ failure at a single institution from 2015 to 2019 were analysed. Sarcopenia was determined by IMAGE J software on CT. Database was further queried for post-pancreatitis complications and mortality. RESULTS 141 patients with a median age of 59 (range 18-88) and M:F ratio 1.52:1 of were analysed. Sarcopenia was present in 111/141 (79%) patients at admission, 78/79 (99%) at 3 months and 26/36 (72%) at 12 months. 67/111 patients with sarcopenia on admission had sarcopenic obesity. The mortality at 30 days, 3 months and 12 months was 16/141 (11%), 30/141 (21%) and 42/141 (30%) respectively. Mortality was significantly higher in sarcopenic patients at admission (35.14%) compared to the non-sarcopenic group (10%), P = 0.008). Mortality in the sarcopenic obesity group was significantly higher (45%) compared to the sarcopenic non-obese group (20%), P = 0.009) at admission. Multivariate logistic regression identified sarcopenic obesity (OR: 2.880), age (OR: 1.048) and number of organ failures (OR: 3.225) as significant predictors of mortality. CONCLUSIONS Sarcopenia and Sarcopenic obesity are highly prevalent in SAP patients on admission and during follow up. Furthermore, sarcopenic obesity was shown to be a significant predictor of mortality at admission, suggesting that body composition analysis could be a potential predictive marker of mortality in SAP patients.
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Affiliation(s)
- Robert Farquhar
- School of Medical Education, Newcastle University, Newcastle Upon Tyne, UK.
| | - Scott Matthews
- Department of Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Nesta Baxter
- School of Medical Education, Newcastle University, Newcastle Upon Tyne, UK
| | - George Rayers
- School of Medical Education, Newcastle University, Newcastle Upon Tyne, UK
| | | | | | - Sandip Nandhra
- HPB and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Wei Boon Lim
- School of Medical Education, Newcastle University, Newcastle Upon Tyne, UK
| | - Miles Witham
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Sanjay Pandanaboyana
- HPB and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
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11
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Giorga A, Hughes M, Parker S, Smith A, Young A. Quality of life after severe acute pancreatitis: systematic review. BJS Open 2023; 7:zrad067. [PMID: 37619216 PMCID: PMC10449419 DOI: 10.1093/bjsopen/zrad067] [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: 08/12/2022] [Revised: 04/13/2023] [Accepted: 05/14/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Severe acute pancreatitis, the most severe form of acute pancreatitis, can alter pancreatic morphology, physiology, and function resulting in long-term morbidity, even after a single episode. This review assesses long-term outcomes and quality of life of severe acute pancreatitis. METHODS A comprehensive literature review was conducted across MEDLINE, Embase, Scopus, and PubMed electronic databases on 18 January 2021 and updated on 26 April 2022 to ensure no new literature had been omitted. All studies were prospective or retrospective, included adult patients (>18 years) presenting with acute pancreatitis for whom data on long-term outcomes specifically after severe acute pancreatitis were reported. Quantitative and qualitative data extraction and synthesis were carried out and no meta-analysis was performed. Outcome measures included aetiology and mortality of severe acute pancreatitis, length of stay, endocrine and exocrine pancreatic insufficiency, chronic symptoms, and quality of life compared with healthy controls as assessed by validated questionnaires. RESULTS Fourteen retrospective cohort studies were included, for a total of 779 patients, using quality of life questionnaires. The most common aetiology of severe acute pancreatitis was biliary (36 per cent) followed by alcoholic (29 per cent). Mortality rate ranged from 5 to 35 per cent and length of stay ranged from 2 to 367 days. Quality of life was somewhat lower in patients with exocrine insufficiency, but unaffected by endocrine insufficiency or chronic symptoms. Quality of life was more likely to be reduced in the first 4 years but normalize thereafter and was more likely to be negatively affected where alcohol was the aetiology. In four studies, the relationship between disease severity and lower quality of life was investigated, and a significant correlation was found. CONCLUSION The review shows how a single episode of severe acute pancreatitis can have a variable effect on long-term quality of life, which is different to previous studies showing a strong reduction in quality of life. This could indicate that in current times treatment modalities are more effective.
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Affiliation(s)
- Andrea Giorga
- Department of Pancreatic Surgery, St James's University Hospital, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Michael Hughes
- Department of Pancreatic Surgery, St James's University Hospital, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Simon Parker
- Organisational Behaviour and Human Resource Management, Nottingham University Business School, UK
| | - Andrew Smith
- Department of Pancreatic Surgery, St James's University Hospital, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Alistair Young
- Department of Pancreatic Surgery, St James's University Hospital, Leeds Teaching Hospitals Trust, Leeds, UK
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12
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Wang X, Zhan W, Huang L, Guo Y, Wang Y, Tan H, Wang L. The effect of anxiety and depression on the health-related quality of life of severe acute pancreatitis survivors: structural equation modeling approach. Front Psychiatry 2023; 14:1160807. [PMID: 37200902 PMCID: PMC10185751 DOI: 10.3389/fpsyt.2023.1160807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/17/2023] [Indexed: 05/20/2023] Open
Abstract
Background Understanding the relationship between anxiety, depression and health-related quality of life (HRQOL) provides important clues to alleviate anxiety, depression and improve HRQOL in patients after severe acute pancreatitis (SAP). The aim of this study was to examine the effects of anxiety and depression on HRQOL in post-SAP patients using structural equation modeling. Methods A cross-sectional study design was used and 134 patients with SAP from the Affiliated Hospital of Zunyi Medical University were recruited. Data collected included demographic and clinical characteristics, the English Standard Short Form 36 (SF-36) Health Survey, The Self-rating Anxiety Scale (SAS) and The Self-rating Depression Scale (SDS). Structural equation modeling analysis was conducted using the AMOS 24.0 program. Results The mean of HRQOL score was 49.42 (SD = 23.01). The prevalence of anxiety and depression in post-SAP patients was 33.6 and 34.3%, respectively. Both anxiety and depression have a direct negative impact on HRQOL (β = -0.360, p < 0.001; β = -0.202, p = 0.034). Anxiety also negatively affects HRQOL indirectly through depression (β = -0.118, p = 0.043). The analysis of the covariance structure revealed that the resulting model had a reasonable goodness of fit. Conclusion Anxiety and depression reduce the quality of life of SAP patients during recovery. Regular assessment and management of the anxiety and depression status of SAP patients is necessary and will help them improve their HRQOL more effectively.
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Affiliation(s)
- Xueting Wang
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Critical Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Nursing College, Zunyi Medical University, Zunyi, China
| | - Weili Zhan
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Critical Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Nursing College, Zunyi Medical University, Zunyi, China
| | - Ling Huang
- Department of Critical Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yunmei Guo
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yousha Wang
- Nursing College, Zunyi Medical University, Zunyi, China
| | - Huiwen Tan
- Nursing College, Zunyi Medical University, Zunyi, China
| | - Lianhong Wang
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Nursing College, Zunyi Medical University, Zunyi, China
- *Correspondence: Lianhong Wang,
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13
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Szatmary P, Grammatikopoulos T, Cai W, Huang W, Mukherjee R, Halloran C, Beyer G, Sutton R. Acute Pancreatitis: Diagnosis and Treatment. Drugs 2022; 82:1251-1276. [PMID: 36074322 PMCID: PMC9454414 DOI: 10.1007/s40265-022-01766-4] [Citation(s) in RCA: 88] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 11/11/2022]
Abstract
Acute pancreatitis is a common indication for hospital admission, increasing in incidence, including in children, pregnancy and the elderly. Moderately severe acute pancreatitis with fluid and/or necrotic collections causes substantial morbidity, and severe disease with persistent organ failure causes significant mortality. The diagnosis requires two of upper abdominal pain, amylase/lipase ≥ 3 ×upper limit of normal, and/or cross-sectional imaging findings. Gallstones and ethanol predominate while hypertriglyceridaemia and drugs are notable among many causes. Serum triglycerides, full blood count, renal and liver function tests, glucose, calcium, transabdominal ultrasound, and chest imaging are indicated, with abdominal cross-sectional imaging if there is diagnostic uncertainty. Subsequent imaging is undertaken to detect complications, for example, if C-reactive protein exceeds 150 mg/L, or rarer aetiologies. Pancreatic intracellular calcium overload, mitochondrial impairment, and inflammatory responses are critical in pathogenesis, targeted in current treatment trials, which are crucially important as there is no internationally licenced drug to treat acute pancreatitis and prevent complications. Initial priorities are intravenous fluid resuscitation, analgesia, and enteral nutrition, and when necessary, critical care and organ support, parenteral nutrition, antibiotics, pancreatic exocrine and endocrine replacement therapy; all may have adverse effects. Patients with local complications should be referred to specialist tertiary centres to guide further management, which may include drainage and/or necrosectomy. The impact of acute pancreatitis can be devastating, so prevention or reduction of the risk of recurrence and progression to chronic pancreatitis with an increased risk of pancreas cancer requires proactive management that should be long term for some patients.
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Affiliation(s)
- Peter Szatmary
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Tassos Grammatikopoulos
- Paediatric Liver, GI and Nutrition Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Wenhao Cai
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,West China Centre of Excellence for Pancreatitis and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Huang
- West China Centre of Excellence for Pancreatitis and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Rajarshi Mukherjee
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Department of Molecular Physiology and Cell Signalling, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool , UK
| | - Chris Halloran
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Georg Beyer
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Robert Sutton
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK. .,Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK. .,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
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14
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A "tailored" interventional and surgical management for moderate to critical acute pancreatitis in late phase: a cohort study. Langenbecks Arch Surg 2022; 407:2833-2841. [PMID: 35639137 DOI: 10.1007/s00423-022-02557-x] [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: 07/16/2021] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Several interventional procedures are available to treat moderate-to-critical acute pancreatitis (AP) in its late phase. The ongoing debate on these options, together with the scarcity of reported quality of life (QoL) information in the Literature, prompted us to conduct a review of our experience. METHODS All the patients treated at our referral Center for moderate-to-critical AP according to Determinant-Based Classification (DBC) were retrospectively reviewed. Patients treated conservatively or operated within 4 weeks were excluded. The included patients were managed following a "tailored" interventional-surgical approach, which did not exclude the possibility to skip one or more steps of the classic "step-up" approach, based on the patient's clinical course, and divided into four groups, according to the first procedure performed: percutaneous drainage (PD), endoscopic approach (END), internal derivation (INT), and necrosectomy (NE). In-hospital and mid-term follow-up variables were analyzed. RESULTS The study sample consisted in 47 patients: 11 patients were treated by PD, 11 by END, 13 by INT, and 12 by NE. A significant distribution of the DBC severity (p = 0.029) was registered among the four groups. Moreover, the NE group had statistically significant reduced SF-36 scores in the domain of social functioning at 3 months (p = 0.011), at 1 year (p = 0.002), and at 2 years (p = 0.001); role limitations due to physical health at 6 months (p = 0.027); and role limitations due to emotional problems at 1 year (p = 0.020). CONCLUSIONS In the "late phase" of moderate to critical AP requiring an invasive management, PD, END, INT, and NE are all effective options, depending on patents' status and necrosis location. A "tailored" interventional-surgical management could be pursued, but up-front more invasive approaches are at higher risk of worse QoL. TRIAL REGISTRATION The manuscript was registered at clinicaltrials.gov in 04/2021 and identified with NCT04870268.
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15
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Tham SW, Wang F, Gariepy CE, Cress GA, Abu-El-Haija MA, Bellin MD, Ellery KM, Fishman DS, Gonska T, Heyman MB, Lin TK, Maqbool A, McFerron BA, Morinville VD, Nathan JD, Ooi CY, Perito ER, Schwarzenberg SJ, Sellers ZM, Shah U, Troendle DM, Wilschanski M, Zheng Y, Yuan Y, Lowe ME, Uc A, Palermo TM. Health-Related Quality of Life in Pediatric Acute Recurrent or Chronic Pancreatitis: Association With Biopsychosocial Risk Factors. J Pediatr Gastroenterol Nutr 2022; 74:636-642. [PMID: 35192575 PMCID: PMC9117452 DOI: 10.1097/mpg.0000000000003420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Abdominal pain, emergency department visits, and hospitalizations impact lives of children with acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP). Data on health-related quality of life (HRQOL) in this population, however, remains limited. We aimed to evaluate HRQOL in children with ARP or CP; and test biopsychosocial risk factors associated with low HRQOL. METHODS Data were acquired from the INternational Study Group of Pediatric Pancreatitis: In search for a cuRE registry. Baseline demographic and clinical questionnaires, the Child Health Questionnaire (measures HRQOL) and Child Behavior Checklist (measures emotional and behavioral functioning) were completed at enrollment. RESULTS The sample included 368 children (54.3% girls, mean age = 12.7years, standard deviation [SD] = 3.3); 65.2% had ARP and 34.8% with CP. Low physical HRQOL (M = 38.5, SD = 16.0) was demonstrated while psychosocial HRQOL (M = 49.5, SD = 10.2) was in the normative range. Multivariate regression analysis revealed that clinical levels of emotional and behavioral problems (B = -10.28, P < 0.001), episodic and constant abdominal pain (B = 04.66, P = 0.03; B = -13.25, P < 0.001) were associated with low physical HRQOL, after accounting for ARP/CP status, age, sex, exocrine, and endocrine disease (F [9, 271] = 8.34, P < 0.001). Borderline and clinical levels of emotional and behavioral problems (B = -10.18, P < 0.001; B = -15.98, P < 0.001), and constant pain (B = -4.46, P < 0.001) were associated with low psychosocial HRQOL (F [9, 271] = 17.18, P < 0.001). CONCLUSIONS Findings highlight the importance of assessing HRQOL and treating pain and psychosocial problems in this vulnerable group of children.
