1
|
Gagyi EB, Teutsch B, Veres DS, Pálinkás D, Vörhendi N, Ocskay K, Márta K, Hegyi PJ, Hegyi P, Erőss B. Incidence of recurrent and chronic pancreatitis after acute pancreatitis: a systematic review and meta-analysis. Therap Adv Gastroenterol 2024; 17:17562848241255303. [PMID: 38883160 PMCID: PMC11179553 DOI: 10.1177/17562848241255303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/26/2024] [Indexed: 06/18/2024] Open
Abstract
Background Acute pancreatitis (AP) has a high incidence, and patients can develop recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) after AP. Objectives We aimed to estimate the pooled incidence rates (IRs), cumulative incidences, and proportions of RAP and CP after AP. Design A systematic review and meta-analysis of studies reporting the proportion of RAP and CP after AP. Data sources and methods The systematic search was conducted in three (PubMed, EMBASE, and CENTRAL) databases on 19 December 2023. Articles reporting the proportion of RAP or CP in patients after the first and multiple episodes of AP were eligible. The random effects model was used to calculate the pooled IR with 95% confidence intervals (CIs). The I 2 value assessed heterogeneity. The risk of bias assessment was conducted with the Joanna Briggs Institute Critical Appraisal Tool. Results We included 119 articles in the quantitative synthesis and 29 in the IRs calculations. Our results showed that the IR of RAP in adult patients after AP was 5.26 per 100 person-years (CI: 3.99-6.94; I 2 = 93%), while in children, it was 4.64 per 100 person-years (CI: 2.73-7.87; I 2 = 88%). We also found that the IR of CP after AP was 1.4 per 100 person-years (CI: 0.9-2; I 2 = 75%), while after RAP, it increased to 4.3 per 100 person-years (CI: 3.1-6.0; I 2 = 76%). The risk of bias was moderate in the majority of the included studies. Conclusion Our results showed that RAP affects many patients with AP. Compared to patients with the first AP episode, RAP leads to a threefold higher IR for developing CP. Trial registration Our protocol was registered on PROSPERO (CRD42021283252).
Collapse
Affiliation(s)
- Endre-Botond Gagyi
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Selye János Doctoral College for Advanced Studies, Semmelweis University, Budapest, Hungary
| | - Brigitta Teutsch
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Dániel Sándor Veres
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Dániel Pálinkás
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Gastroenterology, Military Hospital Medical Centre, Hungarian Defense Forces, Budapest, Hungary
| | - Nóra Vörhendi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Klementina Ocskay
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Katalin Márta
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Péter Jenő Hegyi
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Institute for Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Bálint Erőss
- Institute for Pancreatic Diseases, Semmelweis University, Budapest, Hungary
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| |
Collapse
|
2
|
Angyal D, Kleinfelder K, Ciciriello F, Groeneweg TA, De Marchi G, de Pretis N, Bernardoni L, Rodella L, Tomba F, De Angelis P, Surace C, Pintani E, Alghisi F, de Jonge HR, Melotti P, Sorio C, Lucidi V, Bijvelds MJC, Frulloni L. CFTR function is impaired in a subset of patients with pancreatitis carrying rare CFTR variants. Pancreatology 2024; 24:394-403. [PMID: 38493004 DOI: 10.1016/j.pan.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Many affected by pancreatitis harbor rare variants of the cystic fibrosis (CF) gene, CFTR, which encodes an epithelial chloride/bicarbonate channel. We investigated CFTR function and the effect of CFTR modulator drugs in pancreatitis patients carrying CFTR variants. METHODS Next-generation sequencing was performed to identify CFTR variants. Sweat tests and nasal potential difference (NPD) assays were performed to assess CFTR function in vivo. Intestinal current measurement (ICM) was performed on rectal biopsies. Patient-derived intestinal epithelial monolayers were used to evaluate chloride and bicarbonate transport and the effects of a CFTR modulator combination: elexacaftor, tezacaftor and ivacaftor (ETI). RESULTS Of 32 pancreatitis patients carrying CFTR variants, three had CF-causing mutations on both alleles and yielded CF-typical sweat test, NPD and ICM results. Fourteen subjects showed a more modest elevation in sweat chloride levels, including three that were provisionally diagnosed with CF. ICM indicated impaired CFTR function in nine out of 17 non-CF subjects tested. This group of nine included five carrying a wild type CFTR allele. In epithelial monolayers, a reduction in CFTR-dependent chloride transport was found in six out of 14 subjects tested, whereas bicarbonate secretion was reduced in only one individual. In epithelial monolayers of four of these six subjects, ETI improved CFTR function. CONCLUSIONS CFTR function is impaired in a subset of pancreatitis patients carrying CFTR variants. Mutations outside the CFTR locus may contribute to the anion transport defect. Bioassays on patient-derived intestinal tissue and organoids can be used to detect such defects and to assess the effect of CFTR modulators.
Collapse
Affiliation(s)
- Dora Angyal
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Karina Kleinfelder
- Department of Medicine, University of Verona, Division of General Pathology, Verona, Italy
| | - Fabiana Ciciriello
- Cystic Fibrosis Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, Italy
| | - Tessa A Groeneweg
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Giulia De Marchi
- Gastroenterology Unit, Department of Medicine, Borgo Roma Hospital, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Nicolò de Pretis
- Gastroenterology Unit, Department of Medicine, Borgo Roma Hospital, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Laura Bernardoni
- Gastroenterology Unit, Department of Medicine, Borgo Roma Hospital, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Luca Rodella
- Endoscopy Surgery Unit, Azienda Ospedaliera Universitaria Integrata Verona, 37126, Verona, Italy
| | - Francesco Tomba
- Endoscopy Surgery Unit, Azienda Ospedaliera Universitaria Integrata Verona, 37126, Verona, Italy
| | - Paola De Angelis
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Cecilia Surace
- Laboratory of Medical Genetics, Bambino Gesù Children's Hospital, IRCCS, Viale di San Paolo 15, 00146, Rome, Italy
| | - Emily Pintani
- Cystic Fibrosis Centre, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Federico Alghisi
- Cystic Fibrosis Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, Italy
| | - Hugo R de Jonge
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Paola Melotti
- Cystic Fibrosis Centre, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Claudio Sorio
- Department of Medicine, University of Verona, Division of General Pathology, Verona, Italy
| | - Vincenzina Lucidi
- Cystic Fibrosis Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, Italy
| | - Marcel J C Bijvelds
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, the Netherlands.
| | - Luca Frulloni
- Gastroenterology Unit, Department of Medicine, Borgo Roma Hospital, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| |
Collapse
|
3
|
Horitani S, Sanuki T, Fujigaki S, Tabuchi J, Tabuchi K, Shirohata A, Ariyoshi R, Tanaka K, Morikawa T, Kinoshita Y. A case of acute recurrent pancreatitis caused by biliopancreatic reflux without pancreaticobiliary maljunction. Clin J Gastroenterol 2024; 17:183-187. [PMID: 37938454 DOI: 10.1007/s12328-023-01875-x] [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: 07/09/2023] [Accepted: 10/03/2023] [Indexed: 11/09/2023]
Abstract
Acute recurrent pancreatitis (ARP) is a clinical condition characterized by repeated episodes of acute pancreatitis. In this case study, a 62-year-old man was diagnosed with mild pancreatitis five years ago, with alcohol intake initially considered the cause. Since then, he experienced three episodes of pancreatitis despite ceasing alcohol consumption completely. Consequently, the patient was diagnosed with ARP. Various diagnostic and imaging tests were performed to determine the etiology of his condition, including blood tests, magnetic resonance cholangiopancreatography, endoscopic ultrasonography, and contrast-enhanced computed tomography. The results were inconclusive; however, endoscopic retrograde cholangiopancreatography revealed the reflux of bile and pancreatic juice into the alternative ducts, despite the absence of anatomical abnormalities in the biliary tract or pancreatic duct. These findings subsequently led to the diagnosis of biliopancreatic reflux, which activated pancreatic enzymes causing ARP. Endoscopic biliary sphincterotomy was performed to alleviate the patient's symptoms. One year later, the patient remained symptom-free. This case highlights the importance of examining bile and pancreatic juice components before considering endoscopic sphincterotomy in patients with unexplained ARP.
Collapse
Affiliation(s)
- Susumu Horitani
- Department of Gastroenterology and Endoscopy, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264, Kamiya-Cho, Himeji, Hyogo, 670-8560, Japan
| | - Tsuyoshi Sanuki
- Department of Gastroenterology and Endoscopy, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264, Kamiya-Cho, Himeji, Hyogo, 670-8560, Japan.
| | - Seiji Fujigaki
- Department of Gastroenterology and Endoscopy, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264, Kamiya-Cho, Himeji, Hyogo, 670-8560, Japan
| | - Joji Tabuchi
- Department of Gastroenterology and Endoscopy, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264, Kamiya-Cho, Himeji, Hyogo, 670-8560, Japan
| | - Kota Tabuchi
- Department of Gastroenterology and Endoscopy, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264, Kamiya-Cho, Himeji, Hyogo, 670-8560, Japan
| | - Akira Shirohata
- Department of Gastroenterology and Endoscopy, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264, Kamiya-Cho, Himeji, Hyogo, 670-8560, Japan
| | - Ryusuke Ariyoshi
- Department of Gastroenterology and Endoscopy, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264, Kamiya-Cho, Himeji, Hyogo, 670-8560, Japan
| | - Katsuhide Tanaka
- Department of Gastroenterology and Endoscopy, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264, Kamiya-Cho, Himeji, Hyogo, 670-8560, Japan
| | - Teruhisa Morikawa
- Department of Gastroenterology and Endoscopy, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264, Kamiya-Cho, Himeji, Hyogo, 670-8560, Japan
| | - Yoshikazu Kinoshita
- Department of Gastroenterology and Endoscopy, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264, Kamiya-Cho, Himeji, Hyogo, 670-8560, Japan
| |
Collapse
|
4
|
Bing W, Zhang X, Wang D, Gu X. Clinical value of CT imaging features in the diagnosis of acute and chronic pancreatitis: A retrospective study. Technol Health Care 2024; 32:605-613. [PMID: 37522229 DOI: 10.3233/thc-220732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
BACKGROUND Recurrent acute pancreatitis is a common acute abdominal disease in surgery. OBJECTIVE To evaluate the radiographic features of pancreatic computed tomography (CT) imaging in the diagnosis of acute and chronic pancreatitis. METHODS 48 pancreatitis patients who met the criteria were selected in this retrospective study from 2010 to 2019. Each diagnosis was evaluated as functional abdominal pain, recurrent acute pancreatitis, or chronic pancreatitis. All clinical data were collected from the patient's medical records. 54 radiological features were extracted from each region of interest in outline the pancreas and divided into five categories: first order statistics, the gray level co-occurrence matrix (GLCM), the gray level run-length matrix (GLRLM), the neighborhood gray level difference matrix (NGTDM), and morphological features by the MATLAB program. RESULTS Of the 48 patients, 16 had functional abdominal pain (33.3%), 18 had recurrent acute pancreatitis (37.5%), and 14 had chronic pancreatitis (29.2%). In the univariate analysis, nine radiological features, eight GLCM features and one NGTDM feature were significantly different between groups. Nine radiological characteristics had important reference values with AUC values ranging from 0.73-0.91. CONCLUSION Nine radiographic features of CT imaging demonstrate good evaluation efficiency in the diagnosis of pancreatitis and can distinguish patients with functional abdominal pain, recurrent acute pancreatitis, and chronic pancreatitis.