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Affiliation(s)
- See Wan Tham
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA
| | - Fuchenchu Wang
- The University of Texas, MD Anderson Cancer Center, Houston, TX
| | | | - Gretchen A Cress
- University of Iowa, Stead Family Children's Hospital, Iowa City, IA
| | - Maisam A Abu-El-Haija
- Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Melena D Bellin
- University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Kate M Ellery
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Douglas S Fishman
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | | | | | - Tom K Lin
- Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Asim Maqbool
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Brian A McFerron
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | | | | | - Chee Y Ooi
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales and Department of Gastroenterology, Sydney Children's Hospital Randwick, Sydney, NSW, Australia
| | - Emily R Perito
- University of California San Francisco, San Francisco, CA
| | | | | | - Uzma Shah
- Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA
| | | | | | - Yuhua Zheng
- Children's Hospital Los Angeles, Los Angeles, CA
| | - Ying Yuan
- The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Mark E Lowe
- Washington University School of Medicine, St. Louis, MO
| | - Aliye Uc
- University of Iowa, Stead Family Children's Hospital, Iowa City, IA
| | - Tonya M Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA
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16
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Phillips ME, Smith N, McPherson S, O'Reilly DA. Nutritional assessment and management in acute pancreatitis: Ongoing lessons of the NCEPOD report. J Hum Nutr Diet 2021; 35:504-511. [PMID: 34905277 DOI: 10.1111/jhn.12968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/14/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Acute pancreatitis (AP) is a medical emergency that is common, poorly understood and carries a significant risk of death. The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) undertook a comprehensive report into the current management of AP in the UK. The study aimed to provide a more detailed analysis of the findings related to nutritional assessment and support. METHODS The data presented here were analysed from the core dataset used in the NCEPOD study. Adult patients admitted between January and June 2014 with a coded diagnosis of AP were included. A clinical and organisational questionnaire was used to collect data and submitted case notes subjected to peer review. Nutritional data, including assessment and provision of support, were analysed. RESULTS One hundred and forty-seven out of 168 (87.5%) hospitals had a nutrition team in place. A screening nutritional assessment was performed in only 67.4% (368/546) of patients. Subsequent referral to a dietitian and nutrition team input occurred in 39% (201/521) and 25% (143/572) of patients, respectively. Supplemental nutrition was considered and used in 240/555 (43.2%) patients. Overall management of the patients' nutrition was considered adequate by the case reviewers in only 281/332 (85%) of cases and by the clinicians in 77% (421/555) of cases. CONCLUSIONS Many patients do not receive adequate nutritional assessment and, in up to 23% of cases, nutritional intervention is not adequate. Pancreatic exocrine insufficiency is likely under recognised and undertreated. Nutritional strategies to support early intervention and to support clinicians outside of tertiary pancreatic centres are warranted.
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Affiliation(s)
- Mary E Phillips
- Department of Nutrition and Dietetics, Royal Surrey County Hospital, Guildford, UK.,Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Neil Smith
- National Confidential Enquiry into Patient Outcome and Death (NCEPOD), London, UK
| | - Simon McPherson
- National Confidential Enquiry into Patient Outcome and Death (NCEPOD), London, UK.,Department of Interventional Radiology, Leeds General Infirmary, Leeds, UK
| | - Derek A O'Reilly
- National Confidential Enquiry into Patient Outcome and Death (NCEPOD), London, UK.,Department of Surgery, Manchester Royal Infirmary, Manchester, UK
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Zelga P, Rees J, Iaculli E, Johnson C, Jah A. Patient-reported outcomes after minimally invasive retroperitoneal pancreatic necrosectomy to treat acute pancreatitis: An exploratory study. J Dig Dis 2021; 22:604-614. [PMID: 34331420 DOI: 10.1111/1751-2980.13036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/27/2021] [Accepted: 07/28/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study (abbreviated as QUANTUM) was to assess the quality of life (QoL) of patients who underwent minimally invasive retroperitoneal pancreatic necrosectomy (MIRPN) for acute pancreatic necrosis with or without infection of necrotic tissue collections after discharge and to compare the patient-reported outcomes (PRO) in these patients with published data in normative population. METHODS Patients with acute pancreatitis who underwent MIRPN between January 2010 and December 2016 were identified and invited to complete the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and EORTC PAN28(CP) questionnaires. PRO were compared using Pearson correlation coefficient and ANOVA (significance P < 0.01) with an age- and sex-matched normative population of western Europe, stratified by age, and also the time duration after MIRPN (<3 y and >3 y). A change >15 points in the PRO score was taken as clinically important. RESULTS Among 52 eligible patients identified, 46 (88%) agreed to participate, 74% returned questionnaires. After the MIRPN all patients had worse physical and social functioning scores with a clinically important (>15 points) reduction in those ≤50 years; while fatigue, pain and insomnia symptom scales had the highest scores (42, 26 and 30 points, respectively). Patients <3 years after MIRPN had similar scores for all functional scales and global health-related quality of life (HRQoL) compared to the normative population. However, over time their global HRQoL deteriorated and after 3 years their scores for functioning and symptoms were statistically (P < 0.0001) and clinically (>15 points) worse than those in age-matched controls. CONCLUSIONS During the first 3 years after the MIRPN patients have a relatively high QoL but report worse fatigue than the normative population. However, patients should be informed that their HRQoL deteriorates with time, often due to chronic pancreatitis and pancreatic insufficiency. This study supports the use of MIRPN and prospective studies of HRQoL in this setting are indicated.
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Affiliation(s)
- Piotr Zelga
- Cambridge Hepatobiliary and Transplant Unit, Addenbrookes Hospital and University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jonathan Rees
- Centre for Surgical Research, Population Health Sciences, University of Bristol, Bristol, UK
| | - Edoardo Iaculli
- Cambridge Hepatobiliary and Transplant Unit, Addenbrookes Hospital and University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Colin Johnson
- Surgical Unit, University Hospital Southampton, University of Southampton, Southampton, UK
| | - Asif Jah
- Cambridge Hepatobiliary and Transplant Unit, Addenbrookes Hospital and University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Abstract
INTRODUCTION Future burden has been modeled from population-based data for several common gastrointestinal diseases. However, as we enter the third decade in the 21st century, there are no such data on diseases of the pancreas holistically. The study aimed to estimate future incidence of pancreatitis, pancreatic cancer, diabetes of the exocrine pancreas (DEP), and exocrine pancreatic dysfunction (EPD) as well as years of life lost (YLL) due to premature death in individuals with those diseases up to 2050. METHODS Historical New Zealand nationwide data on hospital discharge, pharmaceutical dispensing, cancer, and mortality were obtained. Annual incidence of each disease and annual YLLs due to premature death in individuals with each disease were calculated. A time series analysis using the stepwise autoregressive method was conducted. RESULTS Pancreatitis yielded the highest projected incidence (123.7 per 100,000; 95% confidence interval, 116.7-130.7) and YLL (14,709 years; 13,642-15,777) in 2050. The projected incidence and YLL of pancreatic cancer were 18.6 per 100,000 (95% confidence interval, 13.1-24.1) and 14,247 years (11,349-17,144) in 2050, respectively. Compared with pancreatitis and pancreatic cancer, DEP and EPD yielded lower but more steeply increasing projected incidence rates and YLLs. DISCUSSION The findings suggest that the burden of pancreatitis, pancreatic cancer, DEP, and EPD will rise in the next 3 decades unless healthcare systems introduce effective prevention or early treatment strategies for diseases of the pancreas and their sequelae.
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19
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Phillips ME, Hopper AD, Leeds JS, Roberts KJ, McGeeney L, Duggan SN, Kumar R. Consensus for the management of pancreatic exocrine insufficiency: UK practical guidelines. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000643. [PMID: 34140324 PMCID: PMC8212181 DOI: 10.1136/bmjgast-2021-000643] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/08/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Pancreatic exocrine insufficiency is a finding in many conditions, predominantly affecting those with chronic pancreatitis, pancreatic cancer and acute necrotising pancreatitis. Patients with pancreatic exocrine insufficiency can experience gastrointestinal symptoms, maldigestion, malnutrition and adverse effects on quality of life and even survival.There is a need for readily accessible, pragmatic advice for healthcare professionals on the management of pancreatic exocrine insufficiency. METHODS AND ANALYSIS A review of the literature was conducted by a multidisciplinary panel of experts in pancreatology, and recommendations for clinical practice were produced and the strength of the evidence graded. Consensus voting by 48 pancreatic specialists from across the UK took place at the 2019 Annual Meeting of the Pancreatic Society of Great Britain and Ireland annual scientific meeting. RESULTS Recommendations for clinical practice in the diagnosis, initial management, patient education and long term follow up were developed. All recommendations achieved over 85% consensus and are included within these comprehensive guidelines.
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Affiliation(s)
- Mary E Phillips
- Nutrition and Dietetics, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Andrew D Hopper
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - John S Leeds
- HPB Unit, Freeman Hospital, Newcastle Upon Tyne, Tyne and Wear, UK
| | - Keith J Roberts
- HPB Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Laura McGeeney
- Nutrition and Dietetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sinead N Duggan
- Department of Surgery, Trinity College Dublin, Dublin, Ireland
| | - Rajesh Kumar
- HPB Surgery, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
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20
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Yu S, Xiong Y, Fu Y, Chen G, Zhu H, Mo X, Wu D, Xu J. Shotgun metagenomics reveals significant gut microbiome features in different grades of acute pancreatitis. Microb Pathog 2021; 154:104849. [PMID: 33781869 DOI: 10.1016/j.micpath.2021.104849] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acute pancreatitis (AP) has a broad spectrum of severity and is associated with considerable morbidity and mortality. Dysbiosis of gut microbiota may be associated with AP severity. AIMS We aimed to evaluate the composition and functional effects of gut microbiota in different grades of AP severity. METHODS We carried out shotgun metagenomic sequencing on rectal swab samples from three patients with mild acute pancreatitis (MAP), three with moderately severe acute pancreatitis (MSAP), three with severe acute pancreatitis (SAP) and three normal control persons (NOR). Differences analysis in gut microbiota composition and functional enrichment was performed. RESULTS Gut microbiota in AP patients was characterized by decreased species richness. The most representative gut microbiota in mild acute pancreatitis (MAP), moderately severe acute pancreatitis (MSAP), and severe acute pancreatitis (SAP) was Streptococcus, Escherichia-coli, and Enterococcus, respectively. Each of the three AP-associated genera could differentiate AP from healthy control population. Representative pathways associated with the glutathione metabolism, lipopolysaccharide biosynthesis, and amino acid metabolism (valine, leucine and isoleucine degradation) were enriched in MAP, MSAP, and SAP, respectively. CONCLUSIONS The study shows a potential association of gut microbiome composition and function to the progression of AP severity.
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Affiliation(s)
- Shanshan Yu
- Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yangyang Xiong
- Department of Gastroenterology, National Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yangyang Fu
- Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Guorong Chen
- Department of Gastroenterology, National Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Huadong Zhu
- Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xun Mo
- Department of Intensive Care Unit, The Second People's Hospital of Guiyang, Guiyang, 550004, China
| | - Dong Wu
- Department of Gastroenterology, National Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China; Clinical Epidemiology Unit, International Clinical Epidemiology Network, Beijing, 100730, China.
| | - Jun Xu
- Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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Paragomi P, Phillips AE, Machicado JD, Lahooti A, Kamal A, Afghani E, Pothoulakis I, Reynolds SL, Mays M, Conwell DL, Lara LF, Singh VK, Papachristou GI. Post-Acute Pancreatitis Pancreatic Exocrine Insufficiency: Rationale and Methodology of a Prospective, Observational, Multicenter Cohort Study. Pancreas 2021; 50:147-152. [PMID: 33565790 PMCID: PMC9194920 DOI: 10.1097/mpa.0000000000001743] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES We describe the methodology of Post-Acute Pancreatitis Pancreatic Exocrine Insufficiency (PAPPEI), a prospective, observational, multicenter cohort study. The objectives of PAPPEI are to estimate the incidence rate of post-acute pancreatitis (AP) pancreatic exocrine insufficiency (PEI), define factors that determine the development of post-AP PEI, and evaluate the impact of post-AP PEI on nutritional status and quality of life. METHODS Enrollment started in June 2017 in 3 expert academic centers in the United States. Data were collected during hospitalization (baseline) at 3 and 12 months after enrollment. Fecal elastase-1 was used to assess PEI. Study questionnaires are completed by patient interview and review of electronic medical records. Blood is obtained to evaluate vitamin deficiencies and nutritional markers. RESULTS As of August 2020, 77 subjects have completed the baseline evaluation. The median age was 58 years (interquartile range, 39-67 years), 38% were male, and 90% were white. The etiology of AP was biliary in 39 subjects (51%), and 51 subjects (66%) had mild AP. Three- and 12-month follow-up data have been collected in 29 and 13 subjects, respectively. CONCLUSION The PAPPEI study aims to expand our understanding of post-AP PEI incidence, including its impact on nutritional status and quality of life.
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Affiliation(s)
- Pedram Paragomi
- Division of Gastroenterology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Anna Evans Phillips
- Division of Gastroenterology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jorge D. Machicado
- Department of Gastroenterology, Mayo Clinic Heath System, Eau Claire, WI
| | - Ali Lahooti
- Division of Gastroenterology, Hepatology, & Nutrition, Department of Internal Medicine, Ohio State University, Wexner Medical Center, Columbus, OH
| | - Ayesha Kamal
- Division of Gastroenterology, Department of Medicine, John Hopkins Medical Institutions, Baltimore, MD
| | - Elham Afghani
- Division of Gastroenterology, Department of Medicine, John Hopkins Medical Institutions, Baltimore, MD
| | - Ioannis Pothoulakis
- Department of Medicine, MedStar Washington Hospital Center, Washington, DC
- Division of Gastroenterology, Department of Medicine, Hepatology and Nutrition, University of Pittsburgh and UPMC, Pittsburgh, PA
| | - Shari L. Reynolds
- Division of Gastroenterology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Melanie Mays
- Division of Gastroenterology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Darwin L. Conwell
- Division of Gastroenterology, Hepatology, & Nutrition, Department of Internal Medicine, Ohio State University, Wexner Medical Center, Columbus, OH
| | - Luis F. Lara
- Division of Gastroenterology, Hepatology, & Nutrition, Department of Internal Medicine, Ohio State University, Wexner Medical Center, Columbus, OH
| | - Vikesh K. Singh
- Division of Gastroenterology, Department of Medicine, John Hopkins Medical Institutions, Baltimore, MD
| | - Georgios I. Papachristou
- Division of Gastroenterology, Hepatology, & Nutrition, Department of Internal Medicine, Ohio State University, Wexner Medical Center, Columbus, OH
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Stuart CE, Ko J, Alarcon Ramos GC, Modesto AE, Cho J, Petrov MS. Associations Between Cannabis Use, Abdominal Fat Phenotypes and Insulin Traits. J Clin Med Res 2020; 12:377-388. [PMID: 32587654 PMCID: PMC7295553 DOI: 10.14740/jocmr4165] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/04/2020] [Indexed: 02/06/2023] Open
Abstract
Background General obesity has been linked to dysregulation of the endocannabinoid system in humans. However, there is a lack of studies on the relationship between cannabis use and specific abdominal fat phenotypes. The aim was to investigate the associations between cannabis use and magnetic resonance imaging-derived fat phenotypes, as well as indices of insulin sensitivity and insulin secretion. Methods In this cross-sectional study, magnetic resonance imaging was used to quantify subcutaneous fat volume (SFV), visceral fat volume (VFV), intra-hepatic fat deposition (IHFD), intra-pancreatic fat deposition (IPFD) and skeletal muscle fat deposition (SMFD) by two independent observers. Insulin sensitivity was determined based on HOMA-IS, Raynaud index and Matsuda index, whereas insulin secretion was determined based on HOMA-β, insulinogenic index 30’ and insulinogenic index 60’. A validated questionnaire was used to ascertain participants’ cannabis use. Linear regression models were constructed, adjusting for demographics, glycated hemoglobin, physical activity, tobacco smoking and alcohol consumption. Results A total of 120 individuals were included. Cannabis use explained 9.2% of variance in IHFD, 4.4% in SMFD, 3.4% in VFV, 0.4% in SFV and 0.2% in IPFD. Regular cannabis users had significantly greater IHFD compared with never users, in both the unadjusted (P = 0.002) and all adjusted (P = 0.002; P = 0.008) analyses. The other fat phenotypes did not differ significantly between either regular or non-regular users compared with never users. Regular cannabis users had significantly greater insulin secretion (as defined by the insulinogenic index 60’) compared with never users, in both the unadjusted (P = 0.049) and all adjusted (P = 0.003; P = 0.004) analyses. Cannabis use explained 20.3% of variance in the insulinogenic index 60’, but was not significantly associated with the other indices of insulin secretion. There were no significant differences in indices of insulin sensitivity in either regular or non-regular cannabis users compared with never users. Conclusion Regular cannabis use may be a risk factor for non-alcoholic fatty liver disease (but not IPFD) and may alter the neuromodulation of insulin secretion. Further investigations are now warranted to elucidate the mechanisms underlying these associations.
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Affiliation(s)
| | - Juyeon Ko
- School of Medicine, University of Auckland, Auckland, New Zealand
| | | | - Andre E Modesto
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Jaelim Cho
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Maxim S Petrov
- School of Medicine, University of Auckland, Auckland, New Zealand
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Li Y, Zhang J, Zou J. Evaluation of four scoring systems in prognostication of acute pancreatitis for elderly patients. BMC Gastroenterol 2020; 20:165. [PMID: 32487074 PMCID: PMC7268671 DOI: 10.1186/s12876-020-01318-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/25/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To evaluate the ability of four scoring systems (Ranson, BISAP, Glasgow, and APACHE II) to predict outcomes of acute pancreatitis (AP) in elderly patients. METHODS This was a retrospective study of 918 patients presenting with AP at Zhongda Hospital Southeast University, from January 2015 to December 2018. We divided patients into two groups: 368 patients who were ≥ 60 years old, and 550 patients who were < 60 years old. Four scoring systems were used to analyze all patients. RESULTS The severity of the disease, and mortality were significantly different between the two groups (p < 0.05), while the difference between the two groups about pancreatic necrosis is statistically insignificant (p = 0.399). The differences of the AUCs (Area under curves) for prediction of outcome of SAP (severe acute pancreatitis) between the two groups were statistically significant for Ranson and APACHE II (p < 0.05), but not for the differences between BISAP and Glasgow. All the four scoring systems were similar in terms of prediction of pancreatic necrosis and death in both groups. CONCLUSIONS Prediction of severity, pancreatic necrosis, and death in AP for elderly patients can be performed very well by using BISAP. APACHE II is more suitable for younger patients when dealing with severity. Ranson and Glasgow can be used to evaluate all AP patients in most cases; however, Ranson is more effective for younger patients when used to assess severity.
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Affiliation(s)
- Yajie Li
- Geriatrics Department, Zhongda Hospital Southeast University, No.87, Dingjiaqiao, Nanjing, China.
| | - Jun Zhang
- Geriatrics Department, Zhongda Hospital Southeast University, No.87, Dingjiaqiao, Nanjing, China
| | - Jihong Zou
- Geriatrics Department, Zhongda Hospital Southeast University, No.87, Dingjiaqiao, Nanjing, China
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Perito ER, Palermo TM, Pohl JF, Mascarenhas M, Abu-El-Haija M, Barth B, Bellin MD, Fishman DS, Freedman S, Gariepy C, Giefer M, Gonska T, Heyman MB, Himes RW, Husain SZ, Lin T, Liu Q, Maqbool A, McFerron B, Morinville VD, Nathan JD, Ooi CY, Rhee S, Schwarzenberg SJ, Shah U, Troendle DM, Werlin S, Wilschanski M, Zheng Y, Zimmerman MB, Lowe M, Uc A. Factors Associated With Frequent Opioid Use in Children With Acute Recurrent and Chronic Pancreatitis. J Pediatr Gastroenterol Nutr 2020; 70:106-114. [PMID: 31567889 PMCID: PMC6934913 DOI: 10.1097/mpg.0000000000002502] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The aim of the study was to understand the association of frequent opioid use with disease phenotype and pain pattern and burden in children and adolescents with acute recurrent (ARP) or chronic pancreatitis (CP). METHODS Cross-sectional study of children <19 years with ARP or CP, at enrollment into the INSPPIRE cohort. We categorized patients as opioid "frequent use" (daily/weekly) or "nonfrequent use" (monthly or less, or no opioids), based on patient and parent self-report. RESULTS Of 427 children with ARP or CP, 17% reported frequent opioid use. More children with CP (65%) reported frequent opioid use than with ARP (41%, P = 0.0002). In multivariate analysis, frequent opioid use was associated with older age at diagnosis (odds ratio [OR] 1.67 per 5 years, 95% confidence interval [CI] 1.13-2.47, P = 0.01), exocrine insufficiency (OR 2.44, 95% CI 1.13-5.24, P = 0.02), constant/severe pain (OR 4.14, 95% CI 2.06-8.34, P < 0.0001), and higher average pain impact score across all 6 functional domains (OR 1.62 per 1-point increase, 95% CI 1.28-2.06, P < 0.0001). Children with frequent opioid use also reported more missed school days, hospitalizations, and emergency room visits in the past year than children with no frequent use (P < 0.0002 for each). Participants in the US West and Midwest accounted for 83% of frequent opioid users but only 56% of the total cohort. CONCLUSIONS In children with CP or ARP, frequent opioid use is associated with constant pain, more healthcare use, and higher levels of pain interference with functioning. Longitudinal and prospective research is needed to identify risk factors for frequent opioid use and to evaluate nonopioid interventions for reducing pain and disability in these children.
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Affiliation(s)
- Emily R. Perito
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Tonya M. Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | - John F. Pohl
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Maria Mascarenhas
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Maisam Abu-El-Haija
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Bradley Barth
- Department of Pediatrics, University of Texas Southwestern, Dallas, TX
| | - Melena D. Bellin
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | | | | | - Cheryl Gariepy
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Matthew Giefer
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | - Tanja Gonska
- Department of Pediatrics, Sick Kids Hospital, University of Toronto, Toronto, ON, Canada
| | - Melvin B. Heyman
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Ryan W. Himes
- Department of Pediatrics, Texas Children’s Hospital, Houston, TX
| | - Sohail Z. Husain
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA
| | - Tom Lin
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Quin Liu
- Department of Pediatrics, Cedars-Sinai, Los Angeles, CA
| | - Asim Maqbool
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Brian McFerron
- Department of Pediatrics, Indiana University, Indianapolis, IN
| | - Veronique D. Morinville
- Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montreal, QC, Canada
| | - Jaime D. Nathan
- Department of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Chee Y. Ooi
- School of Women’s and Children’s Health, Medicine, University of New South Wales, New South Wales, Sydney, Australia
| | - Sue Rhee
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | | | - Uzma Shah
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - David M. Troendle
- Department of Pediatrics, University of Texas Southwestern, Dallas, TX
| | - Steven Werlin
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | | | - Yuhua Zheng
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA
| | | | - Mark Lowe
- Department of Pediatrics, Washington University, St. Louis, MO
| | - Aliye Uc
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA
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Wang XL, Han W, Zhao P, Liu X, Wang JZ, Wang FR, Yan CH, Zhang YY, Mo XD, Wang Y, Fu HX, Chen YH, Chang YJ, Xu LP, Liu KY, Huang XJ, Zhang XH. Incidence, Risk Factors, Outcomes, and Risk Score Model of Acute Pancreatitis after Allogeneic Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2019; 26:1171-1178. [PMID: 31874219 DOI: 10.1016/j.bbmt.2019.12.721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/03/2019] [Accepted: 12/13/2019] [Indexed: 02/07/2023]
Abstract
Acute pancreatitis (AP) has been recognized as an uncommon yet potentially lethal complication after hematopoietic stem cell transplant (HSCT). This retrospective, nested, case-control study reviewed data from 5284 consecutive patients who underwent allogeneic (allo)-HSCT between 2009 and 2018 at a single center, identifying 40 patients (0.76%) with AP after allo-HSCT. The diagnosis and severity of AP were established and classified according to existing criteria. Younger age (P = .008), grades II to IV acute graft-versus-host disease (P = .010), a history of donor lymphocyte infusion (P = .033), and pre-existing gallstones (P = .003) were independent risk factors of AP after allo-HSCT. Post-transplant AP had a trend to negatively influence overall survival (OS) and nonrelapse mortality (NRM) (P = .063) for allo-HSCT recipients, but no significant difference was found. Patients with moderately severe and severe AP had significantly lower OS (P = .002) and higher NRM (P = .000) than other patients. Based on these findings, a risk score model was also established to predict the occurrence of AP. Our risk score model performed well in terms of discrimination when applied to derivation samples. Patients were classified into a low-risk group (0 to 1 point), a medium-risk group (2 to 3 points), and a high-risk group (4 points or more). Significant difference was observed in AP incidence among the 3 groups. The predictive tool explored by our study might contribute to target high-risk patients and guide personalized AP prevention in allo-HSCT recipients.
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Affiliation(s)
- Xing-Lin Wang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Wei Han
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Peng Zhao
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Xiao Liu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Jing-Zhi Wang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Feng-Rong Wang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Chen-Hua Yan
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Yuan-Yuan Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Xiao-Dong Mo
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Yu Wang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Hai-Xia Fu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Yu-Hong Chen
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Ying-Jun Chang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Lan-Ping Xu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Kai-Yan Liu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Xiao-Jun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Xiao-Hui Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China.