Collapse
Affiliation(s)
- Wanchun Bing
- Department of Radiology, Hospital of Northwest Minzu University, Lanzhou, Gansu, China
| | - Xiaoxiao Zhang
- Department of Imaging, Taihe People's Hospital, Fuyang, Anhui, China
| | - Dawei Wang
- Department of Imaging, Taihe People's Hospital, Fuyang, Anhui, China
| | - Xiaoyan Gu
- Department of Imaging, Taihe People's Hospital, Fuyang, Anhui, China
| |
Collapse
|
5
|
Zhu L, Yuan L, Wang T, Zhu Q, Zhang Q, Pan C, Xu Q, Deng D, Chen W, Chen J. Relation between triglycerides and the severity of acute pancreatitis combined with nonalcoholic fatty liver disease: a retrospective study. BMC Gastroenterol 2023; 23:313. [PMID: 37710167 PMCID: PMC10503164 DOI: 10.1186/s12876-023-02951-9] [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: 04/01/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) can exacerbate the severity of acute pancreatitis (AP), and this severity is worsened with increased severity of NAFLD. This study aimed to investigate the relation between serum triglyceride (TG) and the severity of AP with NAFLD by collecting clinical data from AP patients with NAFLD. METHODS AP patients with NAFLD were divided into 2 groups according to TG levels: hypertriglyceridemia (HTG) group and non-hypertriglyceridemia (NHTG) group. RESULTS In total, 598 AP patients with NAFLD were enrolled in this study, including 433 in the HTG group and 165 in the NHTG group. Compared with the NHTG group, AP patients in the HTG group were more serious (P < 0.05). The incidence of persistent organ failure (POF), especially persistent respiratory failure, and the ratio of acute peripancreatic fluid collection (APFC) were higher in the HTG group (P < 0.05). Higher TG levels were associated with a higher incidence of APFC (P < 0.05). Logistic regression analysis showed that the risk of APFC was significantly higher in moderate and severe NAFLD than in mild NAFLD. CONCLUSION HTG may aggravate the severity and local complications of AP combined with NAFLD.
Collapse
Affiliation(s)
- Lei Zhu
- Department of Gastroenterology, Northern Jiangsu People's Hospital, Yangzhou University, No 98, Nantong West Rd, Yangzhou, Jiangsu, China, 225000
| | - Leyao Yuan
- Department of Gastroenterology, Northern Jiangsu People's Hospital, Yangzhou University, No 98, Nantong West Rd, Yangzhou, Jiangsu, China, 225000
| | - Tingting Wang
- Department of Gastroenterology, Northern Jiangsu People's Hospital, Yangzhou University, No 98, Nantong West Rd, Yangzhou, Jiangsu, China, 225000
| | - Quping Zhu
- Department of Gastroenterology, Northern Jiangsu People's Hospital, Yangzhou University, No 98, Nantong West Rd, Yangzhou, Jiangsu, China, 225000
| | - Qian Zhang
- Department of Gastroenterology, Northern Jiangsu People's Hospital, Yangzhou University, No 98, Nantong West Rd, Yangzhou, Jiangsu, China, 225000
| | - Changbao Pan
- Department of Gastroenterology, Northern Jiangsu People's Hospital, Yangzhou University, No 98, Nantong West Rd, Yangzhou, Jiangsu, China, 225000
| | - Qingcheng Xu
- Department of Gastroenterology, Northern Jiangsu People's Hospital, Yangzhou University, No 98, Nantong West Rd, Yangzhou, Jiangsu, China, 225000
| | - Denghao Deng
- Department of Gastroenterology, Northern Jiangsu People's Hospital, Yangzhou University, No 98, Nantong West Rd, Yangzhou, Jiangsu, China, 225000
| | - Weiwei Chen
- Department of Gastroenterology, Northern Jiangsu People's Hospital, Yangzhou University, No 98, Nantong West Rd, Yangzhou, Jiangsu, China, 225000.
| | - Juan Chen
- Department of Gastroenterology, Northern Jiangsu People's Hospital, Yangzhou University, No 98, Nantong West Rd, Yangzhou, Jiangsu, China, 225000.
| |
Collapse
|
6
|
CAMARNEIRO RM, GOMES AP, CAIRES FG, SILVA CR, CAPUNGE IR, ROCHA RP, FERREIRA ÁE, NUNES VM. Transient hyperbilirubinemia as a risk factor for gallstones related events of the acute gallstone pancreatitis. Chirurgia (Bucur) 2023. [DOI: 10.23736/s0394-9508.22.05395-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
|
7
|
Qin XZ, Zhou CH, Zhang BY, Zhang L, Gong TT, Zhang MM, Wang D, Zou DW. Recurrent acute pancreatitis caused by duodenal papillary adenoma: A case report and literature review. J Dig Dis 2023; 24:60-66. [PMID: 36790293 DOI: 10.1111/1751-2980.13160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/10/2023] [Accepted: 02/12/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Xian Zheng Qin
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chun Hua Zhou
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ben Yan Zhang
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ling Zhang
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting Ting Gong
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Min Zhang
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dong Wang
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Duo Wu Zou
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
8
|
Xie H, Wang X, Xue M, Qiu Y, Ge W. Effectiveness and safety of path-based analgesic regimens designed by clinical pharmacists based on the type of biliary and pancreatic surgery. J Clin Pharm Ther 2022; 47:2302-2311. [PMID: 36440669 DOI: 10.1111/jcpt.13814] [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: 06/17/2022] [Revised: 10/19/2022] [Accepted: 10/23/2022] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE As the incidence of postoperative pain in patients with biliary and pancreatic diseases has gradually increased, how to control postoperative pain has received increasing research attention. By reading pain management guidelines and multidisciplinary communication and cooperation, clinical pharmacists designed multi-mode analgesia regimens based on surgical types, in order to provide strong evidence for the effectiveness and safety of postoperative analgesia regimens and better serve patients. METHODS Data from biliary or pancreatic surgery performed at Nanjing Drum Tower Hospital from 2019 to 2021 were collected. Take October 2020 as the time point to compare the outcomes before and after the implementation of the path-based postoperative analgesic regimens. The primary outcomes were NRS pain scores, sleep quality, and incidence of adverse reactions. Length of stay was a secondary outcome. RESULTS AND DISCUSSION A total of 268 and 239 patients were enrolled in the study and control groups, respectively. Four path-based postoperative analgesic management regimens significantly reduced patients' static and dynamic NRS scores in the 24 h (p < 0.05). The patients' sleep quality were better than controls (p > 0.05). The incidence of adverse reactions and the length of stay in the study group were numerically lower than controls. Moderate analysis indicated that four analgesia regimens are more precise and better meet actual clinical needs. WHAT IS NEW AND CONCLUSION Effective and safe postoperative pain management is particularly important for clinical purposes. Path-based postoperative analgesia regimens based on different types of surgery overcome the disadvantages of overly broad and generalized traditional guidelines, which play an important role in providing personalized and precise clinical services. Further, study findings provide evidence that four path-based analgesic regimens can reduce postoperative pain and reduce the length of hospital stay, which may provide a better direction for clinical postoperative pain management.
Collapse
Affiliation(s)
- Han Xie
- Department of Pharmacy, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.,State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Taipa, Macau
| | - Xinmei Wang
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Min Xue
- Department of Pharmacy, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yudong Qiu
- Department of General Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Weihong Ge
- Department of Pharmacy, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| |
Collapse
|
9
|
Acute recurrent pancreatitis in a child with pancreatic divisum– A case report. Ann Med Surg (Lond) 2022; 82:104642. [PMID: 36268436 PMCID: PMC9577615 DOI: 10.1016/j.amsu.2022.104642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 09/09/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction and importance In children, acute recurrent pancreatitis is attributed to pancreato-biliary anomalies, hereditary pancreatitis and cystic fibrosis. Pancreatic divisum is a common congenital ductal anomaly that leads to recurrence of pancreatitis. Case presentation A 13 years old female presented with clinical features of acute recurrent pancreatitis. After ruling out common causes, magnetic resonance cholangiopancreatography was done which showed pancreatic divisum. Her symptoms resolved following duodenum preserving pancreatic head resection. Discussion Acute recurrent pancreatitis is attributed to raised intrapancreatic dorsal ductal pressure due to ductal anomalies especially pancreatic divisum (PD). It is the embryological failure in the fusion of the dorsal and ventral ductal system. PD is further classified into a classical subtype where there is complete failure of ductal fusion and an incomplete subtype where there is partial fusion of the ductal system. The diagnosis is commonly done through abdominal imaging with secretin enhanced magnetic resonance cholangiopancreatography being the choice of imaging modality. The initial approach is endoscopic intervention unless patients present with signs of pancreatic fibrosis where a duodenum preserving pancreatic head resection can be carried out. Conclusion A keen suspicion should be given towards anatomical or structural variants in absence of common etiologies. Early identification and management of pancreatic divisum prevents the recurrence of pancreatitis. Pancreatic divisum is a ductal anomaly which leads to acute recurrent pancreatitis. In symptomatic cases the diagnosis is established following abdominal imaging. Conservative or surgical management are weighed upon by the severity of pancreatitis. Symptomatic patients may benefit from endoscopic or open surgical interventions.
Collapse
|
10
|
Jia X, Zhang X, Sun D, Yang N, Li R, Luo Z. Triglyceride to HDL-C ratio is associated with plasma D-dimer levels in different types of pancreatitis. Sci Rep 2022; 12:12952. [PMID: 35902759 PMCID: PMC9334300 DOI: 10.1038/s41598-022-17421-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 07/25/2022] [Indexed: 12/05/2022] Open
Abstract
This study aims to evaluate levels of D-dimer and serum lipid in different types of pancreatitis, and the relationship between D-dimer and dyslipidemia, especially triglyceride to HDL-C ratio (TG/HDL-C) in different types of pancreatitis. We analyzed the D-dimer and dyslipidemia levels in acute pancreatitis (AP), recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP). A single-centered retrospective study was conducted on 1013 patients diagnosed with AP, RAP or CP. Only patients hospitalized within 24 h of onset were included, and 204 patients were enrolled in pancreatitis groups. 68 normal persons without pancreatitis, malignant diseases, pregnancy, or organ failure, who had health check-ups, were enrolled in the control group. Blood samples were taken within 24 h of admission. The relevant information on epidemiology and etiology was collected. D-dimer and serum lipid levels in different types of pancreatitis were analyzed. Furthermore, the area under the receiver-operating characteristic curve (AUC) was used to estimate the validity of the predictor and to define optimal cut-off points for prediction. We found that D-dimer and TG/HDL-C ratio could distinguish mild AP (MAP) and non-MAP in AP and RAP patients. The D-dimer level was related to TG/HDL-C ratio and severity of pancreatitis, with the coefficient correlation of 0.379 and 0.427(p < 0.05), respectively. TG/HDL-C was related to D-dimer in different types of pancreatitis. Logistic regression analysis was conducted in the parameters at admission like alcohol abuse, dyslipidemia and coagulation disturbance in distinguishing AP and RAP groups from the control group, and the parameter like diabetes in RAP and CP groups significantly increased compared with that of the control group. The value of D-dimer level and TG/HDL-C ratio in predicting the severity of AP and RAP was confirmed but there was no significant difference between CP group and the control group. The D-dimer level was related to dyslipidemia and TG/HDL-C ratio.