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26
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Mueck KM, Wei S, Pedroza C, Bernardi K, Jackson ML, Liang MK, Ko TC, Tyson JE, Kao LS. Gallstone Pancreatitis: Admission Versus Normal Cholecystectomy-a Randomized Trial (Gallstone PANC Trial). Ann Surg 2019; 270:519-527. [PMID: 31415304 PMCID: PMC6949044 DOI: 10.1097/sla.0000000000003424] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Early cholecystectomy shortly after admission for mild gallstone pancreatitis has been proposed based on observational data. We hypothesized that cholecystectomy within 24 hours of admission versus after clinical resolution of gallstone pancreatitis that is predicted to be mild results in decreased length-of-stay (LOS) without an increase in complications. METHODS Adults with predicted mild gallstone pancreatitis were randomized to cholecystectomy with cholangiogram within 24 hours of presentation (early group) versus after clinical resolution (control) based on abdominal exam and normalized laboratory values. Primary outcome was 30-day LOS including readmissions. Secondary outcomes were time to surgery, endoscopic retrograde cholangiopancreatography (ERCP) rates, and postoperative complications. Frequentist and Bayesian intention-to-treat analyses were performed. RESULTS Baseline characteristics were similar in the early (n = 49) and control (n = 48) groups. Early group had fewer ERCPs (15% vs 29%, P = 0.038), faster time to surgery (16 h vs 43 h, P < 0.005), and shorter 30-day LOS (50 h vs 77 h, RR 0.68 95% CI 0.65 - 0.71, P < 0.005). Complication rates were 6% in early group versus 2% in controls (P = 0.613), which included recurrence/progression of pancreatitis (2 early, 1 control) and a cystic duct stump leak (early). On Bayesian analysis, early cholecystectomy has a 99% probability of reducing 30-day LOS, 93% probability of decreasing ERCP use, and 72% probability of increasing complications. CONCLUSION In patients with predicted mild gallstone pancreatitis, cholecystectomy within 24 hours of admission reduced rate of ERCPs, time to surgery, and 30-day length-of-stay. Minor complications may be increased with early cholecystectomy. Identification of patients with predicted mild gallstone pancreatitis in whom early cholecystectomy is safe warrants further investigation.
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Affiliation(s)
- Krislynn M Mueck
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
- Center for Surgical Trials and Evidence-based Practice (CSTEP), McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Shuyan Wei
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
- Center for Surgical Trials and Evidence-based Practice (CSTEP), McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Claudia Pedroza
- Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Karla Bernardi
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
- Center for Surgical Trials and Evidence-based Practice (CSTEP), McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Margaret L Jackson
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Mike K Liang
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
- Center for Surgical Trials and Evidence-based Practice (CSTEP), McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Tien C Ko
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Jon E Tyson
- Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Lillian S Kao
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
- Center for Surgical Trials and Evidence-based Practice (CSTEP), McGovern Medical School at the University of Texas Health Science Center, Houston, TX
- Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
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Cho J, Walia M, Scragg R, Petrov MS. Frequency and risk factors for mental disorders following pancreatitis: a nationwide cohort study. Curr Med Res Opin 2019; 35:1157-1164. [PMID: 30614299 DOI: 10.1080/03007995.2018.1560748] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective: To investigate the frequency and risk factors for mental disorders following pancreatitis. Methods: Patients with acute pancreatitis (AP) and chronic pancreatitis (CP) were identified (n = 18,074) from a nationwide database in New Zealand (1998-2015). They were followed from their first hospital admissions for AP or CP to incident mental disorders. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using multivariable Cox regression analyses. Results: CP (vs AP) was associated with a significantly higher risk of mental disorders (adjusted HR = 2.00 [95% CI = 1.53-2.62]). Pre-existing diabetes (adjusted HR = 8.99 [95% CI = 6.23-12.96] for AP and adjusted HR = 3.42 [95% CI = 2.37-4.96] for CP) and post-pancreatitis diabetes mellitus (adjusted HR = 7.10 [95% CI = 4.14-12.19] for AP and adjusted HR = 2.97 [95% CI = 1.83-4.82] for CP) were risk factors for mental disorders in individuals following pancreatitis. Severe (adjusted HR = 2.07 [95% CI = 1.39-3.06] vs mild) and recurrent (adjusted HR = 1.62 [95% CI = 1.07-2.45] vs single episode) attacks were associated with significantly higher risks of mental disorders following AP. Conclusions: Patients following CP, recurrent AP, severe AP, and those with diabetes are at high risk for developing mental disorders.
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Affiliation(s)
- Jaelim Cho
- a School of Medicine , University of Auckland , Auckland , New Zealand
| | - Monika Walia
- a School of Medicine , University of Auckland , Auckland , New Zealand
| | - Robert Scragg
- b School of Population Health , University of Auckland , Auckland , New Zealand
| | - Maxim S Petrov
- a School of Medicine , University of Auckland , Auckland , New Zealand
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28
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Wu D, Lu B, Xue HD, Yang H, Qian JM, Lee P, Windsor JA. Validation of Modified Determinant-Based Classification of severity for acute pancreatitis in a tertiary teaching hospital. Pancreatology 2019; 19:217-223. [PMID: 30642724 DOI: 10.1016/j.pan.2019.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/04/2019] [Accepted: 01/05/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The relative merits of two recent classifications of acute pancreatitis severity, the Determinant-Based Classification (DBC) and the Revised Atlanta Classification (RAC), have been debated. A Modified DBC (MDBC) was recently proposed in intensive care unit (ICU) patients. By dividing the DBC 'severe' category into two groups, the MDBC classified non-mild acute pancreatitis into 4 groups rather than 2 in RAC and 3 in DBC. In this study we aim to validate MDBC in both ICU and non-ICU patients and evaluate infected necrosis as a determinant of severity. METHODS Prospective data collected on consecutive patients admitted to a tertiary teaching hospital were retrospectively analyzed. Patients were assigned to the categories of severity defined by the DBC, RAC and MDBC. Clinical interventions and outcomes were compared between categories. RESULTS A total of 1102 patients were enrolled and the overall mortality was 5.7%. When MDBC was applied, the four Groups were significantly different in regard to ICU admission rates (30%, 40%, 69% and 87%) and mortality (2%, 15%, 40% and 57%). Groups 2 and 3 were different in intervention rates and morbidity, providing evidence that IN is an important determinant of severity. CONCLUSIONS This study validates the MDBC proposal to subdivide the DBC 'severe' category into two groups for ICU and non-ICU patients in a tertiary hospital.
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Affiliation(s)
- Dong Wu
- Department of Gastroenterology, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Bo Lu
- Department of Gastroenterology, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Hua-Dan Xue
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Hong Yang
- Department of Gastroenterology, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Jia-Ming Qian
- Department of Gastroenterology, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Peter Lee
- Divison of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, United States
| | - John Albert Windsor
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Park Road, Auckland, New Zealand.
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29
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Li J, Chen J, Tang W. The consensus of integrative diagnosis and treatment of acute pancreatitis-2017. J Evid Based Med 2019; 12:76-88. [PMID: 30806495 DOI: 10.1111/jebm.12342] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Indexed: 01/11/2023]
Abstract
Acute pancreatitis (AP) is one of the most common acute abdominal diseases. The digestive disease committee, Chinese Association of Integrative Medicine, released Integrated traditional Chinese and Western medicine for diagnosis and treatment of acute pancreatitis in 2010.1 Since then, further studies and great progress have been made by domestic and foreign counterparts from the perspective of both Chinese and Western medicine in AP, including the classification, fluid resuscitation, organ function maintenance, surgery intervention, enteral nutrition (EN), and syndrome differentiation and treatment. It is necessary to update the consensus on diagnosis and treatment of integrated Chinese and Western medicine to meet clinical needs. Therefore, the 2012 Revision of the Atlanta Classification Standard (RAC) by the International AP Consensus,2 the 2013 the Management of Acute Pancreatitis by the American College of Gastroenterology,3, 4 the 2014 Guidelines for diagnosis and treatment of the acute pancreatitis guide (2014) by the Chinese medical association branch,5 the 2014 Guidelines on Integrative Medicine for Severe Acute Pancreatitis by the General Surgery Committee of the Chinese Society of Integrated Traditional Chinese and Western Medicine,6 and Traditional Chinese Medicine Consensus on the Diagnosis and Treatment for Acute Pancreatitis by the Spleen and Stomach committee of China Association of Traditional Chinese Medicine7, 8 were taken into account for the revision of the consensus published in 2010. The digestive specialists in Chinese and Western medicine had a discussion on traditional Chinese medicine (TCM) types, syndrome differentiation, the main points of integrative medicine, and so on. According to the Delphi method, Consensus of Integrative Diagnosis and Treatment of Acute Pancreatitis (the 2017 revision) has been passed after three rounds votes. (The voting options are as follows: (a) totally agree; (b) agree, but with some reservations; (c) agree, but with larger reservations; (d) disagree, but reserved; and (e) absolutely disagree. If more than two out of three choose (a), or over 85% choose (a) + (b), the consensus will be passed.) The final validation was carried out by the core expert group in Taizhou, Jiangsu on June 9, 2017. The full text is as follows.
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Affiliation(s)
- Junxiang Li
- Digestive Disease Committee, Chinese Association of Integrative Medicine
| | - Jing Chen
- Digestive Disease Committee, Chinese Association of Integrative Medicine
| | - Wenfu Tang
- Digestive Disease Committee, Chinese Association of Integrative Medicine
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30
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Huang W, de la Iglesia-García D, Baston-Rey I, Calviño-Suarez C, Lariño-Noia J, Iglesias-Garcia J, Shi N, Zhang X, Cai W, Deng L, Moore D, Singh VK, Xia Q, Windsor JA, Domínguez-Muñoz JE, Sutton R. Exocrine Pancreatic Insufficiency Following Acute Pancreatitis: Systematic Review and Meta-Analysis. Dig Dis Sci 2019; 64:1985-2005. [PMID: 31161524 PMCID: PMC6584228 DOI: 10.1007/s10620-019-05568-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES The epidemiology of exocrine pancreatic insufficiency (EPI) after acute pancreatitis (AP) is uncertain. We sought to determine the prevalence, progression, etiology and pancreatic enzyme replacement therapy (PERT) requirements for EPI during follow-up of AP by systematic review and meta-analysis. METHODS Scopus, Medline and Embase were searched for prospective observational studies or randomized clinical trials (RCTs) of PERT reporting EPI during the first admission (between the start of oral refeeding and before discharge) or follow-up (≥ 1 month of discharge) for AP in adults. EPI was diagnosed by direct and/or indirect laboratory exocrine pancreatic function tests. RESULTS Quantitative data were analyzed from 370 patients studied during admission (10 studies) and 1795 patients during follow-up (39 studies). The pooled prevalence of EPI during admission was 62% (95% confidence interval: 39-82%), decreasing significantly during follow-up to 35% (27-43%; risk difference: - 0.34, - 0.53 to - 0.14). There was a two-fold increase in the prevalence of EPI with severe compared with mild AP, and it was higher in patients with pancreatic necrosis and those with an alcohol etiology. The prevalence decreased during recovery, but persisted in a third of patients. There was no statistically significant difference between EPI and new-onset pre-diabetes/diabetes (risk difference: 0.8, 0.7-1.1, P = 0.33) in studies reporting both. Sensitivity analysis showed fecal elastase-1 assay detected significantly fewer patients with EPI than other tests. CONCLUSIONS The prevalence of EPI during admission and follow-up is substantial in patients with a first attack of AP. Unanswered questions remain about the way this is managed, and further RCTs are indicated.
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Affiliation(s)
- Wei Huang
- 0000 0004 1770 1022grid.412901.fDepartment of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Daniel de la Iglesia-García
- 0000 0000 8816 6945grid.411048.8Department of Gastroenterology and Hepatology, Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Iria Baston-Rey
- 0000 0000 8816 6945grid.411048.8Department of Gastroenterology and Hepatology, Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Cristina Calviño-Suarez
- 0000 0000 8816 6945grid.411048.8Department of Gastroenterology and Hepatology, Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jose Lariño-Noia
- 0000 0000 8816 6945grid.411048.8Department of Gastroenterology and Hepatology, Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Julio Iglesias-Garcia
- 0000 0000 8816 6945grid.411048.8Department of Gastroenterology and Hepatology, Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Na Shi
- 0000 0004 1770 1022grid.412901.fDepartment of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoying Zhang
- 0000 0004 1770 1022grid.412901.fDepartment of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China ,0000 0004 1936 8470grid.10025.36Liverpool Pancreatitis Research Group, Royal Liverpool University Hospital, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Wenhao Cai
- 0000 0004 1770 1022grid.412901.fDepartment of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Lihui Deng
- 0000 0004 1770 1022grid.412901.fDepartment of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Danielle Moore
- 0000 0004 1936 8470grid.10025.36Liverpool Pancreatitis Research Group, Royal Liverpool University Hospital, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Vikesh K. Singh
- 0000 0001 2171 9311grid.21107.35Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, USA
| | - Qing Xia
- 0000 0004 1770 1022grid.412901.fDepartment of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - John A. Windsor
- 0000 0004 0372 3343grid.9654.eSurgical and Translational Research Center, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - J. Enrique Domínguez-Muñoz
- 0000 0000 8816 6945grid.411048.8Department of Gastroenterology and Hepatology, Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Robert Sutton
- 0000 0004 1936 8470grid.10025.36Liverpool Pancreatitis Research Group, Royal Liverpool University Hospital, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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Smith ZL, Gregory MH, Elsner J, Alajlan BA, Kodali D, Hollander T, Sayuk GS, Lang GD, Das KK, Mullady DK, Early DS, Kushnir VM. Health-related quality of life and long-term outcomes after endoscopic therapy for walled-off pancreatic necrosis. Dig Endosc 2019; 31:77-85. [PMID: 30152143 DOI: 10.1111/den.13264] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 08/20/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM Walled-off pancreatic necrosis (WON) frequently develops after necrotizing pancreatitis. Endoscopic drainage has become the preferred modality for symptomatic or infected WON. The aim of the present study was to assess health-related quality of life (HR-QOL) and long-term outcomes in patients undergoing endoscopic drainage for WON. METHODS Patients undergoing endoscopic drainage of WON from January 2006 to May 2016 were identified. Data recorded included demographic information, and the incidence of long-term sequelae including pancreatic endocrine and exocrine insufficiency. Attempts were made to contact all patients. HR-QOL was assessed using the SF-36 questionnaire. RESULTS Eighty patients were analyzed, 41 (51.3%) of whom completed the SF-36. One-year all-cause mortality was 6.2%, and disease-related mortality was 3.7%. A notable proportion of patients developed exocrine insufficiency (32.5%), endocrine insufficiency (27.7%), and long-term opiate use (42.5%). Development of exocrine insufficiency was predictive of lower total SF-36 scores (P = 0.016). Patients with WON had better HR-QOL compared with cohorts of irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). In patients developing exocrine insufficiency versus healthy controls, poorer scores in the physical role (P < 0.001), general health (P < 0.001), vitality (P = 0.001), and emotional role (P = 0.029) domains were observed. Exocrine insufficiency patients had better HR-QOL than the IBS and IBD cohorts, although these differences were less pronounced. CONCLUSION After undergoing endoscopic drainage for WON, patients have relatively preserved HR-QOL. The subset of patients that develop exocrine insufficiency have significantly poorer HR-QOL compared to healthy controls, although not to the degree of chronic gastrointestinal disorders such as IBS and IBD.
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Affiliation(s)
- Zachary L Smith
- Division of Gastroenterology, Washington University School of Medicine, St Louis, USA
| | - Martin H Gregory
- Division of Gastroenterology, Washington University School of Medicine, St Louis, USA
| | - Jeffrey Elsner
- Division of Gastroenterology, Washington University School of Medicine, St Louis, USA
| | - Bader A Alajlan
- Division of Gastroenterology, Washington University School of Medicine, St Louis, USA
| | - Divya Kodali
- Division of Gastroenterology, Washington University School of Medicine, St Louis, USA
| | - Thomas Hollander
- Division of Gastroenterology, Washington University School of Medicine, St Louis, USA
| | - Gregory S Sayuk
- Division of Gastroenterology, Washington University School of Medicine, St Louis, USA
| | - Gabriel D Lang
- Division of Gastroenterology, Washington University School of Medicine, St Louis, USA
| | - Koushik K Das
- Division of Gastroenterology, Washington University School of Medicine, St Louis, USA
| | - Daniel K Mullady
- Division of Gastroenterology, Washington University School of Medicine, St Louis, USA
| | - Dayna S Early
- Division of Gastroenterology, Washington University School of Medicine, St Louis, USA
| | - Vladimir M Kushnir
- Division of Gastroenterology, Washington University School of Medicine, St Louis, USA
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Leerhøy B, Shabanzadeh DM, Nordholm-Carstensen A, Jørgensen LN. Quality of life, performance status, and work capacity after post-endoscopic retrograde cholangiopancreatography pancreatitis. Scand J Gastroenterol 2018; 53:994-999. [PMID: 29978732 DOI: 10.1080/00365521.2018.1485730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study evaluated the long-term consequences of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) on health related quality of life (HRQOL), performance status, and work capacity. MATERIALS AND METHODS A follow-up study with prospective outcome measurements on patients with previous PEP and matched controls from a Danish cohort of 772 patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). HRQOL was evaluated by the short form 36 health surveys, performance status by the Zubrod score, and work capacity by employment status. Multivariable models were applied to adjust for potential confounders. RESULTS Twenty-nine cases and 49 controls were included. Twelve (41%), eight (28%), and nine (31%) patients had mild, moderate, and severe PEP, respectively. Mean follow-up time was 4.8 ± 1.7 years. PEP was associated with long-term reduced mental HRQOL (-13.0 role-emotional score points, 95% CI: -25.4; -0.52). An increased Zubrod score representing reduced performance status was present in 12 of the 29 cases (41.4%) and in nine of the 49 controls (18.4%), p = .002. Reduced work capacity was present in 14 of the 29 cases (48.2%) and in 12 of the 49 controls (24.4%), p = .023. CONCLUSIONS This study indicates that PEP has a detrimental effect on long-term HRQOL, performance score, and work capacity.
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Affiliation(s)
- Bonna Leerhøy
- a Digestive Disease Center, Bispebjerg Hospital , University of Copenhagen , Copenhagen , Denmark
| | | | | | - Lars Nannestad Jørgensen
- a Digestive Disease Center, Bispebjerg Hospital , University of Copenhagen , Copenhagen , Denmark
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Coté GA, Yadav D, Abberbock JA, Whitcomb DC, Sherman S, Sandhu BS, Anderson MA, Lewis MD, Alkaade S, Singh VK, Baillie J, Banks PA, Conwell D, Guda NM, Muniraj T, Tang G, Brand R, Gelrud A, Amann ST, Forsmark CE, Wilcox MC, Slivka A, Gardner TB. Recurrent Acute Pancreatitis Significantly Reduces Quality of Life Even in the Absence of Overt Chronic Pancreatitis. Am J Gastroenterol 2018; 113:906-912. [PMID: 29867178 PMCID: PMC6136830 DOI: 10.1038/s41395-018-0087-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 03/13/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The impact of recurrent acute pancreatitis (RAP) on quality of life (QOL) is unknown. We hypothesized that RAP would reduce QOL even in the absence of chronic pancreatitis (CP). METHODS Data were pooled from three prospective, cross-sectional studies conducted across 27 U.S. centers (the North American Pancreatitis Studies); these included subjects with chronic pancreatitis (n = 1086), RAP alone (n = 508), and non-disease controls (n = 1025). QOL was measured using the Short Form 12 (SF-12), generating a Physical Component Summary (PCS) and the Mental Component Summary score (MCS). Multivariable regression models were developed to measure the effect of RAP on QOL, the predictors of lower QOL in those with RAP, and the differential effect QOL predictors between CP and RAP. RESULTS Compared to controls (51.0 ± 9.4), subjects with RAP (41.1 ± 11.4) and CP (37.2 ± 11.8) had lower PCS (p < 0.01). Subjects with CP had lower PCS compared to those with RAP (p < 0.01). Similarly, MCS was lower among RAP (44.6 ± 11.5) and CP (42.8 ± 12.2) subjects compared to controls (51.7 ± 9.1, p < 0.01). Subjects with CP had lower MCS compared to those with RAP (p < 0.01). After controlling for independent predictors of PCS, RAP was associated with lower PCS (estimate -8.46, p < 0.01) and MCS (estimate -6.45, p < 0.0001) compared to controls. The effect of endocrine insufficiency on PCS was differentially greater among RAP subjects (-1.28 for CP vs. -4.9 for RAP, p = 0.0184). CONCLUSIONS Even in the absence of CP, subjects with RAP have lower physical and mental QOL. This underscores the importance of identifying interventions to attenuate RAP before the development of overt CP.
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Affiliation(s)
- Gregory A Coté
- Medical university of South Carolina, Charleston, SC, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Indiana university School of Medicine, Indianapolis, IN, USA. Richmond Gastroenterology Associates, Richmond, VA, USA. university of Michigan, Ann Arbor, MI, USA. Mayo Clinic, Jacksonville, FL, USA. Saint Louis university, St. Louis, MO, USA. Johns Hopkins Medical Institutions, Baltimore, MD, USA. Virginia Commonwealth university, Richmond, VA, USA. Brigham and Women's Hospital, Boston, MA, USA. Ohio State university, Columbus, OH, USA. Aurora St. Luke's Medical Center, Milwaukee, WI, USA. Yale School of Medicine, New Haven, CT, USA. University of Chicago, Chicago, IL, USA. Digestive Health Specialists, Tupelo, MS, USA. University of Florida, Gainesville, FL, USA. University of Alabama, Birmingham, AL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Dhiraj Yadav
- Medical university of South Carolina, Charleston, SC, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Indiana university School of Medicine, Indianapolis, IN, USA. Richmond Gastroenterology Associates, Richmond, VA, USA. university of Michigan, Ann Arbor, MI, USA. Mayo Clinic, Jacksonville, FL, USA. Saint Louis university, St. Louis, MO, USA. Johns Hopkins Medical Institutions, Baltimore, MD, USA. Virginia Commonwealth university, Richmond, VA, USA. Brigham and Women's Hospital, Boston, MA, USA. Ohio State university, Columbus, OH, USA. Aurora St. Luke's Medical Center, Milwaukee, WI, USA. Yale School of Medicine, New Haven, CT, USA. University of Chicago, Chicago, IL, USA. Digestive Health Specialists, Tupelo, MS, USA. University of Florida, Gainesville, FL, USA. University of Alabama, Birmingham, AL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Judah A Abberbock
- Medical university of South Carolina, Charleston, SC, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Indiana university School of Medicine, Indianapolis, IN, USA. Richmond Gastroenterology Associates, Richmond, VA, USA. university of Michigan, Ann Arbor, MI, USA. Mayo Clinic, Jacksonville, FL, USA. Saint Louis university, St. Louis, MO, USA. Johns Hopkins Medical Institutions, Baltimore, MD, USA. Virginia Commonwealth university, Richmond, VA, USA. Brigham and Women's Hospital, Boston, MA, USA. Ohio State university, Columbus, OH, USA. Aurora St. Luke's Medical Center, Milwaukee, WI, USA. Yale School of Medicine, New Haven, CT, USA. University of Chicago, Chicago, IL, USA. Digestive Health Specialists, Tupelo, MS, USA. University of Florida, Gainesville, FL, USA. University of Alabama, Birmingham, AL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - David C Whitcomb
- Medical university of South Carolina, Charleston, SC, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Indiana university School of Medicine, Indianapolis, IN, USA. Richmond Gastroenterology Associates, Richmond, VA, USA. university of Michigan, Ann Arbor, MI, USA. Mayo Clinic, Jacksonville, FL, USA. Saint Louis university, St. Louis, MO, USA. Johns Hopkins Medical Institutions, Baltimore, MD, USA. Virginia Commonwealth university, Richmond, VA, USA. Brigham and Women's Hospital, Boston, MA, USA. Ohio State university, Columbus, OH, USA. Aurora St. Luke's Medical Center, Milwaukee, WI, USA. Yale School of Medicine, New Haven, CT, USA. University of Chicago, Chicago, IL, USA. Digestive Health Specialists, Tupelo, MS, USA. University of Florida, Gainesville, FL, USA. University of Alabama, Birmingham, AL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Stuart Sherman
- Medical university of South Carolina, Charleston, SC, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Indiana university School of Medicine, Indianapolis, IN, USA. Richmond Gastroenterology Associates, Richmond, VA, USA. university of Michigan, Ann Arbor, MI, USA. Mayo Clinic, Jacksonville, FL, USA. Saint Louis university, St. Louis, MO, USA. Johns Hopkins Medical Institutions, Baltimore, MD, USA. Virginia Commonwealth university, Richmond, VA, USA. Brigham and Women's Hospital, Boston, MA, USA. Ohio State university, Columbus, OH, USA. Aurora St. Luke's Medical Center, Milwaukee, WI, USA. Yale School of Medicine, New Haven, CT, USA. University of Chicago, Chicago, IL, USA. Digestive Health Specialists, Tupelo, MS, USA. University of Florida, Gainesville, FL, USA. University of Alabama, Birmingham, AL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Bimaljit S Sandhu
- Medical university of South Carolina, Charleston, SC, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Indiana university School of Medicine, Indianapolis, IN, USA. Richmond Gastroenterology Associates, Richmond, VA, USA. university of Michigan, Ann Arbor, MI, USA. Mayo Clinic, Jacksonville, FL, USA. Saint Louis university, St. Louis, MO, USA. Johns Hopkins Medical Institutions, Baltimore, MD, USA. Virginia Commonwealth university, Richmond, VA, USA. Brigham and Women's Hospital, Boston, MA, USA. Ohio State university, Columbus, OH, USA. Aurora St. Luke's Medical Center, Milwaukee, WI, USA. Yale School of Medicine, New Haven, CT, USA. University of Chicago, Chicago, IL, USA. Digestive Health Specialists, Tupelo, MS, USA. University of Florida, Gainesville, FL, USA. University of Alabama, Birmingham, AL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Michelle A Anderson
- Medical university of South Carolina, Charleston, SC, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Indiana university School of Medicine, Indianapolis, IN, USA. Richmond Gastroenterology Associates, Richmond, VA, USA. university of Michigan, Ann Arbor, MI, USA. Mayo Clinic, Jacksonville, FL, USA. Saint Louis university, St. Louis, MO, USA. Johns Hopkins Medical Institutions, Baltimore, MD, USA. Virginia Commonwealth university, Richmond, VA, USA. Brigham and Women's Hospital, Boston, MA, USA. Ohio State university, Columbus, OH, USA. Aurora St. Luke's Medical Center, Milwaukee, WI, USA. Yale School of Medicine, New Haven, CT, USA. University of Chicago, Chicago, IL, USA. Digestive Health Specialists, Tupelo, MS, USA. University of Florida, Gainesville, FL, USA. University of Alabama, Birmingham, AL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Michele D Lewis
- Medical university of South Carolina, Charleston, SC, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Indiana university School of Medicine, Indianapolis, IN, USA. Richmond Gastroenterology Associates, Richmond, VA, USA. university of Michigan, Ann Arbor, MI, USA. Mayo Clinic, Jacksonville, FL, USA. Saint Louis university, St. Louis, MO, USA. Johns Hopkins Medical Institutions, Baltimore, MD, USA. Virginia Commonwealth university, Richmond, VA, USA. Brigham and Women's Hospital, Boston, MA, USA. Ohio State university, Columbus, OH, USA. Aurora St. Luke's Medical Center, Milwaukee, WI, USA. Yale School of Medicine, New Haven, CT, USA. University of Chicago, Chicago, IL, USA. Digestive Health Specialists, Tupelo, MS, USA. University of Florida, Gainesville, FL, USA. University of Alabama, Birmingham, AL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Samer Alkaade
- Medical university of South Carolina, Charleston, SC, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Indiana university School of Medicine, Indianapolis, IN, USA. Richmond Gastroenterology Associates, Richmond, VA, USA. university of Michigan, Ann Arbor, MI, USA. Mayo Clinic, Jacksonville, FL, USA. Saint Louis university, St. Louis, MO, USA. Johns Hopkins Medical Institutions, Baltimore, MD, USA. Virginia Commonwealth university, Richmond, VA, USA. Brigham and Women's Hospital, Boston, MA, USA. Ohio State university, Columbus, OH, USA. Aurora St. Luke's Medical Center, Milwaukee, WI, USA. Yale School of Medicine, New Haven, CT, USA. University of Chicago, Chicago, IL, USA. Digestive Health Specialists, Tupelo, MS, USA. University of Florida, Gainesville, FL, USA. University of Alabama, Birmingham, AL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Vikesh K Singh
- Medical university of South Carolina, Charleston, SC, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Indiana university School of Medicine, Indianapolis, IN, USA. Richmond Gastroenterology Associates, Richmond, VA, USA. university of Michigan, Ann Arbor, MI, USA. Mayo Clinic, Jacksonville, FL, USA. Saint Louis university, St. Louis, MO, USA. Johns Hopkins Medical Institutions, Baltimore, MD, USA. Virginia Commonwealth university, Richmond, VA, USA. Brigham and Women's Hospital, Boston, MA, USA. Ohio State university, Columbus, OH, USA. Aurora St. Luke's Medical Center, Milwaukee, WI, USA. Yale School of Medicine, New Haven, CT, USA. University of Chicago, Chicago, IL, USA. Digestive Health Specialists, Tupelo, MS, USA. University of Florida, Gainesville, FL, USA. University of Alabama, Birmingham, AL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - John Baillie