Collapse
Affiliation(s)
- Xiaoqing Jia
- Department of Geriatric Medicine, Qilu Hospital, Shandong University, 107 West Wenhua Road, Jinan, 250012, Shandong, China
| | - Xiaoting Zhang
- Department of Geriatric Medicine, Qilu Hospital, Shandong University, 107 West Wenhua Road, Jinan, 250012, Shandong, China
| | - Dalong Sun
- Department of Geriatric Medicine, Qilu Hospital, Shandong University, 107 West Wenhua Road, Jinan, 250012, Shandong, China
| | - Na Yang
- Department of Geriatric Medicine, Qilu Hospital, Shandong University, 107 West Wenhua Road, Jinan, 250012, Shandong, China
| | - Rong Li
- Department of Geriatric Medicine, Qilu Hospital, Shandong University, 107 West Wenhua Road, Jinan, 250012, Shandong, China
| | - Zheng Luo
- Department of Geriatric Medicine, Qilu Hospital, Shandong University, 107 West Wenhua Road, Jinan, 250012, Shandong, China.
| |
Collapse
|
11
|
Tuck NL, Teo K, Kuhlmann L, Olesen SS, Johnson M, Bean DJ, Rashid U, MacCormick AD, Srikumar G, Drewes AM, Windsor JA. Pain patterns in chronic pancreatitis and chronic primary pain. Pancreatology 2022; 22:572-582. [PMID: 35562269 DOI: 10.1016/j.pan.2022.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 04/12/2022] [Accepted: 04/28/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Abdominal pain is the most distressing symptom of chronic pancreatitis (CP), and current treatments show limited benefit. Pain phenotypes may be more useful than diagnostic categories when planning treatments, and the presence or absence of constant pain in CP may be a useful prognostic indicator. AIMS This cross-sectional study examined dimensions of pain in CP, compared pain in CP with chronic primary pain (CPP), and assessed whether constant pain in CP is associated with poorer outcomes. METHODS Patients with CP (N = 91) and CPP (N = 127) completed the Comprehensive Pancreatitis Assessment Tool. Differences in clinical characteristics and pain dimensions were assessed between a) CP and CPP and b) CP patients with constant versus intermittent pain. Latent class regression analysis was performed (N = 192) to group participants based on pain dimensions and clinical characteristics. RESULTS Compared to CPP, CP patients had higher quality of life (p < 0.001), lower pain severity (p < 0.001), and were more likely to use strong opioids (p < 0.001). Within CP, constant pain was associated with a stronger response to pain triggers (p < 0.05), greater pain spread (p < 0.01), greater pain severity, more features of central sensitization, greater pain catastrophising, and lower quality of life compared to intermittent pain (all p values ≤ 0.001). Latent class regression analysis identified three groups, that mapped onto the following patient groups 1) combined CPP and CP-constant, 2) majority CPP, and 3) majority CP-intermittent. CONCLUSIONS Within CP, constant pain may represent a pain phenotype that corresponds with poorer outcomes. CP patients with constant pain show similarities to some patients with CPP, potentially indicating shared mechanisms.
Collapse
Affiliation(s)
- N L Tuck
- The Health and Rehabilitation Research Institute, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology (AUT), Auckland, New Zealand; The Auckland Regional Pain Service (TARPS), Auckland District Health Board (ADHB), Auckland, New Zealand; The Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, Waitematā District Health Board (WDHB), Auckland, New Zealand.
| | - K Teo
- Department of Surgery, School of Medicine, Faculty of Medical and Health Science, University of Auckland, New Zealand
| | - L Kuhlmann
- Centre for Pancreatic Diseases & Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - S S Olesen
- Centre for Pancreatic Diseases & Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - M Johnson
- Department of Psychological Medicine, Faculty of Medical and Health Science, University of Auckland, New Zealand
| | - D J Bean
- The Health and Rehabilitation Research Institute, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology (AUT), Auckland, New Zealand; The Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, Waitematā District Health Board (WDHB), Auckland, New Zealand
| | - U Rashid
- The Health and Rehabilitation Research Institute, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology (AUT), Auckland, New Zealand
| | - A D MacCormick
- Department of Surgery, School of Medicine, Faculty of Medical and Health Science, University of Auckland, New Zealand; Department of General Surgery, Counties Manukau District Health Board (CMDHB), Auckland, New Zealand
| | - G Srikumar
- Department of General Surgery, Counties Manukau District Health Board (CMDHB), Auckland, New Zealand
| | - A M Drewes
- Centre for Pancreatic Diseases & Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - J A Windsor
- Department of Surgery, School of Medicine, Faculty of Medical and Health Science, University of Auckland, New Zealand
| |
Collapse
|
12
|
Losurdo G, Gravina AG, Maroni L, Gabrieletto EM, Ianiro G, Ferrarese A. Future challenges in gastroenterology and hepatology, between innovations and unmet needs: A SIGE Young Editorial Board's perspective. Dig Liver Dis 2022; 54:583-597. [PMID: 34509394 DOI: 10.1016/j.dld.2021.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 02/08/2023]
Abstract
Gastroenterology, Digestive Endoscopy and Hepatology have faced significant improvements in terms of diagnosis and therapy in the last decades. However, many fields still remain poorly explored, and many questions unanswered. Moreover, basic-science, as well as translational and clinical discoveries, together with technology advancement will determine further steps toward a better, refined care for many gastroenterological disorders in the future. Therefore, the Young Investigators of the Italian Society of Gastroenterology (SIGE) joined together, offering a perspective on major future innovations in some hot clinical topics in Gastroenterology, Endoscopy, and Hepatology, as well as the current pitfalls and the grey zones.
Collapse
Affiliation(s)
- Giuseppe Losurdo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University 'Aldo Moro' of Bari; PhD Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Emergency and Organ Transplantation, University 'Aldo Moro' of Bari.
| | - Antonietta Gerarda Gravina
- Hepatogastroenterology Division, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Luca Maroni
- Department of Gastroenterology, Marche Polytechnic University, Ancona, Italy
| | | | - Gianluca Ianiro
- Digestive Disease Center, Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alberto Ferrarese
- Gastroenterology and Hepatology, Azienda Ospedaliera Universitaria Integrata, Ospedale Borgo Trento, Verona, Italy
| | | |
Collapse
|
13
|
Hu Y, Liu N, Tang L, Liu Q, Pan K, Lei L, Huang X. Three-Dimensional Radiomics Features of Magnetic Resonance T2-Weighted Imaging Combined With Clinical Characteristics to Predict the Recurrence of Acute Pancreatitis. Front Med (Lausanne) 2022; 9:777368. [PMID: 35360712 PMCID: PMC8960240 DOI: 10.3389/fmed.2022.777368] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/31/2022] [Indexed: 12/12/2022] Open
Abstract
ObjectiveTo explore the diagnostic value of radiomics model based on magnetic resonance T2-weighted imaging for predicting the recurrence of acute pancreatitis.MethodsWe retrospectively collected 190 patients with acute pancreatitis (AP), including 122 patients with initial acute pancreatitis (IAP) and 68 patients with recurrent acute pancreatitis (RAP). At the same time, the clinical characteristics of the two groups were collected. They were randomly divided into training group and validation group in the ratio of 7:3. One hundred thirty-four cases in the training group, including 86 cases of IAP and 48 cases of RAP. There were 56 cases in the validation group, including 36 cases of IAP and 20 cases of RAP. Least absolute shrinkage and selection operator (LASSO) were used for feature screening. Logistic regression was used to establish the radiomics model, clinical model and combined model for predicting AP recurrence. The predictive ability of the three models was evaluated by the area under the curve (AUC). The recurrence risk in patients with AP was assessed using the nomogram.ResultsThe AUCs of radiomics model in training group and validation group were 0.804 and 0.788, respectively. The AUCs of the combined model in the training group and the validation group were 0.833 and 0.799, respectively. The AUCs of the clinical model in training group and validation group were 0.677 and 0.572, respectively. The sensitivities of the radiomics model, combined model, and clinical model were 0.646, 0.691, and 0.765, respectively. The specificities of the radiomics model, combined model, and clinical model were 0.791, 0.828, and 0.590, respectively. There was no significant difference in AUC between the radiomics model and the combined model for predicting RAP (p = 0.067). The AUCs of the radiomics model and combined model were greater than those of the clinical model (p = 0.008 and p = 0.007, respectively).ConclusionsRadiomics features based on magnetic resonance T2WI could be used as biomarkers to predict the recurrence of AP, and radiomics model and combined model can provide new directions for predicting recurrence of acute pancreatitis.
Collapse
|
14
|
Okobi OE, Dawkins B, Saoji J, Nyabera K, Metellus D, Hapshy V, Osueni A, Gunawardene IA, Dorcé-Medard J. Recurrent Acute Pancreatitis and Superior Mesenteric Venous Thrombosis - Cause or Course. Cureus 2021; 13:e18558. [PMID: 34765342 PMCID: PMC8575324 DOI: 10.7759/cureus.18558] [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] [Accepted: 10/07/2021] [Indexed: 11/05/2022] Open
Abstract
The management of pancreatitis can be daunting, especially when associated with other comorbidities. These complexities in management are conflicting in the presence of comorbidities with a similar presentation, such as abdominal pain. Acute pancreatitis (AP) has been associated with mesenteric thrombosis but less commonly with superior mesenteric vein thrombosis (SMVT) as a causal or complicating dilemma. This case report describes the careful intrigues and overlaps in presentation. Furthermore, this paper presents a dilemma in that contrast-enhanced computed tomography (CT) may not be recommended in the early stage of diagnosis of AP according to the 2013 American College of Gastroenterology (ACG) guideline, but SMVT, which can be fatal, sometimes, complicates AP, and contrast-enhanced CT is important in its diagnosis. This paper attempts to address this dilemma. Managing these two potentially fatal pathologies requires promptness and thoughtfulness in averting a deadly outcome. Because SMVT is fatal, in this paper, we reiterate the use of contrast-enhanced CT in the early stages of the management of AP. Fatal complications from AP should not be missed. Although contrast-enhanced CT is not recommended in the early stages of diagnosis of AP in the ACG guideline, fatal complications such as SMVT can be avoided.
Collapse
Affiliation(s)
- Okelue E Okobi
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | - Bryan Dawkins
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | - Janaki Saoji
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | - Kevin Nyabera
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | | | - Vera Hapshy
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | - Azeberoje Osueni
- Nephrology, Brookdale University Hospital Medical Center, New York, USA
| | | | | |
Collapse
|
15
|
Tarar ZI, Zafar MU, Ghous G, Farooq U, Shoukat HMH. Pravastatin-Induced Acute Pancreatitis: A Case Report and Literature Review. J Investig Med High Impact Case Rep 2021; 9:23247096211028386. [PMID: 34180257 PMCID: PMC8243091 DOI: 10.1177/23247096211028386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Pancreatitis is inflammation of pancreas associated most commonly with chronic
alcoholism and gallstones. Other less common causes of pancreatitis are
hyperlipidemia, infections, surgery, trauma, post endoscopic retrograde
cholangiopancreatography, and drugs. Drugs are now increasingly recognized as a
cause of pancreatitis, and high suspicion and exclusion of other most common
causes is required before considering drug-induced pancreatitis. There are few
case reports of acute pancreatitis in the literature after statin use, but out
of these, only 3 are after starting pravastatin. We are reporting a case of
49-year-old male who presented with nausea, vomiting, and abdominal pain. His
laboratory findings were significant for lipase more than 10 000 on admission,
and computed tomography scan of abdomen was showing peripancreatic fat stranding
and inflammation. After exclusion of most common causes of pancreatitis,
pravastatin was found probable culprit for his symptoms, which he started taking
2 weeks ago. We also reviewed the literature on statins-induced acute
pancreatitis. With increased uses of statins, physician need to be vigilant to
suspect statins as a culprit in cases of pancreatitis with unknown etiology.
Prompt discontinuation of statins is required in these cases.