- Medical university of South Carolina, Charleston, SC, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Indiana university School of Medicine, Indianapolis, IN, USA. Richmond Gastroenterology Associates, Richmond, VA, USA. university of Michigan, Ann Arbor, MI, USA. Mayo Clinic, Jacksonville, FL, USA. Saint Louis university, St. Louis, MO, USA. Johns Hopkins Medical Institutions, Baltimore, MD, USA. Virginia Commonwealth university, Richmond, VA, USA. Brigham and Women's Hospital, Boston, MA, USA. Ohio State university, Columbus, OH, USA. Aurora St. Luke's Medical Center, Milwaukee, WI, USA. Yale School of Medicine, New Haven, CT, USA. University of Chicago, Chicago, IL, USA. Digestive Health Specialists, Tupelo, MS, USA. University of Florida, Gainesville, FL, USA. University of Alabama, Birmingham, AL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Peter A Banks
- Medical university of South Carolina, Charleston, SC, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Indiana university School of Medicine, Indianapolis, IN, USA. Richmond Gastroenterology Associates, Richmond, VA, USA. university of Michigan, Ann Arbor, MI, USA. Mayo Clinic, Jacksonville, FL, USA. Saint Louis university, St. Louis, MO, USA. Johns Hopkins Medical Institutions, Baltimore, MD, USA. Virginia Commonwealth university, Richmond, VA, USA. Brigham and Women's Hospital, Boston, MA, USA. Ohio State university, Columbus, OH, USA. Aurora St. Luke's Medical Center, Milwaukee, WI, USA. Yale School of Medicine, New Haven, CT, USA. University of Chicago, Chicago, IL, USA. Digestive Health Specialists, Tupelo, MS, USA. University of Florida, Gainesville, FL, USA. University of Alabama, Birmingham, AL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Darwin Conwell
- Medical university of South Carolina, Charleston, SC, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Indiana university School of Medicine, Indianapolis, IN, USA. Richmond Gastroenterology Associates, Richmond, VA, USA. university of Michigan, Ann Arbor, MI, USA. Mayo Clinic, Jacksonville, FL, USA. Saint Louis university, St. Louis, MO, USA. Johns Hopkins Medical Institutions, Baltimore, MD, USA. Virginia Commonwealth university, Richmond, VA, USA. Brigham and Women's Hospital, Boston, MA, USA. Ohio State university, Columbus, OH, USA. Aurora St. Luke's Medical Center, Milwaukee, WI, USA. Yale School of Medicine, New Haven, CT, USA. University of Chicago, Chicago, IL, USA. Digestive Health Specialists, Tupelo, MS, USA. University of Florida, Gainesville, FL, USA. University of Alabama, Birmingham, AL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Nalini M Guda
- Medical university of South Carolina, Charleston, SC, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Indiana university School of Medicine, Indianapolis, IN, USA. Richmond Gastroenterology Associates, Richmond, VA, USA. university of Michigan, Ann Arbor, MI, USA. Mayo Clinic, Jacksonville, FL, USA. Saint Louis university, St. Louis, MO, USA. Johns Hopkins Medical Institutions, Baltimore, MD, USA. Virginia Commonwealth university, Richmond, VA, USA. Brigham and Women's Hospital, Boston, MA, USA. Ohio State university, Columbus, OH, USA. Aurora St. Luke's Medical Center, Milwaukee, WI, USA. Yale School of Medicine, New Haven, CT, USA. University of Chicago, Chicago, IL, USA. Digestive Health Specialists, Tupelo, MS, USA. University of Florida, Gainesville, FL, USA. University of Alabama, Birmingham, AL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Thiruvengadam Muniraj
- Medical university of South Carolina, Charleston, SC, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Indiana university School of Medicine, Indianapolis, IN, USA. Richmond Gastroenterology Associates, Richmond, VA, USA. university of Michigan, Ann Arbor, MI, USA. Mayo Clinic, Jacksonville, FL, USA. Saint Louis university, St. Louis, MO, USA. Johns Hopkins Medical Institutions, Baltimore, MD, USA. Virginia Commonwealth university, Richmond, VA, USA. Brigham and Women's Hospital, Boston, MA, USA. Ohio State university, Columbus, OH, USA. Aurora St. Luke's Medical Center, Milwaukee, WI, USA. Yale School of Medicine, New Haven, CT, USA. University of Chicago, Chicago, IL, USA. Digestive Health Specialists, Tupelo, MS, USA. University of Florida, Gainesville, FL, USA. University of Alabama, Birmingham, AL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Gong Tang
- Medical university of South Carolina, Charleston, SC, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Indiana university School of Medicine, Indianapolis, IN, USA. Richmond Gastroenterology Associates, Richmond, VA, USA. university of Michigan, Ann Arbor, MI, USA. Mayo Clinic, Jacksonville, FL, USA. Saint Louis university, St. Louis, MO, USA. Johns Hopkins Medical Institutions, Baltimore, MD, USA. Virginia Commonwealth university, Richmond, VA, USA. Brigham and Women's Hospital, Boston, MA, USA. Ohio State university, Columbus, OH, USA. Aurora St. Luke's Medical Center, Milwaukee, WI, USA. Yale School of Medicine, New Haven, CT, USA. University of Chicago, Chicago, IL, USA. Digestive Health Specialists, Tupelo, MS, USA. University of Florida, Gainesville, FL, USA. University of Alabama, Birmingham, AL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Randall Brand
- Medical university of South Carolina, Charleston, SC, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Indiana university School of Medicine, Indianapolis, IN, USA. Richmond Gastroenterology Associates, Richmond, VA, USA. university of Michigan, Ann Arbor, MI, USA. Mayo Clinic, Jacksonville, FL, USA. Saint Louis university, St. Louis, MO, USA. Johns Hopkins Medical Institutions, Baltimore, MD, USA. Virginia Commonwealth university, Richmond, VA, USA. Brigham and Women's Hospital, Boston, MA, USA. Ohio State university, Columbus, OH, USA. Aurora St. Luke's Medical Center, Milwaukee, WI, USA. Yale School of Medicine, New Haven, CT, USA. University of Chicago, Chicago, IL, USA. Digestive Health Specialists, Tupelo, MS, USA. University of Florida, Gainesville, FL, USA. University of Alabama, Birmingham, AL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Andres Gelrud
- Medical university of South Carolina, Charleston, SC, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Indiana university School of Medicine, Indianapolis, IN, USA. Richmond Gastroenterology Associates, Richmond, VA, USA. university of Michigan, Ann Arbor, MI, USA. Mayo Clinic, Jacksonville, FL, USA. Saint Louis university, St. Louis, MO, USA. Johns Hopkins Medical Institutions, Baltimore, MD, USA. Virginia Commonwealth university, Richmond, VA, USA. Brigham and Women's Hospital, Boston, MA, USA. Ohio State university, Columbus, OH, USA. Aurora St. Luke's Medical Center, Milwaukee, WI, USA. Yale School of Medicine, New Haven, CT, USA. University of Chicago, Chicago, IL, USA. Digestive Health Specialists, Tupelo, MS, USA. University of Florida, Gainesville, FL, USA. University of Alabama, Birmingham, AL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Stephen T Amann
- Medical university of South Carolina, Charleston, SC, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Indiana university School of Medicine, Indianapolis, IN, USA. Richmond Gastroenterology Associates, Richmond, VA, USA. university of Michigan, Ann Arbor, MI, USA. Mayo Clinic, Jacksonville, FL, USA. Saint Louis university, St. Louis, MO, USA. Johns Hopkins Medical Institutions, Baltimore, MD, USA. Virginia Commonwealth university, Richmond, VA, USA. Brigham and Women's Hospital, Boston, MA, USA. Ohio State university, Columbus, OH, USA. Aurora St. Luke's Medical Center, Milwaukee, WI, USA. Yale School of Medicine, New Haven, CT, USA. University of Chicago, Chicago, IL, USA. Digestive Health Specialists, Tupelo, MS, USA. University of Florida, Gainesville, FL, USA. University of Alabama, Birmingham, AL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Christopher E Forsmark
- Medical university of South Carolina, Charleston, SC, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Indiana university School of Medicine, Indianapolis, IN, USA. Richmond Gastroenterology Associates, Richmond, VA, USA. university of Michigan, Ann Arbor, MI, USA. Mayo Clinic, Jacksonville, FL, USA. Saint Louis university, St. Louis, MO, USA. Johns Hopkins Medical Institutions, Baltimore, MD, USA. Virginia Commonwealth university, Richmond, VA, USA. Brigham and Women's Hospital, Boston, MA, USA. Ohio State university, Columbus, OH, USA. Aurora St. Luke's Medical Center, Milwaukee, WI, USA. Yale School of Medicine, New Haven, CT, USA. University of Chicago, Chicago, IL, USA. Digestive Health Specialists, Tupelo, MS, USA. University of Florida, Gainesville, FL, USA. University of Alabama, Birmingham, AL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Mel C Wilcox
- Medical university of South Carolina, Charleston, SC, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Indiana university School of Medicine, Indianapolis, IN, USA. Richmond Gastroenterology Associates, Richmond, VA, USA. university of Michigan, Ann Arbor, MI, USA. Mayo Clinic, Jacksonville, FL, USA. Saint Louis university, St. Louis, MO, USA. Johns Hopkins Medical Institutions, Baltimore, MD, USA. Virginia Commonwealth university, Richmond, VA, USA. Brigham and Women's Hospital, Boston, MA, USA. Ohio State university, Columbus, OH, USA. Aurora St. Luke's Medical Center, Milwaukee, WI, USA. Yale School of Medicine, New Haven, CT, USA. University of Chicago, Chicago, IL, USA. Digestive Health Specialists, Tupelo, MS, USA. University of Florida, Gainesville, FL, USA. University of Alabama, Birmingham, AL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Adam Slivka
- Medical university of South Carolina, Charleston, SC, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Indiana university School of Medicine, Indianapolis, IN, USA. Richmond Gastroenterology Associates, Richmond, VA, USA. university of Michigan, Ann Arbor, MI, USA. Mayo Clinic, Jacksonville, FL, USA. Saint Louis university, St. Louis, MO, USA. Johns Hopkins Medical Institutions, Baltimore, MD, USA. Virginia Commonwealth university, Richmond, VA, USA. Brigham and Women's Hospital, Boston, MA, USA. Ohio State university, Columbus, OH, USA. Aurora St. Luke's Medical Center, Milwaukee, WI, USA. Yale School of Medicine, New Haven, CT, USA. University of Chicago, Chicago, IL, USA. Digestive Health Specialists, Tupelo, MS, USA. University of Florida, Gainesville, FL, USA. University of Alabama, Birmingham, AL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Timothy B Gardner
- Medical university of South Carolina, Charleston, SC, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Indiana university School of Medicine, Indianapolis, IN, USA. Richmond Gastroenterology Associates, Richmond, VA, USA. university of Michigan, Ann Arbor, MI, USA. Mayo Clinic, Jacksonville, FL, USA. Saint Louis university, St. Louis, MO, USA. Johns Hopkins Medical Institutions, Baltimore, MD, USA. Virginia Commonwealth university, Richmond, VA, USA. Brigham and Women's Hospital, Boston, MA, USA. Ohio State university, Columbus, OH, USA. Aurora St. Luke's Medical Center, Milwaukee, WI, USA. Yale School of Medicine, New Haven, CT, USA. University of Chicago, Chicago, IL, USA. Digestive Health Specialists, Tupelo, MS, USA. University of Florida, Gainesville, FL, USA. University of Alabama, Birmingham, AL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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34
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Crockett SD, Wani S, Gardner TB, Falck-Ytter Y, Barkun AN, Falck-Ytter Y, Feuerstein J, Flamm S, Gellad Z, Gerson L, Gupta S, Hirano I, Inadomi J, Nguyen GC, Rubenstein JH, Singh S, Smalley WE, Stollman N, Street S, Sultan S, Vege SS, Wani SB, Weinberg D. American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis. Gastroenterology 2018; 154:1096-1101. [PMID: 29409760 DOI: 10.1053/j.gastro.2018.01.032] [Citation(s) in RCA: 463] [Impact Index Per Article: 77.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Seth D Crockett
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Timothy B Gardner
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Yngve Falck-Ytter
- Division of Gastroenterology, Case Western Reserve University, Cleveland, Ohio; Louis Stokes VA Medical Center, Cleveland, Ohio
| | - Alan N Barkun
- Division of Gastroenterology, McGill University, Montréal, Québec, Canada
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35
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Mueck KM, Wei S, Liang MK, Ko TC, Tyson JE, Kao LS. Protocol for a randomized trial of the effect of timing of cholecystectomy during initial admission for predicted mild gallstone pancreatitis at a safety-net hospital. Trauma Surg Acute Care Open 2018; 3:e000152. [PMID: 29766134 PMCID: PMC5887782 DOI: 10.1136/tsaco-2017-000152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 12/31/2017] [Indexed: 01/06/2023] Open
Abstract
Background There is evidence-based consensus for laparoscopic cholecystectomy during index admission for predicted mild gallstone pancreatitis, defined by the absence of organ failure and of local or systemic complications. However, the optimal timing for surgery within that admission is controversial. Early cholecystectomy may shorten hospital length of stay (LOS) and increase patient satisfaction. Alternatively, it may increase operative difficulty and complications resulting in readmissions. Methods This trial is a single-center randomized trial of patients with predicted mild gallstone pancreatitis comparing laparoscopic cholecystectomy with intraoperative cholangiogram (IOC) at index admission within 24 hours of presentation versus after clinical resolution on clinical and patient-reported outcomes (PROs). The primary endpoint is 30-day LOS (hours) after initial presentation, which includes the index admission and readmissions. Secondary outcomes are conversion to open, complications, time from admission to cholecystectomy, initial hospital LOS, number of procedures within 30 days, 30-day readmissions, and PROs (change in Gastrointestinal Quality-of-Life Index). Discussion The primary goal of this research is to obtain the least biased estimate of effect of timing of cholecystectomy for mild gallstone pancreatitis on clinical and PROs; the results of this trial will be used to inform patient care locally as well as to design future multicenter effectiveness and implementation trials. This trial will provide data regarding PROs including health-related quality of life that can be used in cost-utility and cost-effectiveness analyses. Trial registration number NCT02806297, ClinicalTrials.gov.