Collapse
Affiliation(s)
- Zahid Ijaz Tarar
- University of Missouri, Columbia, MO,
USA
- Zahid Ijaz Tarar, MD, Department of
Internal Medicine, University of Missouri, 1 Hospital Drive, Columbia, MO 65211,
USA.
| | | | | | - Umer Farooq
- Loyola Medicine, MacNeal Hospital,
Berwyn, IL, USA
| | | |
Collapse
|
16
|
Manohar M, Kandikattu HK, Upparahalli Venkateshaiah S, Yadavalli CS, Mishra A. Eosinophils in the pathogenesis of pancreatic disorders. Semin Immunopathol 2021; 43:411-422. [PMID: 33783592 PMCID: PMC8249347 DOI: 10.1007/s00281-021-00853-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/18/2021] [Indexed: 12/19/2022]
Abstract
Eosinophils comprise approximately 1-4% of total blood leukocytes that reside in the intestine, bone marrow, mammary gland, and adipose tissues to maintain innate immunity in healthy individuals. Eosinophils have four toxic granules known as major basic protein (MBP), eosinophil cationic protein (ECP), eosinophil peroxidase (EPO), and eosinophil-derived neurotoxin (EDN), and upon degranulation, these granules promote pathogenesis of inflammatory diseases like allergy, asthma, dermatitis, and gastrointestinal disorders. Additionally, the role of eosinophils is underscored in exocrine disorders including pancreatitis. Chronic pancreatitis (CP) is an inflammatory disorder that occurs due to the alcohol consumption, blockage of the pancreatic duct, and trypsinogen mutation. Eosinophil levels are detected in higher numbers in both CP and pancreatic cancer patients compared with healthy individuals. The mechanistic understanding of chronic inflammation-induced pancreatic malignancy has not yet been reached and requires further exploration. This review provides a comprehensive summary of the epidemiology, pathophysiology, evaluation, and management of eosinophil-associated pancreatic disorders and further summarizes current evidence regarding risk factors, pathophysiology, clinical features, diagnostic evaluation, treatment, and prognosis of eosinophilic pancreatitis (EP) and pancreatic cancer.
Collapse
Affiliation(s)
- Murli Manohar
- School of Medicine, Gastrointestinal and Hepatology Division, Stanford University, Stanford, CA, 94304, USA
| | - Hemanth Kumar Kandikattu
- John W. Deming Department of Medicine, Section of Pulmonary Diseases, Tulane Eosinophilic Disorder Center (TEDC), Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Sathisha Upparahalli Venkateshaiah
- John W. Deming Department of Medicine, Section of Pulmonary Diseases, Tulane Eosinophilic Disorder Center (TEDC), Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Chandra Sekhar Yadavalli
- John W. Deming Department of Medicine, Section of Pulmonary Diseases, Tulane Eosinophilic Disorder Center (TEDC), Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Anil Mishra
- John W. Deming Department of Medicine, Section of Pulmonary Diseases, Tulane Eosinophilic Disorder Center (TEDC), Tulane University School of Medicine, New Orleans, LA, 70112, USA.
| |
Collapse
|
17
|
Abstract
Acute pancreatitis is one of the most commonly encountered etiologies in the emergency setting, with a broad spectrum of findings that varies in severity from mild interstitial pancreas to severe forms with significant local and systemic complications that are associated with a substantial degree of morbidity and mortality. In this article the radiological aspect of the terminology and classification of acute pancreatitis are reviewed. The roles of ultrasound, computed tomography, and magnetic resonance imaging in the diagnosis and evaluation of acute pancreatitis and its complications are discussed. The authors present a practical image-rich guide, applying the revised Atlanta classification system, with the goal of facilitating radiologists to write a correct report, and reinforcing the radiologist’s role as a key member of a multidisciplinary team in treating patients with acute pancreatitis. Computed tomography is the most performed imaging test for acute pancreatitis. Nevertheless, MRI is useful in many specific situations, due to its superiority soft tissue contrast resolution and better assessment of biliary and pancreatic duct, for example in the ductal disconnection. The purpose if this article is to review recent advances in imaging acquisition and analytic techniques in the evaluation of AP.
Collapse
|
18
|
Acute pancreatitis secondary to cocaine use: a case-based systematic literature review. Clin J Gastroenterol 2021; 14:1269-1277. [PMID: 33945068 PMCID: PMC8094976 DOI: 10.1007/s12328-021-01427-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/26/2021] [Indexed: 02/07/2023]
Abstract
Cocaine use continues to be an important global public health problem. As the use of cocaine remains pervasive so have a myriad of adverse events associated with this drug. These deleterious effects are well-studied, but gastrointestinal complications remain esoteric and the existing clinical evidence is scarce. Ischemia of the esophagus and small bowel, perforation, peptic ulceration, gastrointestinal bleeding, and ischemic colitis are among the reported complications. In specific, acute pancreatitis secondary to cocaine use is an exceedingly rare clinicopathologic entity. To date, only 7 cases of this condition have been reported in the English-language literature. We hereby delineate a rare case of a 29-year-old female who developed her first episode of cocaine-associated pancreatitis. The diagnosis was made based on a standard battery of investigations and meticulous exclusion of common etiologies of acute pancreatitis. To our knowledge, this case represents the first report of re-occurrence of acute pancreatitis upon subsequent crack cocaine insufflation, adding a higher level of evidence to a fallible association. We also present a systematic review of the existing literature on acute pancreatitis following cocaine use. An updated knowledge regarding this rare association is of paramount importance for early diagnosis and astute management.
Collapse
|
19
|
Swentek L, Chung D, Ichii H. Antioxidant Therapy in Pancreatitis. Antioxidants (Basel) 2021; 10:657. [PMID: 33922756 PMCID: PMC8144986 DOI: 10.3390/antiox10050657] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 12/12/2022] Open
Abstract
Pancreatitis is pathologic inflammation of the pancreas characterized by acinar cell destruction and oxidative stress. Repeated pancreatic insults can result in the development of chronic pancreatitis, characterized by irreversible fibrosis of the pancreas and many secondary sequelae, ultimately leading to the loss of this important organ. We review acute pancreatitis, chronic pancreatitis, and pancreatitis-related complications. We take a close look at the pathophysiology with a focus on oxidative stress and how it contributes to the complications of the disease. We also take a deep dive into the evolution and current status of advanced therapies for management including dietary modification, antioxidant supplementation, and nuclear factor erythroid-2-related factor 2-Kelch-like ECH-associated protein 1(Nrf2-keap1) pathway activation. In addition, we discuss the surgeries aimed at managing pain and preventing further endocrine dysfunction, such as total pancreatectomy with islet auto-transplantation.
Collapse
Affiliation(s)
| | | | - Hirohito Ichii
- Department of Surgery, University of California, Irvine, CA 92868, USA; (L.S.); (D.C.)
| |
Collapse
|
20
|
Muniraj T, Aslanian HR, Laine L, Jamidar PA, Farrell JF, Mitchell KA, Salem RR. Resection of pancreatic cystic neoplasms in recurrent acute pancreatitis prevents recurrent pancreatitis but does not identify more malignancies. World J Gastroenterol 2021; 27:1630-1642. [PMID: 33958848 PMCID: PMC8058652 DOI: 10.3748/wjg.v27.i15.1630] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/24/2021] [Accepted: 03/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Recurrent acute pancreatitis (RAP) may be a presenting feature of and an indication for resection of pancreatic cysts, including intra-ductal papillary mucinous neoplasm (IPMN). Few data are available regarding the prevalence of malignancy and post-operative RAP in this population.
AIM To study the role of resection to help prevent RAP and analyze if presentation as RAP would be a predictor for malignancy.
METHODS This retrospective study assessed 172 patients who underwent surgical resection of pancreatic cystic neoplasms at a university hospital between 2002 and 2016. The prevalence of preoperative high-risk cyst features, and of neoplasia was compared between patients with and without RAP. To identify the cause of pancreatitis, all the patients had a detailed history of alcohol, smoking, medications obtained, and had cross-sectional imaging (contrast-enhanced computed tomography/magnetic resonance imaging) and endoscopic ultrasound to look for gallstone etiology and other structural causes for pancreatitis. The incidence of RAP post-resection was the primary outcome.
RESULTS IPMN accounted for 101 cases (58.7%) {[branch duct (BD) 59 (34.3%), main duct (MD) 42] (24.4%)}. Twenty-nine (16.9%) presented with RAP (mean 2.2 episodes): 15 had BD-IPMN, 8 MD-IPMN, 5 mucinous cystic neoplasm and 1 serous cystic neoplasm. Malignancy was similar among those with vs without RAP for all patients [6/29 (20.7%) vs 24/143 (16.8%)] and IPMN patients [6/23 (26.1%) vs 23/78 (29.5%)], although tended to be higher with RAP in BD-IPMN, [5/15 (33.3%) vs 3/44 (6.8%), P = 0.04]. At mean follow-up of 7.2 years, 1 (3.4%) RAP patient had post-resection RAP. The mean episodes of acute pancreatitis before vs after surgery were 3.4 vs 0.02 (P < 0.0001).
CONCLUSION Malignancy was not increased in patients with pancreatic cystic neoplasms who have RAP compared to those without RAP. In addition, specific cyst charac-teristics were not clearly associated with RAP. The incidence of RAP was markedly decreased in almost all patients following cyst resection.
Collapse
Affiliation(s)
- Thiruvengadam Muniraj
- Section of Digestive Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Harry R Aslanian
- Section of Digestive Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Loren Laine
- Section of Digestive Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Priya A Jamidar
- Section of Digestive Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT 06510, United States
| | - James F Farrell
- Section of Digestive Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Kisha A Mitchell
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Ronald R Salem
- Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, United States
| |
Collapse
|
21
|
Sandhu H, Mallik D, Lokavarapu MJ, Huda F, Basu S. Acute Recurrent Pancreatitis and COVID-19 Infection: A Case Report with Literature Review. Cureus 2021; 13:e13490. [PMID: 33777577 PMCID: PMC7990082 DOI: 10.7759/cureus.13490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 01/19/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection typically presents with respiratory symptoms, although presentation with gastrointestinal symptoms is not uncommon. Coronavirus disease 2019 (COVID-19) presenting as acute pancreatitis is rare. There are several etiological factors for acute recurrent pancreatitis, but its association with COVID-19 disease is not yet known. We present an unusual case of recurrent attacks of acute pancreatitis in a young woman with SARS-CoV-2 infection, which was diagnosed early but had a rapid downhill course in the second attack with a fatal outcome.
Collapse
Affiliation(s)
- Harindra Sandhu
- General Surgery, All India Institute of Medical Sciences, Rishikesh, IND
- General Surgery, Lala Lajpat Rai Memorial Medical College, Meerut, IND
| | - Dhiraj Mallik
- General Surgery, All India Institute of Medical Sciences, Rishikesh, IND
| | | | - Farhanul Huda
- General Surgery, All India Institute of Medical Sciences, Rishikesh, IND
| | - Somprakas Basu
- General Surgery, All India Institute of Medical Sciences, Rishikesh, IND
| |
Collapse
|
22
|
New-Aaron M, Ganesan M, Dagur RS, Kharbanda KK, Poluektova LY, Osna NA. Pancreatogenic Diabetes: Triggering Effects of Alcohol and HIV. BIOLOGY 2021; 10:108. [PMID: 33546230 PMCID: PMC7913335 DOI: 10.3390/biology10020108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 02/07/2023]
Abstract
Multiorgan failure may not be completely resolved among people living with HIV despite HAART use. Although the chances of organ dysfunction may be relatively low, alcohol may potentiate HIV-induced toxic effects in the organs of alcohol-abusing, HIV-infected individuals. The pancreas is one of the most implicated organs, which is manifested as diabetes mellitus or pancreatic cancer. Both alcohol and HIV may trigger pancreatitis, but the combined effects have not been explored. The aim of this review is to explore the literature for understanding the mechanisms of HIV and alcohol-induced pancreatotoxicity. We found that while premature alcohol-inducing zymogen activation is a known trigger of alcoholic pancreatitis, HIV entry through C-C chemokine receptor type 5(CCR5)into pancreatic acinar cells may also contribute to pancreatitis in people living with HIV (PLWH). HIV proteins induce oxidative and ER stresses, causing necrosis. Furthermore, infiltrative immune cells induce necrosis on HIV-containing acinar cells. When necrotic products interact with pancreatic stellate cells, they become activated, leading to the release of both inflammatory and profibrotic cytokines and resulting in pancreatitis. Effective therapeutic strategies should block CCR5 and ameliorate alcohol's effects on acinar cells.
Collapse
Affiliation(s)
- Moses New-Aaron
- Department of Environmental Health, Occupational Health and Toxicology, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Veteran Affairs Nebraska—Western Iowa Health Care System, Omaha, NE 68105, USA; (M.G.); (R.S.D.); (K.K.K.)
| | - Murali Ganesan
- Veteran Affairs Nebraska—Western Iowa Health Care System, Omaha, NE 68105, USA; (M.G.); (R.S.D.); (K.K.K.)
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Raghubendra Singh Dagur
- Veteran Affairs Nebraska—Western Iowa Health Care System, Omaha, NE 68105, USA; (M.G.); (R.S.D.); (K.K.K.)
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Kusum K. Kharbanda
- Veteran Affairs Nebraska—Western Iowa Health Care System, Omaha, NE 68105, USA; (M.G.); (R.S.D.); (K.K.K.)
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Larisa Y. Poluektova
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA;
| | - Natalia A. Osna
- Department of Environmental Health, Occupational Health and Toxicology, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Veteran Affairs Nebraska—Western Iowa Health Care System, Omaha, NE 68105, USA; (M.G.); (R.S.D.); (K.K.K.)
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA;
| |
Collapse
|
23
|
Weiss FU, Laemmerhirt F, Lerch MM. Acute Pancreatitis: Genetic Risk and Clinical Implications. J Clin Med 2021; 10:E190. [PMID: 33430357 PMCID: PMC7825757 DOI: 10.3390/jcm10020190] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/23/2020] [Accepted: 01/04/2021] [Indexed: 12/16/2022] Open
Abstract
Acute pancreatitis (AP) is one of the most common gastroenterological indications for emergency admittance and hospitalization. Gallstones, alcohol consumption or the presence of additional initiating factors give rise to a disease with a diverse clinical appearance and a hard-to predict course of progression. One major challenge in the treatment of AP patients is the early identification of patients at risk for the development of systemic complications and organ failure. In addition, 20%-30% of patients with a first episode of AP later experience progress to recurrent or chronic disease. Complex gene-environment interactions have been identified to play a role in the pathogenesis of pancreatitis, but so far no predictive genetic biomarkers could be implemented into the routine clinical care of AP patients. The current review explains common and rare etiologies of acute pancreatitis with emphasis on underlying genetic aberrations and ensuing clinical management.
Collapse
Affiliation(s)
- Frank U. Weiss
- Department of Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany; (F.L.); (M.M.L.)
| | | | | |
Collapse
|
24
|
Zhao Z, Yu Y, Xie R, Yang K, Xu D, Li L, Lin J, Zheng L, Zhang C, Xu X, Chen Y, Xu Z, Chen E, Luo M, Fei J. Prognostic value of the creatinine-albumin ratio in acute pancreatitis debridement. BMC Surg 2020; 20:322. [PMID: 33298030 PMCID: PMC7727165 DOI: 10.1186/s12893-020-00991-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/29/2020] [Indexed: 12/20/2022] Open
Abstract
Background Increases in the levels of serum C-reactive protein (CRP) and creatinine (Cr) and decreases in those of albumin (Alb) are commonly observed in acute pancreatitis (AP). We aimed to evaluate the efficacy of the Cr/Alb and CRP/Alb ratios in the prediction of surgical treatment effect in AP patients. Methods This study retrospectively analyzed clinical data obtained from 140 AP patients who underwent debridement from January 2008 to November 2018 in Shanghai Ruijin Hospital. The Cr/Alb and CRP/Alb ratios at admission and before surgery were assessed in the analysis of clinical statistics, prediction of prognoses, and logistic regression analysis. Results The admission Cr/Alb had the best predictive value of the four ratios. This value was significantly higher in patients with re-operation and those who died (P < 0.05) and was correlated with the Acute Physiology and Chronic Health Evaluation (APACHE II) score, admission CRP/Alb, preoperative Cr/Alb, and post-operative complications. The admission Cr/Alb could predict the risk of AP-related re-operation and mortality with sensitivities, specificities and areas under the curve of 86.3%, 61.7% and 0.824, and 73.4%, 81.3% and 0.794, respectively. At a cut-off value of 3.43, admission Cr/Alb values were indicative of a worse clinical state, including impaired laboratory test values, APACHE II scores, rates of post-operative complications and re-operation, and mortality (P < 0.05). In the logistic regression analysis, admission Cr/Alb values were independently related to the APACHE II score, post-operative renal failure, and mortality. Conclusion Cr/Alb is a novel but promising, easy-to-measure, reproducible, non-invasive prognostic score for the prediction of the effect of debridement in AP patients.
Collapse
Affiliation(s)
- Zhifeng Zhao
- Department of General Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, Shanghai, People's Republic of China.,Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China
| | - Yeping Yu
- School of Clinical Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China
| | - Rongli Xie
- Luwan Branch, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China
| | - Kaige Yang
- Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China
| | - Dan Xu
- Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China
| | - Li Li
- Luwan Branch, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China
| | - Jiayun Lin
- Department of General Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, Shanghai, People's Republic of China.,Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China
| | - Lei Zheng
- Department of General Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, Shanghai, People's Republic of China.,Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China
| | - Chihao Zhang
- Department of General Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, Shanghai, People's Republic of China.,Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China
| | - Xin Xu
- Department of General Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, Shanghai, People's Republic of China.,Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China
| | - Ying Chen
- Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China. .,Department of Emergency, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China.
| | - Zhiwei Xu
- Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China
| | - Erchen Chen
- Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China.,Department of Emergency, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China
| | - Meng Luo
- Department of General Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, Shanghai, People's Republic of China. .,Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China.
| | - Jian Fei
- Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China.
| |
Collapse
|
25
|
Idiopathic recurrent acute pancreatitis in the context of pancreas divisum: A case report. Radiol Case Rep 2020; 15:2255-2258. [PMID: 32963664 PMCID: PMC7490984 DOI: 10.1016/j.radcr.2020.07.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/21/2020] [Accepted: 07/24/2020] [Indexed: 12/25/2022] Open
|
26
|
Abstract
OBJECTIVE The aim of this study was to evaluate the epidemiology, etiology, severity, and outcomes of acute pancreatitis (AP) in the southern Sichuan region of China. METHODS All patients with first-attack AP between 2013 and 2018 in the Affiliated Hospital of Southwest Medical University were retrospectively identified. The etiology tendency was analyzed, and the relationship was defined with sex, aging, severity, length of stay, and mortality. RESULTS Three thousand twenty-eight patients were enrolled for analysis. Acute biliary pancreatitis had the highest incidence rate; the second and third most common causes were hypertriglyceridemic (14.4%) and alcoholic (14.2%), followed by idiopathic (13.6%), mixed etiology (12.9%), and miscellaneous (2.31%). Patients with alcoholic AP were more likely to be middle-aged males, whereas patients with acute biliary pancreatitis were more likely to be elderly females (P < 0.05). The overall mortality in the hospital was 1%, and there was no difference in each etiological groups (P > 0.05). CONCLUSIONS Biliary disease was the predominant etiology of AP in southern Sichuan of China, and hypertriglyceridemia ranked second. The proportion of hypertriglyceridemic AP and mixed etiology AP gradually increased, whereas idiopathic AP decreased. There were different etiology proportion of AP according age, sex, and severity.
Collapse
|
27
|
Abstract
As the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) continues across the globe, more details about the disease manifestations and clinical course have been emerging. The main clinical presentation of the ongoing coronavirus disease-19 (COVID-19) pandemic is respiratory symptoms. Along with this, the involvement of the gastrointestinal system and associated symptoms have also been reported. Here we present a case of a 58-year-old patient who presented with acute abdominal pain and was diagnosed with acute pancreatitis. He did not have any respiratory symptoms, but had radiological evidence of lung involvement and was diagnosed to be positive for COVID-19.
Collapse
Affiliation(s)
| | | | - Naushad Va
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
| | - Joe Mathew
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
| |
Collapse
|
28
|
The Lived Experience of Inpatients With Acute Recurrent Pancreatitis: A Qualitative Research Study From West China. Gastroenterol Nurs 2020; 43:249-257. [PMID: 32487957 DOI: 10.1097/sga.0000000000000442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The incidence of acute pancreatitis (AP) has increased year by year. Approximately 20%-30% of these patients will have further subsequent attacks, described as acute recurrent pancreatitis (ARP). Patients who are repeatedly admitted to hospitals suffer significant psychological problems and mental hardships. In the current study, we aimed to illuminate the lived experience of inpatients with ARP from Chongqing, China. A purposive sample of 13 ARP patients was recruited from the First Affiliated Hospital of Chongqing Medical University. Semistructured and in-depth qualitative interviews were adopted in this phenomenological research. Data were analyzed by Colaizzi's Method of descriptive phenomenology and feedback on early findings from the participants. All interviews were audio-recorded and transcribed with the permission of the participants. Five themes presented in the study: anxiety and fear, lack of related knowledge, inevitability and helplessness, guilt and shame, hope, and perseverance. Overall, the ARP inpatients showed complexed experience, both active and positive. They also performed poor compliance during their hospitalization but wished for professional knowledge. Nurses should pay attention to their psychological changes to take effective interventions for them.
Collapse
|
29
|
Hadi A, Werge M, Kristiansen KT, Pedersen UG, Karstensen JG, Novovic S, Gluud LL. Coronavirus Disease-19 (COVID-19) associated with severe acute pancreatitis: Case report on three family members. Pancreatology 2020; 20:665-667. [PMID: 32387082 PMCID: PMC7199002 DOI: 10.1016/j.pan.2020.04.021] [Citation(s) in RCA: 166] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Abdominal pain is one of the known symptoms associated with coronavirus disease 2019. Little is known about the development of acute pancreatitis as a complication of severe acute respiratory syndrome coronavirus 2 infection. This case report describes the presentation of acute pancreatitis in two of three family members with severe COVID-19 infection. METHODS Data were collected from three family members admitted with COVID-19 to the intensive care unit in March 2020. This study was reviewed and approved by the local data and ethics committee (31-1521-253). RESULTS Two of the three family members were diagnosed with acute pancreatitis associated with SARS-CoV-2. Other causes of acute pancreatitis were excluded for both patients (including alcohol, biliary obstruction/gall stones, drugs, trauma, hypertriglyceridemia, hypercalcemia, and hypotension). CONCLUSIONS These cases highlight acute pancreatitis as a complication associated with COVID-19 and underlines the importance of measuring pancreas-specific plasma amylase in patients with COVID-19 and abdominal pain.