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Affiliation(s)
- Krislynn M Mueck
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA.,Departments of Surgery and Pediatric Surgery, Center for Surgical Trials and Evidence-based Practice (CSTEP), McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
| | - Shuyan Wei
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA.,Departments of Surgery and Pediatric Surgery, Center for Surgical Trials and Evidence-based Practice (CSTEP), McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA.,Department of Pediatrics, Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA.,Department of Surgery, Center for Translational Injury Research, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
| | - Mike K Liang
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA.,Departments of Surgery and Pediatric Surgery, Center for Surgical Trials and Evidence-based Practice (CSTEP), McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
| | - Tien C Ko
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
| | - Jon E Tyson
- Department of Pediatrics, Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA.,Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
| | - Lillian S Kao
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA.,Departments of Surgery and Pediatric Surgery, Center for Surgical Trials and Evidence-based Practice (CSTEP), McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA.,Department of Pediatrics, Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA.,Department of Surgery, Center for Translational Injury Research, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
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36
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Chen HM, Chen VCH, Wang TN, Lu ML, Huang YC, Dewey ME, Lee JKW, Tsai CP. Diseases of the pancreas and suicide mortality: A nationwide nested case-control study among patients with mental health disorders in Taiwan. Gen Hosp Psychiatry 2018; 50:45-50. [PMID: 29017085 DOI: 10.1016/j.genhosppsych.2017.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/28/2017] [Accepted: 09/28/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Diseases of the pancreas, especially pancreatitis, have been implicated as possible risk factors for psychiatric illnesses, such as depression and anxiety disorder. This nested case-control study aimed to investigate the association between diseases of the pancreas and completed suicide in a psychiatric population-based study. METHODS The case group comprised 6568 completed suicides (ICD-9: E950-E959, E980-989) patients from the national mortality database between January 1, 2002 and December 1, 2010. These cases were compared with 6568 gender-, age-, residence-, and insurance premium-matched controls. Both suicide and non-suicide study patients were drawn from a group with previous psychiatric diagnoses. The risk of suicide among patients with diseases of the pancreas was analyzed using a conditional logistic regression model that controlled for alcohol-related disorder, drug dependence, schizophrenia, depressive disorder, bipolar disorder, anxiety disorder, Charlson comorbidity score, and outpatient visits. RESULTS Disease of the pancreas was an independent risk factor for psychiatric patients who had completed suicide when adjusted for clinical and other comorbid factors. Among these covariates, alcohol-related disorders partially mediate the suicide risk among patients with disease of the pancreas, and mental disorders may not mediate this suicide risk. CONCLUSIONS Diseases of the pancreas were associated with increased risk of completed suicide after controlling for potential confounding factors.
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Affiliation(s)
- Hong-Ming Chen
- Department of Psychiatry, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Taiwan; School of Medicine, Chang Gung University, Taiwan
| | - Vincent Chin-Hung Chen
- Department of Psychiatry, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Taiwan; School of Medicine, Chang Gung University, Taiwan
| | - Tsu-Nai Wang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Mong-Liang Lu
- Department of Psychiatry, Wan-Fang Hospital & School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yin-Cheng Huang
- School of Medicine, Chang Gung University, Taiwan; Department of Neurosurgery, Chang Gung Memorial Hospital at Chiayi, Taiwan
| | - Michael E Dewey
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | | | - Ching-Piao Tsai
- Department of Neurology, Taipei Veterans General Hospital, Taiwan; Department of Biotechnology, Asia University, Taiwan.
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Soo DHE, Pendharkar SA, Jivanji CJ, Gillies NA, Windsor JA, Petrov MS. Derivation and validation of the prediabetes self-assessment screening score after acute pancreatitis (PERSEUS). Dig Liver Dis 2017; 49:1146-1154. [PMID: 28666861 DOI: 10.1016/j.dld.2017.05.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/21/2017] [Accepted: 05/22/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Approximately 40% of patients develop abnormal glucose metabolism after a single episode of acute pancreatitis. This study aimed to develop and validate a prediabetes self-assessment screening score for patients after acute pancreatitis. METHODS Data from non-overlapping training (n=82) and validation (n=80) cohorts were analysed. Univariate logistic and linear regression identified variables associated with prediabetes after acute pancreatitis. Multivariate logistic regression developed the score, ranging from 0 to 215. The area under the receiver-operating characteristic curve (AUROC), Hosmer-Lemeshow χ2 statistic, and calibration plots were used to assess model discrimination and calibration. The developed score was validated using data from the validation cohort. RESULTS The score had an AUROC of 0.88 (95% CI, 0.80-0.97) and Hosmer-Lemeshow χ2 statistic of 5.75 (p=0.676). Patients with a score of ≥75 had a 94.1% probability of having prediabetes, and were 29 times more likely to have prediabetes than those with a score of <75. The AUROC in the validation cohort was 0.81 (95% CI, 0.70-0.92) and the Hosmer-Lemeshow χ2 statistic was 5.50 (p=0.599). Model calibration of the score showed good calibration in both cohorts. CONCLUSION The developed and validated score, called PERSEUS, is the first instrument to identify individuals who are at high risk of developing abnormal glucose metabolism following an episode of acute pancreatitis.
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Affiliation(s)
- Danielle H E Soo
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | | | - Chirag J Jivanji
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Nicola A Gillies
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - John A Windsor
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Maxim S Petrov
- Department of Surgery, University of Auckland, Auckland, New Zealand.
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Early management of acute pancreatitis: A review of the best evidence. Dig Liver Dis 2017; 49:585-594. [PMID: 28262458 DOI: 10.1016/j.dld.2017.01.168] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/27/2017] [Accepted: 01/27/2017] [Indexed: 12/11/2022]
Abstract
In the 20th century early management of acute pancreatitis often included surgical intervention, despite overwhelming mortality. The emergence of high-quality evidence (randomized controlled trials and meta-analyses) over the past two decades has notably shifted the treatment paradigm towards predominantly non-surgical management early in the course of acute pancreatitis. The present evidence-based review focuses on contemporary aspects of early management (which include analgesia, fluid resuscitation, antibiotics, nutrition, and endoscopic retrograde cholangiopancreatography) with a view to providing clear and succinct guidelines on early management of patients with acute pancreatitis in 2017 and beyond.
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Moggia E, Koti R, Belgaumkar AP, Fazio F, Pereira SP, Davidson BR, Gurusamy KS. Pharmacological interventions for acute pancreatitis. Cochrane Database Syst Rev 2017; 4:CD011384. [PMID: 28431202 PMCID: PMC6478067 DOI: 10.1002/14651858.cd011384.pub2] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND In people with acute pancreatitis, it is unclear what the role should be for medical treatment as an addition to supportive care such as fluid and electrolyte balance and organ support in people with organ failure. OBJECTIVES To assess the effects of different pharmacological interventions in people with acute pancreatitis. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, 2016, Issue 9), MEDLINE, Embase, Science Citation Index Expanded, and trial registers to October 2016 to identify randomised controlled trials (RCTs). We also searched the references of included trials to identify further trials. SELECTION CRITERIA We considered only RCTs performed in people with acute pancreatitis, irrespective of aetiology, severity, presence of infection, language, blinding, or publication status for inclusion in the review. DATA COLLECTION AND ANALYSIS Two review authors independently identified trials and extracted data. We did not perform a network meta-analysis as planned because of the lack of information on potential effect modifiers and differences of type of participants included in the different comparisons, when information was available. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) for the binary outcomes and rate ratios with 95% CIs for count outcomes using a fixed-effect model and random-effects model. MAIN RESULTS We included 84 RCTs with 8234 participants in this review. Six trials (N = 658) did not report any of the outcomes of interest for this review. The remaining 78 trials excluded 210 participants after randomisation. Thus, a total of 7366 participants in 78 trials contributed to one or more outcomes for this review. The treatments assessed in these 78 trials included antibiotics, antioxidants, aprotinin, atropine, calcitonin, cimetidine, EDTA (ethylenediaminetetraacetic acid), gabexate, glucagon, iniprol, lexipafant, NSAIDs (non-steroidal anti-inflammatory drugs), octreotide, oxyphenonium, probiotics, activated protein C, somatostatin, somatostatin plus omeprazole, somatostatin plus ulinastatin, thymosin, ulinastatin, and inactive control. Apart from the comparison of antibiotics versus control, which included a large proportion of participants with necrotising pancreatitis, the remaining comparisons had only a small proportion of patients with this condition. Most trials included either only participants with severe acute pancreatitis or included a mixture of participants with mild acute pancreatitis and severe acute pancreatitis (75 trials). Overall, the risk of bias in trials was unclear or high for all but one of the trials. SOURCE OF FUNDING seven trials were not funded or funded by agencies without vested interest in results. Pharmaceutical companies partially or fully funded 21 trials. The source of funding was not available from the remaining trials.Since we considered short-term mortality as the most important outcome, we presented only these results in detail in the abstract. Sixty-seven studies including 6638 participants reported short-term mortality. There was no evidence of any differences in short-term mortality in any of the comparisons (very low-quality evidence). With regards to other primary outcomes, serious adverse events (number) were lower than control in participants taking lexipafant (rate ratio 0.67, 95% CI 0.46 to 0.96; N = 290; 1 study; very low-quality evidence), octreotide (rate ratio 0.74, 95% CI 0.60 to 0.89; N = 770; 5 studies; very low-quality evidence), somatostatin plus omeprazole (rate ratio 0.36, 95% CI 0.19 to 0.70; N = 140; 1 study; low-quality evidence), and somatostatin plus ulinastatin (rate ratio 0.30, 95% CI 0.15 to 0.60; N = 122; 1 study; low-quality evidence). The proportion of people with organ failure was lower in octreotide than control (OR 0.51, 95% CI 0.27 to 0.97; N = 430; 3 studies; very low-quality evidence). The proportion of people with sepsis was lower in lexipafant than control (OR 0.26, 95% CI 0.08 to 0.83; N = 290; 1 study; very low-quality evidence). There was no evidence of differences in any of the remaining comparisons in these outcomes or for any of the remaining primary outcomes (the proportion of participants experiencing at least one serious adverse event and the occurrence of infected pancreatic necrosis). None of the trials reported heath-related quality of life. AUTHORS' CONCLUSIONS Very low-quality evidence suggests that none of the pharmacological treatments studied decrease short-term mortality in people with acute pancreatitis. However, the confidence intervals were wide and consistent with an increase or decrease in short-term mortality due to the interventions. We did not find consistent clinical benefits with any intervention. Because of the limitations in the prognostic scoring systems and because damage to organs may occur in acute pancreatitis before they are clinically manifest, future trials should consider including pancreatitis of all severity but power the study to measure the differences in the subgroup of people with severe acute pancreatitis. It may be difficult to power the studies based on mortality. Future trials in participants with acute pancreatitis should consider other outcomes such as complications or health-related quality of life as primary outcomes. Such trials should include health-related quality of life, costs, and return to work as outcomes and should follow patients for at least three months (preferably for at least one year).