Collapse
Affiliation(s)
- Amer Hadi
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
| | - Mikkel Werge
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | | | | | - John Gásdal Karstensen
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Srdan Novovic
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark.
| | - Lise Lotte Gluud
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| |
Collapse
|
30
|
Seppänen H, Puolakkainen P. Classification, Severity Assessment, and Prevention of Recurrences in Acute Pancreatitis. Scand J Surg 2020; 109:53-58. [PMID: 32192420 DOI: 10.1177/1457496920910007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Acute pancreatitis is a common disease, the incidence of which is 75-100/100,000/year in Finland. The worldwide incidence of acute pancreatitis is increasing. The identified mildcases usually show rapid recovery with conservative treatment allowing early discharge. Severe cases need early intensive care to reduce the risk of serious complications such as multi-organ failure. The revised Atlanta classification of acute pancreatitis was introduced in 2012-2013. A recurrent acute pancreatitis is defined as two or more well-documented separate attacks of acute pancreatitis with complete resolution in between. Alcoholic pancreatitis is the most common recurrent acute pancreatitis type. METHODS In this review current severity classifications and literature on the prevention of recurrent acute pancreatitis are analyzed. RESULTS The severity of the disease is classified as mild, moderately severe, and severe acute pancreatitis. Novel entities include acute peripancreatic fluid collections in mild acute pancreatitis and acute necrotic collections in necrotizing acute pancreatitis lesser than 4 weeks after the onset and pancreatic pseudocyst in mild acute pancreatitis and walled-off necrosis in necrotizing acute pancreatitis more than 4 weeks after the onset of the disease. After the first attack of alcohol-induced acute pancreatitis, 46% of the patients develop at least one recurrence within 10- to 20-year follow-up. With repeated intervention against alcohol consumption, it is possible to reduce the recurrences. Removing the gall bladder after biliary pancreatitis is the key preventing recurrences. In mild cases, even during the index admission; in severe cases, it is recommended to wait until the inflammatory changes have resolved. Of total, 59% of the idiopathic pancreatitis had sludge of stones in the gall bladder. In other etiologies, addressing the etiological factor may prevent recurrent acute pancreatitis. CONCLUSIONS This review describes current use of novel severity classifications and also different possibilities to prevent recurrent acute pancreatitis with different etiologies including idiopathic.
Collapse
Affiliation(s)
- H Seppänen
- Department of Surgery, Translational Cancer Medicine Research Program, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P Puolakkainen
- Department of Surgery, Translational Cancer Medicine Research Program, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
31
|
Silva-Vaz P, Abrantes AM, Castelo-Branco M, Gouveia A, Botelho MF, Tralhão JG. Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice. Int J Mol Sci 2020; 21:ijms21010338. [PMID: 31947993 PMCID: PMC6982212 DOI: 10.3390/ijms21010338] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/30/2019] [Accepted: 01/02/2020] [Indexed: 02/07/2023] Open
Abstract
Acute pancreatitis (AP) is a severe inflammation of the pancreas presented with sudden onset and severe abdominal pain with a high morbidity and mortality rate, if accompanied by severe local and systemic complications. Numerous studies have been published about the pathogenesis of AP; however, the precise mechanism behind this pathology remains unclear. Extensive research conducted over the last decades has demonstrated that the first 24 h after symptom onset are critical for the identification of patients who are at risk of developing complications or death. The identification of these subgroups of patients is crucial in order to start an aggressive approach to prevent mortality. In this sense and to avoid unnecessary overtreatment, thereby reducing the financial implications, the proper identification of mild disease is also important and necessary. A large number of multifactorial scoring systems and biochemical markers are described to predict the severity. Despite recent progress in understanding the pathophysiology of AP, more research is needed to enable a faster and more accurate prediction of severe AP. This review provides an overview of the available multifactorial scoring systems and biochemical markers for predicting severe AP with a special focus on their advantages and limitations.
Collapse
Affiliation(s)
- Pedro Silva-Vaz
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal;
- General Surgery Department, Hospital Local de Saúde de Castelo Branco, 6000-085 Castelo Branco, Portugal;
- Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal
- Correspondence: ; Tel.: +351-966-498-337
| | - Ana Margarida Abrantes
- Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; (A.M.A.); (M.F.B.); (J.G.T.)
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Biophysics and Biomathematics Institute, IBILI-Faculty of Medicine of University of Coimbra, 3000-348 Coimbra, Portugal
| | - Miguel Castelo-Branco
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal;
- Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal
| | - António Gouveia
- General Surgery Department, Hospital Local de Saúde de Castelo Branco, 6000-085 Castelo Branco, Portugal;
- Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal
| | - Maria Filomena Botelho
- Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; (A.M.A.); (M.F.B.); (J.G.T.)
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Biophysics and Biomathematics Institute, IBILI-Faculty of Medicine of University of Coimbra, 3000-348 Coimbra, Portugal
| | - José Guilherme Tralhão
- Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; (A.M.A.); (M.F.B.); (J.G.T.)
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Biophysics and Biomathematics Institute, IBILI-Faculty of Medicine of University of Coimbra, 3000-348 Coimbra, Portugal
- Surgery Department, Centro Hospitalar e Universitário de Coimbra (CHUC), University Hospital, Faculty of Medicine, 3000-075 Coimbra, Portugal
| |
Collapse
|
32
|
Cho JH, Jeong YH, Kim KH, Kim TN. Risk factors of recurrent pancreatitis after first acute pancreatitis attack: a retrospective cohort study. Scand J Gastroenterol 2020; 55:90-94. [PMID: 31822144 DOI: 10.1080/00365521.2019.1699598] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background and aims: Few studies have been conducted in Asia on the recurrence of acute pancreatitis (AP). This study was designed to investigate characteristics of the disease to predict recurrence.Methods: We retrospectively analyzed 617 patients that experienced a first AP attack between January 2009 and December 2014. Based on reviews of clinical and follow-up data, we attempted to identify risk factors of recurrence using Cox regression analysis.Results: During a median follow-up of 3.2 years (range 3-72 months), 100(16.2%) of the 617 study subjects experienced one or more episodes of recurrent acute pancreatitis (RAP). Of these 100 patients, 75(75%) experienced one relapse, 12(12%) two relapses, and 13(13%) three or more relapses. The etiologies of RAP were an alcohol (48%), gallstone (31%), idiopathic (14%), and others (7%). Univariate analysis showed that an age of <60 years, male gender, smoking, an alcohol-associated etiology, and a local complication at index admission were significant risk factors of RAP. Cox regression analysis showed that an age of <60 years (HR = 1.602, 95% CI: 1.029-2.493), male gender (HR = 1.927, 95% CI: 1.127-3.295), and the presence of a local complication (HR = 3.334, 95% CI: 2.211-5.026) were significant risk factors of RAP development.Conclusion: A local complication at index admission was found to be the strongest risk factor of RAP, and a male gender and an age of <60 years were significantly associated with RAP. Special attention and close follow-up should be afforded to patients with a local complication at index admission or male patients <60 years old.
Collapse
Affiliation(s)
- Joon Hyun Cho
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Yo Han Jeong
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Kook Hyun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Tae Nyeun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| |
Collapse
|
33
|
Mashayekhi R, Parekh VS, Faghih M, Singh VK, Jacobs MA, Zaheer A. Radiomic features of the pancreas on CT imaging accurately differentiate functional abdominal pain, recurrent acute pancreatitis, and chronic pancreatitis. Eur J Radiol 2019; 123:108778. [PMID: 31846864 DOI: 10.1016/j.ejrad.2019.108778] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/25/2019] [Accepted: 11/30/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Patients with recurrent abdominal pain and pancreatic enzyme elevations may be diagnosed clinically with recurrent acute pancreatitis (RAP) even with normal imaging or no imaging at all. Since neither abdominal pain nor enzyme elevations are specific for acute pancreatitis (AP), and patients with RAP often have a normal appearing pancreas on CT after resolution of an AP episode, RAP diagnosis can be challenging. This study aims to determine if quantitative radiomic features of the pancreas on CT can differentiate patients with functional abdominal pain, RAP, and chronic pancreatitis (CP). METHOD Contrast enhanced CT abdominal images of adult patients evaluated in a pancreatitis clinic from 2010 to 2018 with the diagnosis of RAP, functional abdominal pain, or CP were retrospectively reviewed. The pancreas was outlined by drawing region of interest (ROI) on images. 54 radiomic features were extracted from each ROI and were compared between the patient groups. A one-vs-one Isomap and Support Vector Machine (IsoSVM) classifier was also trained and tested to classify patients into one of the three diagnostic groups based on their radiomic features. RESULTS Among the study's 56 patients, 20 (35.7 %) had RAP, 19 (33.9 %) had functional abdominal pain, and 17 (30.4 %) had CP. On univariate analysis, 11 radiomic features (10 GLCM features and one NGTDM feature) were significantly different between the patient groups. The IsoSVM classifier for prediction of patient diagnosis had an overall accuracy of 82.1 %. CONCLUSIONS Certain radiomic features on CT imaging can differentiate patients with functional abdominal pain, RAP, and CP.
Collapse
Affiliation(s)
- Rouzbeh Mashayekhi
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
| | - Vishwa S Parekh
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA; Department of Computer Science, The Johns Hopkins University, Baltimore, MD, 21208, USA.
| | - Mahya Faghih
- Pancreatitis Center, Division of Gastroenterology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
| | - Vikesh K Singh
- Pancreatitis Center, Division of Gastroenterology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
| | - Michael A Jacobs
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
| | - Atif Zaheer
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA; Pancreatitis Center, Division of Gastroenterology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
| |
Collapse
|
34
|
Caldrer S, Bergamini G, Sandri A, Vercellone S, Rodella L, Cerofolini A, Tomba F, Catalano F, Frulloni L, Buffelli M, Tridello G, de Jonge H, Assael BM, Sorio C, Melotti P. Cystic fibrosis transmembrane conductance regulator functional evaluations in a G542X+/- IVS8Tn:T7/9 patient with acute recurrent pancreatitis. World J Clin Cases 2019; 7:3757-3764. [PMID: 31799301 PMCID: PMC6887611 DOI: 10.12998/wjcc.v7.i22.3757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/16/2019] [Accepted: 10/15/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Acute recurrent pancreatitis (ARP) is characterized by episodes of acute pancreatitis in an otherwise normal gland. When no cause of ARP is identifiable, the diagnosis of "idiopathic" ARP is given. Mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene increase the risk of ARP by 3- to 4-times compared to the general population, while cystic fibrosis (CF) patients present with a 40- to 80-times higher risk of developing pancreatitis.
CASE SUMMARY In non-classical CF or CFTR-related disorders, CFTR functional tests can help to ensure a proper diagnosis. We applied an individualized combination of standardized and new CFTR functional bioassays for a patient referred to the Verona CF Center for evaluation after several episodes of acute pancreatitis. The CFTR genotype was G542X+/- with IVS8Tn:T7/9 polymorphism. The sweat (Cl-) values were borderline. Intestinal current measurements were performed according to the European Cystic Fibrosis Society Standardized Operating Procedure. Recent nasal surgery for deviated septum did not allow for nasal potential difference measurements. Lung function and sputum cultures were normal; azoospermia was excluded. Pancreas divisum was excluded by imaging but hypoplasia of the left hepatic lobe was detected. Innovative tests applied in this case include sweat rate measurement by image analysis, CFTR function in monocytes evaluated using a membrane potential-sensitive fluorescent probe, and the intestinal organoids forskolin-induced swelling assay.
CONCLUSION Combination of innovative CFTR functional assays might support a controversial diagnosis when CFTR-related disorders and/or non-classical CF are suspected.