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Affiliation(s)
- Elisabetta Moggia
- IRCCS Humanitas Research HospitalDepartment of General and Digestive SurgeryVia Manzoni 5620089 RozzanoMilanItaly20089
| | - Rahul Koti
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free HospitalPond StreetLondonUKNW3 2QG
| | - Ajay P Belgaumkar
- Ashford and St Peter's NHS TrustDept of Upper GI SurgerySt Peter's HospitalGuildford RoadChertseyUKKT16 0PZ
| | - Federico Fazio
- Royal Free Hospital, NHS Foundation TrustHPB and Liver Transplant SurgeryLondonUK
| | - Stephen P Pereira
- Royal Free Hospital CampusUCL Institute for Liver and Digestive HealthUpper 3rd FloorLondonUKNW3 2PF
| | - Brian R Davidson
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free HospitalPond StreetLondonUKNW3 2QG
| | - Kurinchi Selvan Gurusamy
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free HospitalPond StreetLondonUKNW3 2QG
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Netinatsunton N, Attasaranya S, Sottisuporn J, Witeerungrot T, Jongboonyanuparp T, Piratvisuth T, Ovartlarnporn B. Comparing cost-effectiveness between endoscopic ultrasound and endoscopic retrograde cholangiopancreatography in diagnosis of common bile duct stone in patients with predefined risks: A study from a developing country. Endosc Ultrasound 2016; 5:165-72. [PMID: 27386473 PMCID: PMC4918299 DOI: 10.4103/2303-9027.183971] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background and Objectives: Endoscopic ultrasound (EUS) achieves results comparable to endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of common bile duct (CBD) stone, but studies from the western have shown EUS to be less expensive in patients with intermediate risk for CBD stones. The aim of this study was to compare the costs of EUS and ERCP in the diagnosis of CBD stones in a developing country. Materials and Methods: A prospective study was done with 141 patients with suspected CBD stones, categorized as having high or intermediate risk for CBD stone. All underwent EUS, and the high-risk patients had ERCP after the EUS. For intermediate-risk patients, an ERCP was done at the discretion of the attending physician. The CBD stone was confirmed by ERCP in patients who underwent both EUS and ERCP. Patients who received EUS only were followed up every 3 months for 1 year. The false negative rate in patients with EUS and ERCP was estimated in the clinical follow-up. Result: One hundred and forty-one patients (141: 83 females, 58 males) with a mean age ± standard deviation (SD) of 55.71 ±18.68 years were recruited. Ninety-four (94) patients underwent both EUS and ERCP. ERCP confirmed the diagnosis in 83 of 85 patients (97.6%) with CBD stone detected by EUS. Forty-seven (47) patients with a negative EUS and no ERCP done were symptom-free during the follow-up. The overall sensitivity, specificity, positive predictive value, and negative predictive value of EUS were 97.6%, 80%, 97.6%, and 80% respectively. An EUS-based strategy for high-risk patients was 15% more expensive than an ERCP-based strategy, but the EUS-based strategy reduced the cost to 37.78% less than the ERCP-based strategy in intermediate-risk patients. The EUS-based strategy was cost-saving when the CBD stone prevalence was less than 52.5%. Conclusion: EUS is safer and less costly than ERCP for CBD stone diagnosis in patients with intermediate risk.
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Affiliation(s)
- Nisa Netinatsunton
- NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Siriboon Attasaranya
- NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Jaksin Sottisuporn
- NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Teepawit Witeerungrot
- NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Theeratus Jongboonyanuparp
- Divison of Gastroenterology, Department of Medicine, International Hospital, Bangmot, Chom Thon, Bangkok, Thailand
| | - Teerha Piratvisuth
- NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Bancha Ovartlarnporn
- NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
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Pendharkar SA, Plank LD, Windsor JA, Petrov MS. Quality of Life in a Randomized Trial of Nasogastric Tube Feeding in Acute Pancreatitis. JPEN J Parenter Enteral Nutr 2016; 40:693-698. [DOI: 10.1177/0148607115574290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
| | - Lindsay D. Plank
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - John A. Windsor
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Maxim S. Petrov
- Department of Surgery, University of Auckland, Auckland, New Zealand
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Ghrelin and gastroparesis as early predictors of clinical outcomes in acute pancreatitis. Pancreatology 2015; 16:181-8. [PMID: 26777539 DOI: 10.1016/j.pan.2015.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 10/30/2015] [Accepted: 12/13/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Impaired motor and hormonal gastrointestinal functions have been implicated in the pathogenesis of acute pancreatitis. The aim of the present study was to investigate the predictive value of the Gastroparesis Cardinal Symptom Index and serum ghrelin in the development of clinically meaningful outcomes in patients with acute pancreatitis. METHODS This was a prospective clinical study. The Gastroparesis Cardinal Symptom Index and serum ghrelin were measured for 48 h after hospitalization. Univariate and multivariate logistic regression analyses were conducted. RESULTS The Gastroparesis Cardinal Symptom Index total score alone on day 2 was a significant predictor of oral feeding intolerance in both unadjusted (odds ratio 1.21 (1.01-1.46), P = 0.04) and adjusted (odds ratio 1.30 (1.01-1.69), P = 0.05) analyses. Adding ghrelin to Gastroparesis Cardinal Symptom Index further improved prediction in both unadjusted (odds ratio 1.26 (1.02-1.56), P = 0.03) and adjusted (odds ratio 1.53 (1.00-2.35), P = 0.05) analyses. CONCLUSION This pilot study demonstrates that the Gastroparesis Cardinal Symptom Index has a potential to be used as a predictor of oral feeding intolerance. Ghrelin, when combined with the Gastroparesis Cardinal Symptom Index, may further improve the predictive accuracy. These findings need to be confirmed in larger studies.
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Pendharkar SA, Asrani V, Das SL, Wu LM, Grayson L, Plank LD, Windsor JA, Petrov MS. Association between oral feeding intolerance and quality of life in acute pancreatitis: A prospective cohort study. Nutrition 2015; 31:1379-84. [DOI: 10.1016/j.nut.2015.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 06/02/2015] [Accepted: 06/12/2015] [Indexed: 12/14/2022]
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Ma J, Pendharkar SA, O'Grady G, Windsor JA, Petrov MS. Effect of Nasogastric Tube Feeding vs Nil per Os on Dysmotility in Acute Pancreatitis: Results of a Randomized Controlled Trial. Nutr Clin Pract 2015; 31:99-104. [PMID: 26341916 DOI: 10.1177/0884533615603967] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Evidence from animal studies suggests that gastrointestinal motility is impaired in acute pancreatitis. Enteral nutrition, and more specifically nasogastric tube feeding, has emerged as a key treatment modality in patients with acute pancreatitis, but its effect on motility has not been investigated in this setting. The aim was to validate the Gastroparesis Cardinal Symptom Index (GCSI) in patients with acute pancreatitis and determine the effect of nasogastric tube feeding on GCSI. METHODS The study design was a randomized controlled trial. Patients were allocated to nasogastric tube feeding or nil per os within 24 hours of hospital admission. GCSI data from before randomization to 72 hours after randomization were analyzed. The test-retest reliability analysis was used to calculate Cronbach's α. RESULTS Seventeen patients were randomized to nasogastric tube feeding and 18 to nil per os. Overall, the total GCSI score significantly decreased over the study (F = 8.537; P = .001) but was not significantly different between the 2 study groups during hospitalization (F = 1.159; P = .322). However, patients on nasogastric tube feeding did show improved appetite compared with nil per os (F = 3.526; P = .036). The GCSI was found to be a reliable tool in the setting of acute pancreatitis (Cronbach's α = 0.852). CONCLUSIONS Nasogastric tube feeding does not appear to affect dysmotility symptoms in acute pancreatitis as measured by the GCSI, although appetite improved. Use of the simple, noninvasive, and inexpensive GCSI tool to evaluate motility is recommended in future clinical trials in pancreatology.
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Affiliation(s)
- Jiemin Ma
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | | | - Gregory O'Grady
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - John A Windsor
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Maxim S Petrov
- Department of Surgery, University of Auckland, Auckland, New Zealand
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Yang ZW, Meng XX, Xu P. Central role of neutrophil in the pathogenesis of severe acute pancreatitis. J Cell Mol Med 2015; 19:2513-20. [PMID: 26249268 PMCID: PMC4627557 DOI: 10.1111/jcmm.12639] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 05/20/2015] [Indexed: 02/06/2023] Open
Abstract
Severe acute pancreatitis (SAP) is an acute abdominal disease with the strong systemic inflammatory response, and rapidly progresses from a local pancreatic damage into multiple organ dysfunction. For many decades, the contributions of neutrophils to the pathology of SAP were traditionally thought to be the chemokine and cytokine cascades that accompany inflammation. In this review, we focus mainly on those recently recognized aspects of neutrophils in SAP processes. First, emerging evidence suggests that therapeutic interventions targeting neutrophils significantly lower tissue damage and protect against the occurrence of pancreatitis. Second, trypsin activation promotes the initial neutrophils recruitment into local pancreas, and subsequently neutrophils infiltration in turn triggers trypsin production. Finally, neutrophils have the unique ability to release neutrophil extracellular traps even in the absence of pathogens.
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Affiliation(s)
- Zhi-Wen Yang
- Pharmacy Department, Songjiang Hospital Affiliated the First People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao-Xiao Meng
- Digestive Department, Songjiang Hospital Affiliated the First People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ping Xu
- Digestive Department, Songjiang Hospital Affiliated the First People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Ho TW, Wu JM, Kuo TC, Yang CY, Lai HS, Hsieh SH, Lai F, Tien YW. Change of Both Endocrine and Exocrine Insufficiencies After Acute Pancreatitis in Non-Diabetic Patients: A Nationwide Population-Based Study. Medicine (Baltimore) 2015; 94:e1123. [PMID: 26166112 PMCID: PMC4504627 DOI: 10.1097/md.0000000000001123] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Acute pancreatitis (AP) is the most common pancreatic disease and consists of an acute inflammation of the pancreas. AP can contribute to endocrine and exocrine insufficiencies in survivors as a result of the key role of the pancreas in both glucose metabolism and nutritional digestion. The aim of this population-based study was to determine the endocrine or exocrine insufficiencies in patients after initial AP with biliary or alcohol-associated causes.We conducted a nationwide cohort study using data from Taiwan's National Health Insurance Research Database collected between 2001 and 2010. A total of 12,284 patients with AP were identified.Alcohol-associated AP (odds ratio, 1.894; 95% CI, 1.520-2.268; P < 0.001) and ≥2 admissions for AP (odds ratio, 1.937; 95% CI, 1.483-2.391; P < 0.001) were significantly associated with newly diagnosed diabetes mellitus after AP. Further, only alcohol-associated AP (odds ratio, 1.215; 95% CI, 1.133-1.297; P < 0.001) was significantly associated with pancreatic exocrine insufficiency after AP. Additionally, alcohol-associated AP (odds ratio, 1.804; 95% CI, 1.345-2.263; P < 0.001) and ≥2 readmissions for AP (odds ratio, 3.190; 95% CI, 2.317-4.063; P < 0.001) were significantly associated with both exocrine and endocrine insufficiencies after AP.Our data showed that alcohol-associated AP, rather than a biliary cause, contributed to a higher extent to exocrine or endocrine insufficiencies. Furthermore, recurrent AP also led to endocrine insufficiency.
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Affiliation(s)
- Te-Wei Ho
- From the Department of Surgery (J-MW, T-CK, C-YY, H-SL, Y-WT); Department of Nursing, National Taiwan University Hospital and National Taiwan University College of Medicine (S-HH); and Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan, ROC (T-WH, J-MW, FL)
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Bringing Patient-Centered Care to the Fore in Diseases of the Pancreas. Gastroenterol Res Pract 2015; 2015:459214. [PMID: 26074955 PMCID: PMC4446510 DOI: 10.1155/2015/459214] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 04/24/2015] [Accepted: 04/27/2015] [Indexed: 12/17/2022] Open
Abstract
Diseases of the pancreas are often very challenging for both patients and doctors as well as pose a considerable burden on healthcare system. Emerging evidence on the importance of shared-decision making in medicine stresses the need to integrate best clinical evidence and patient-reported outcomes to deliver optimal patient care. This paper argues that patient-centered care should no longer be a hermit in management of pancreatic diseases in the 21st century.
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