Collapse
Affiliation(s)
- Sara Caldrer
- Department of Medicine, General Pathology Division, Cystic Fibrosis Translational Research Laboratory “D. Lissandrini”, University of Verona, Verona 37134, Italy
| | - Gabriella Bergamini
- Department of Medicine, General Pathology Division, Cystic Fibrosis Translational Research Laboratory “D. Lissandrini”, University of Verona, Verona 37134, Italy
- Cystic Fibrosis Center, Azienda Ospedaliera Universitaria Integrata Verona, Verona 37126, Italy
| | - Angela Sandri
- Department of Medicine, General Pathology Division, Cystic Fibrosis Translational Research Laboratory “D. Lissandrini”, University of Verona, Verona 37134, Italy
- Cystic Fibrosis Center, Azienda Ospedaliera Universitaria Integrata Verona, Verona 37126, Italy
| | - Silvia Vercellone
- Department of Medicine, General Pathology Division, Cystic Fibrosis Translational Research Laboratory “D. Lissandrini”, University of Verona, Verona 37134, Italy
| | - Luca Rodella
- Endoscopic Surgery Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona 37126, Italy
| | - Angelo Cerofolini
- Endoscopic Surgery Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona 37126, Italy
| | - Francesco Tomba
- Endoscopic Surgery Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona 37126, Italy
| | - Filippo Catalano
- Endoscopic Surgery Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona 37126, Italy
| | - Luca Frulloni
- Department of Medicine, Pancreas Center, University of Verona, Verona 37134, Italy
| | - Mario Buffelli
- Department of Neurosciences, Biomedicine and Movement Sciences, Physiology Section University, Verona 37126, Italy
| | - Gloria Tridello
- Cystic Fibrosis Center, Azienda Ospedaliera Universitaria Integrata Verona, Verona 37126, Italy
| | - Hugo de Jonge
- Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam 3015, Netherlands
| | - Baroukh Maurice Assael
- Cystic Fibrosis Center, Azienda Ospedaliera Universitaria Integrata Verona, Verona 37126, Italy
| | - Claudio Sorio
- Department of Medicine, General Pathology Division, Cystic Fibrosis Translational Research Laboratory “D. Lissandrini”, University of Verona, Verona 37134, Italy
| | - Paola Melotti
- Cystic Fibrosis Center, Azienda Ospedaliera Universitaria Integrata Verona, Verona 37126, Italy
| |
Collapse
|
35
|
Kucserik LP, Márta K, Vincze Á, Lázár G, Czakó L, Szentkereszty Z, Papp M, Palatka K, Izbéki F, Altorjay Á, Török I, Barbu S, Tantau M, Vereczkei A, Bogár L, Dénes M, Németh I, Szentesi A, Zádori N, Antal J, Lerch MM, Neoptolemos J, Sahin-Tóth M, Petersen OH, Kelemen D, Hegyi P. Endoscopic sphincterotoMy for delayIng choLecystectomy in mild acute biliarY pancreatitis (EMILY study): protocol of a multicentre randomised clinical trial. BMJ Open 2019; 9:e025551. [PMID: 31289058 PMCID: PMC6629406 DOI: 10.1136/bmjopen-2018-025551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION According to the literature, early cholecystectomy is necessary to avoid complications related to gallstones after an initial episode of acute biliary pancreatitis (ABP). A randomised, controlled multicentre trial (the PONCHO trial) revealed that in the case of gallstone-induced pancreatitis, early cholecystectomy was safe in patients with mild gallstone pancreatitis and reduced the risk of recurrent gallstone-related complications, as compared with interval cholecystectomy. We hypothesise that carrying out a sphincterotomy (ES) allows us to delay cholecystectomy, thus making it logistically easier to perform and potentially increasing the efficacy and safety of the procedure. METHODS/DESIGN EMILY is a prospective, randomised, controlled multicentre trial. All patients with mild ABP, who underwent ES during the index admission or in the medical history will be informed to take part in EMILY study. The patients will be randomised into two groups: (1) early cholecystectomy (within 6 days after discharge) and (2) patients with delayed (interval) cholecystectomy (between 45 and 60 days after discharge). During a 12-month period, 93 patients will be enrolled from participating clinics. The primary endpoint is a composite endpoint of mortality and recurrent acute biliary events (that is, recurrent ABP, acute cholecystitis, uncomplicated biliary colic and cholangitis). The secondary endpoints are organ failure, biliary leakage, technical difficulty of the cholecystectomy, surgical and other complications. ETHICS AND DISSEMINATION The trial has been registered internationally ISRCTN 10667869, and approved by the relevant organisation, the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (EKU/2018/12176-5). TRIAL REGISTRATION NUMBER ISCRTN 10667869; Pre-results.
Collapse
Affiliation(s)
- Levente Pál Kucserik
- Division of Surgery, Universitatea de Medicina si Farmacie din Targu Mures, Targu Mures, Romania
| | - Katalin Márta
- Institute for Translational Medicine, Pecsi Tudomanyegyetem Altalanos Orvostudomanyi Kar, Pecs, Hungary
- János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Áron Vincze
- Institute for Translational Medicine, Pecsi Tudomanyegyetem Altalanos Orvostudomanyi Kar, Pecs, Hungary
- Division of Gastroenterology, First Department of Internal Medicine, Pecsi Tudomanyegyetem Altalanos Orvostudomanyi Kar, Pecs, Hungary
| | - György Lázár
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - László Czakó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | | | - Mária Papp
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Debreceni Egyetem, Debrecen, Hungary
| | - Károly Palatka
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Debreceni Egyetem, Debrecen, Hungary
| | - Ferenc Izbéki
- Divison of Gastroenterology, Fejer County Saint George Teaching Hospital of University of Pécs, Székesfehérvár, Hungary
| | - Áron Altorjay
- Division of Surgery, Fejer County Saint George Teaching Hospital of University of Pécs, Székesfehérvár, Hungary
| | - Imola Török
- Division of Gastroenterology, Universitatea de Medicina si Farmacie din Targu Mures, Targu Mures, Romania
| | - Sorin Barbu
- 4thSurgery Department, “Iuliu Hatieganu” University of Medicine & Pharmacy, Cluj-Napoca, Romania
| | - Marcel Tantau
- 4thSurgery Department, “Iuliu Hatieganu” University of Medicine & Pharmacy, Cluj-Napoca, Romania
| | - András Vereczkei
- Department for Surgery, Pecsi Tudomanyegyetem Altalanos Orvostudomanyi Kar, Pecs, Hungary
| | - Lajos Bogár
- Department of Anaesthesiology and Intensive Therapy, Pecsi Tudomanyegyetem Altalanos Orvostudomanyi Kar, Pecs, Hungary
| | - Márton Dénes
- Second Department of Surgery, County Hospital Targu Mures, Targu Mures, Romania
| | - Imola Németh
- Data-Management, Pre-Clinical and Clinical Biostatistics, Adware Research Developing and Consulting Ltd, Balatonfüred, Hungary
| | - Andrea Szentesi
- Institute for Translational Medicine, Pecsi Tudomanyegyetem, Pecs, Hungary
- MTA-SZTE Translational Gastroenterology Research Group, Szegedi Tudomanyegyetem, Szeged, Hungary
| | - Noémi Zádori
- Institute for Translational Medicine, Pecsi Tudomanyegyetem Altalanos Orvostudomanyi Kar, Pecs, Hungary
| | - Judit Antal
- Institute for Translational Medicine, Pecsi Tudomanyegyetem Altalanos Orvostudomanyi Kar, Pecs, Hungary
| | - Markus M Lerch
- Department of Medicine A, Universitatsmedizin Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - John Neoptolemos
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, Liverpool, UK
| | - Miklós Sahin-Tóth
- Department of Molecular and Cell Biology, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA 02118, USA
| | - Ole H Petersen
- School of Biosciences, Cardiff University, Cardiff, South Glamorgan, UK
| | - Dezső Kelemen
- Surgery Clinic, Pecsi Tudomanyegyetem, Pecs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Pecsi Tudomanyegyetem Altalanos Orvostudomanyi Kar, Pecs, Hungary
- MTA-SZTE, Translational Gastroenterology Research Group, Szeged, Hungary
| |
Collapse
|
36
|
Sánchez Rodríguez E, García García de Paredes A, Albillos A. Current management of acute idiopathic pancreatitis and acute recurrent pancreatitis. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2019.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
37
|
Sánchez Rodríguez E, García García de Paredes A, Albillos A. Manejo actual de la pancreatitis aguda idiopática y la pancreatitis aguda recurrente. Rev Clin Esp 2019; 219:266-274. [DOI: 10.1016/j.rce.2018.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 12/28/2018] [Indexed: 02/07/2023]
|
38
|
Idiopathic acute pancreatitis: a review on etiology and diagnostic work-up. Clin J Gastroenterol 2019; 12:511-524. [DOI: 10.1007/s12328-019-00987-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/19/2019] [Indexed: 12/17/2022]
|
39
|
Grupp K, Erbes J, Poppe A, Wodack K, Gocht A, Trepte C, Havel J, Mann O, Izbicki JR, Bachmann K. Melatonin treatment of pigs with acute pancreatitis reduces inflammatory reaction of pancreatic tissue and enhances fitness score of pigs: experimental research. World J Emerg Surg 2019; 14:18. [PMID: 31007709 PMCID: PMC6458612 DOI: 10.1186/s13017-019-0237-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/25/2019] [Indexed: 12/27/2022] Open
Abstract
Background Severe acute pancreatitis is associated with high morbidity and mortality. Melatonin is known as the activator of antioxidant enzymes. The main purpose of this study was to evaluate the clinical effect of melatonin treatment in a pig model with induced acute pancreatitis. Methods In this study, acute pancreatitis was induced in 38 German domestic pigs (German Hybrid). After induction of acute pancreatitis, 18 animals were treated with melatonin. Intraoperative clinical data, postoperative blood parameters, fitness, and Porcine Well-being (PWB) score, and post-mortal histopathological data were analyzed in both study groups. Results The matching procedure created two groups (melatonin group and control group) which were very similar. The fitness and PWB score were postoperative significantly enhanced in the melatonin group as compared to the control group (p = 0.005 and p = 0.003). Additionally, histological analysis revealed that acinar necrosis, fat tissue necrosis, and edema were significantly reduced in the melatonin group as compared to the non-melatonin group (p = 0.025, p = 0.003, and p = 0.028). Conclusions Pigs, which were treated with melatonin, were characterized by higher fitness and PWB scores than those of the control group. Moreover, melatonin treatment reduces the acinar necrosis, fat tissue necrosis, and edema of pancreatic tissue. Thus, melatonin might be a useful therapeutic option in severe acute pancreatitis.
Collapse
Affiliation(s)
- Katharina Grupp
- 1Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Erbes
- 1Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Annika Poppe
- 2Centre of Anesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Karin Wodack
- 2Centre of Anesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Gocht
- 3Institute of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Constantin Trepte
- 2Centre of Anesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Havel
- 1Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Mann
- 1Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob R Izbicki
- 1Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Kai Bachmann
- 1Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
40
|
Abstract
OBJECTIVES This study aimed to compare the clinical course of 5-aminosalicylic acid-derived, drug-induced acute pancreatitis (5-ASA-DIAP) to acute pancreatitis (AP) caused by other etiologies. METHODS A cohort of patients with 5-ASA-DIAP was established through literature search. As a control AP (CAP) group, a cohort was generated from a registry. Data on the diagnostic procedure, symptoms, enzyme elevation, imaging, severity, and recovery parameters were collected. Causality was assessed using the Naranjo algorithm. RESULTS Twenty-nine articles were included, which describe 36 patients with fifty-one 5-ASA-DIAP episodes (60.78% female, 39.22% male). There were 88.2% mild, 3.92% moderate, and 7.84% severe cases of AP in the 5-ASA-DIAP group, and 70.6%, 25.5%, and 3.92% such cases in the CAP population, respectively. Symptoms improved significantly faster (mean ± SE, 2.5 ± 0.34 vs 3.74 ± 0.42 days; P = 0.018); however, pancreatic enzyme levels normalized significantly more slowly (6.27 ± 1.53 vs 3.63 ± 0.61 days, P = 0.008) in the 5-ASA-DIAP cohort compared with the CAP group. This study confirms that there are no diagnostic differences between 5-ASA-DIAP and AP of other etiologies. CONCLUSIONS Fewer moderate but more severe cases were found in the 5-ASA-DIAP group; therefore, 5-ASA-DIAP must be taken as seriously as AP of other etiologies.
Collapse
|
41
|
Weiss FU, Laemmerhirt F, Lerch MM. Etiology and Risk Factors of Acute and Chronic Pancreatitis. Visc Med 2019; 35:73-81. [PMID: 31192240 DOI: 10.1159/000499138] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 02/25/2019] [Indexed: 12/24/2022] Open
Abstract
Based on the recognition of common etiological and genetic risk factors, acute and chronic pancreatitis are increasingly regarded as a continuum of the same disease, with a significant overlap of clinical manifestations and phenotypes but distinct morphological and imaging appearances. Recent population-based and cohort studies have found that tobacco smoke conveys a greater risk than immoderate alcohol consumption for the development of chronic pancreatitis, and hypertriglyceridemia has been identified as a risk factor for acute pancreatitis - even when plasma levels are only mildly elevated. Hereditary pancreatitis, in its autosomal dominant form, is associated with mutations in the cationic trypsinogen gene (PRSS1), whereas a number of germline variations in other genes have been found to represent risk factors for chronic as well as acute pancreatitis. For now, most of these involve the pancreatic digestive protease/antiprotease system. Oftentimes, affected patients are burdened with multiple or accumulating risk factors, and genetic traits when combined with environmental toxins compound the chance of developing the disease. Determining the underlying etiology of pancreatitis is worth the effort since formerly intractable varieties such as autoimmune pancreatitis are now becoming increasingly treatable, and subtype-specific therapeutic modalities may become available.
Collapse
Affiliation(s)
- Frank Ulrich Weiss
- Department of Medicine A, Greifswald Medical School, Greifswald, Germany
| | - Felix Laemmerhirt
- Department of Medicine A, Greifswald Medical School, Greifswald, Germany
| | - Markus M Lerch
- Department of Medicine A, Greifswald Medical School, Greifswald, Germany
| |
Collapse
|
42
|
Barkin JA, Freeman ML, Barkin JS. Is It Acute Pancreatitis or Recurrent Acute Pancreatitis Leading to Chronic Pancreatitis that Increases Pancreatic Cancer Risk? Gastroenterology 2018; 155:1279-1280. [PMID: 30236555 DOI: 10.1053/j.gastro.2018.09.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Jodie A Barkin
- Department of Medicine, Division of Gastroenterology, University of Miami, Leonard M. Miller School of Medicine, Miami, Florida
| | - Martin L Freeman
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Medical School, Minneapolis, Minnesota
| | - Jamie S Barkin
- Department of Medicine, Division of Gastroenterology, University of Miami, Leonard M. Miller School of Medicine, Miami, Florida
| |
Collapse
|
43
|
Bruno M, Ribaldone DG, Fasulo R, Gaia S, Marietti M, Risso A, Stradella D, Strona S, Saracco GM, De Angelis C. Is there a link between periampullary diverticula and biliopancreatic disease? An EUS approach to answer the question. Dig Liver Dis 2018; 50:925-930. [PMID: 30145052 DOI: 10.1016/j.dld.2018.07.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/26/2018] [Accepted: 07/27/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Many studies, almost all in an Endoscopic Retrograde Cholangiopancreatography (ERCP) setting, have been conducted to establish if a link exists between periampullary diverticula (PADs) and biliopancreatic diseases but the issue is still debated. AIMS The objective was to clarify the link between PADs and biliopancreatic disease, for the first time using Endoscopic Ultrasound (EUS). METHODS We retrospectively reviewed our database seeking patients scheduled for EUS with an indication that entailed the exploration of the second duodenum. For each patient with a PAD enrolled in the study, 6 controls were randomly selected. RESULTS 2475 patients met the inclusion criteria. Among them, 185 subjects with a PAD were found (prevalence 7.5%), 1110 subjects served as controls. Patients with a PAD had more frequently a history of cholangitis (8.1 vs 2.2%; OR 3.99, p < 0.001), a higher prevalence of common bile duct (CBD) dilation (44.3 vs 28.2%; OR 2, p < 0.0001) and a higher prevalence of CBD stones (34.1 vs 19.6%; OR 2.1, p < 0.0001). No differences were found about history of jaundice, acute/recurrent pancreatitis or EUS signs of chronic pancreatitis. CONCLUSION Whereas PADs were linked with history of cholangitis, CBD stones and dilation, no association was found with pancreatic diseases.
Collapse
Affiliation(s)
- Mauro Bruno
- Department of General and Specialist Medicine, Gastroenterologia-U, Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Roberta Fasulo
- Department of Gastroenterology, San Giovanni Bosco Hospital, Turin, Italy
| | - Silvia Gaia
- Department of General and Specialist Medicine, Gastroenterologia-U, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Milena Marietti
- Division of Gastroenterology, Chivasso Hospital, Turin, Italy
| | - Alessandro Risso
- Department of Gastroenterology and Digestive Endoscopy, Santa Croce e Carle Hospital, Cuneo, Italy
| | | | - Silvia Strona
- Division of Gastroenterology, Chivasso Hospital, Turin, Italy
| | - Giorgio Maria Saracco
- Department of Medical Sciences, Division of Gastroenterology, University of Torino, Torino, Italy
| | - Claudio De Angelis
- Department of General and Specialist Medicine, Gastroenterologia-U, Città della Salute e della Scienza di Torino, Turin, Italy
| |
Collapse
|
44
|
Anılır E, Özen F, Özemir İA, Yıldırım İH, Bilgiç Ç, Alimoğlu O. TLR4 Asp299Gly and Thr399Ile and TLR2 intron 2 microsatellite gene polymorphism in patients with acute biliary pancreatitis: Does it cause the disease? Turk J Surg 2018; 34:191-197. [PMID: 30216179 DOI: 10.5152/turkjsurg.2017.3828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/19/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES There has been coverage of Toll-like receptor 4 and Toll-like receptor 2 gene polymorphisms in inflammatory episodes in a number of studies. In view of the inflammatory nature of acute pancreatitis, we aimed to determine the predictive value of mutations in Asp299Gly and Thr399Ile of the Toll-like receptor 4 gene, and the intron 2 microsatellite polymorphism of the Toll-like receptor 2 gene on the occurrence of acute biliary pancreatitis. MATERIAL AND METHODS The study included 86 patients for the Toll-like receptor 4 Thr399Ile polymorphism, 100 patients for the Toll-like receptor 4 Asp299Gly polymorphism with acute biliary pancreatitis, and 101 healthy volunteers. At the same time, 93 patients and 92 healthy volunteers were included in the study to research the Toll-like receptor 2 intron 2 microsatellite polymorphism. Genotypes were determined using the restriction fragment length polymorphism analysis of PCR products and by an allele-specific PCR. RESULTS The Toll-like receptor 4 Thr399Ile homozygotes mutant variants (p=0.005) and Toll-like receptor 2 MM genotype (p<0.001) were detected with a significantly higher frequency in patients with acute biliary pancreatitis than in the healthy blood donors. CONCLUSION The Toll-like receptor 4 Asp299Gly and Thr399Ile polymorphisms and the Toll-like receptor 2 intron 2 microsatellite polymorphism are statistically associated with ABP.
Collapse
Affiliation(s)
- Ender Anılır
- Clinic of General Surgery, Amerikan Hospital, İstanbul, Turkey
| | - Filiz Özen
- Department of Medical Genetics, İstanbul Medeniyet University School of Medicine, İstanbul, Turkey
| | - İbrahim Ali Özemir
- Department of General Surgery, İstanbul Medeniyet University School of Medicine, İstanbul, Turkey
| | | | - Çağrı Bilgiç
- Department of General Surgery, Koç University School of Medicine, İstanbul, Turkey
| | - Orhan Alimoğlu
- Department of General Surgery, İstanbul Medeniyet University School of Medicine, İstanbul, Turkey
| |
Collapse
|
45
|
Stigliano S, Belisario F, Piciucchi M, Signoretti M, Delle Fave G, Capurso G. Recurrent biliary acute pancreatitis is frequent in a real-world setting. Dig Liver Dis 2018; 50:277-282. [PMID: 29311029 DOI: 10.1016/j.dld.2017.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/28/2017] [Accepted: 12/04/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Data about recurrent acute pancreatitis (RAP) are limited. AIMS To evaluate the rate of RAP and associated factors. METHODS Single-centre prospective study of consecutive patients at first episode of acute pancreatitis (AP) being followed-up. RESULTS Of 266 consecutive AP patients, (47% biliary, 15.4% alcoholic, 14.3% idiopathic) 66 (24.8%) had RAP in a mean follow-up of 42 months; 17.9% of recurrences occurred within 30 days from discharge. Age, gender, smoking and severity of first AP were not associated with RAP risk. The rate of biliary RAP was 31.3% in patients who did not receive any treatment, 18% in those treated with ERCP only, 16% in those who received cholecystectomy only, and 0% in those treated both with surgery and ERCP. Patients with biliary AP who received cholecystectomy had a significantly longer time of recurrence-free survival and reduced recurrence risk (HR = 0.45). In patients with alcoholic AP, the rate of recurrence was lower in those who quit drinking (5.8% vs 33%; p = 0.05). The alcoholic aetiology was associated with a higher risk of having >2 RAP episodes. CONCLUSION RAP occurs in about 25% of cases, and failure to treat biliary aetiology or quitting drinking is associated with increased recurrence risk.
Collapse
Affiliation(s)
- Serena Stigliano
- Digestive & Liver Disease Unit, S. Andrea Hospital, University "La Sapienza", Rome, Italy
| | - Flaminia Belisario
- Digestive & Liver Disease Unit, S. Andrea Hospital, University "La Sapienza", Rome, Italy
| | - Matteo Piciucchi
- Digestive & Liver Disease Unit, S. Andrea Hospital, University "La Sapienza", Rome, Italy
| | - Marianna Signoretti
- Digestive & Liver Disease Unit, S. Andrea Hospital, University "La Sapienza", Rome, Italy
| | - Gianfranco Delle Fave
- Digestive & Liver Disease Unit, S. Andrea Hospital, University "La Sapienza", Rome, Italy
| | - Gabriele Capurso
- Digestive & Liver Disease Unit, S. Andrea Hospital, University "La Sapienza", Rome, Italy.
| |
Collapse
|
46
|
Andalib I, Kahaleh M. Combination therapy could end the recurrence of biliary pancreatitis: It is about time! Dig Liver Dis 2018; 50:283-284. [PMID: 29452761 DOI: 10.1016/j.dld.2018.01.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 01/16/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Iman Andalib
- Weill Cornell Medical Center, New York, NY, United States
| | - Michel Kahaleh
- Weill Cornell Medical Center, New York, NY, United States.
| |
Collapse
|
47
|
|
48
|
Wang G, Liu H, Xu L, Wen P, Wen J, Zhou SF, Xiao X. Effect of Laparoscopic Peritoneal Lavage and Drainage and Continuous Venovenous Diahemofiltration on Severe Acute Pancreatitis. J Laparoendosc Adv Surg Tech A 2017; 27:1145-1150. [PMID: 28586262 DOI: 10.1089/lap.2016.0637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Guiliang Wang
- Department of Hepatobiliary Surgery, Gannan Medical University Pingxiang Hospital, Pingxiang, People's Republic of China
| | - Hai Liu
- Department of Scientific Research, Gannan Medical University, Gan Zhou, People's Republic of China
| | - Linfang Xu
- Department of Hepatobiliary Surgery, Gannan Medical University Pingxiang Hospital, Pingxiang, People's Republic of China
| | - Ping Wen
- Department of Hepatobiliary Surgery, Gannan Medical University Pingxiang Hospital, Pingxiang, People's Republic of China
| | - Jianbo Wen
- Department of Hepatobiliary Surgery, Gannan Medical University Pingxiang Hospital, Pingxiang, People's Republic of China
| | - Shu-feng Zhou
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, Florida
| | - Xianzhong Xiao
- Laboratory of Shock, Department of Pathophysiology, Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| |
Collapse
|
49
|
Somani P, Sunkara T, Sharma M. Role of endoscopic ultrasound in idiopathic pancreatitis. World J Gastroenterol 2017; 23:6952-6961. [PMID: 29097868 PMCID: PMC5658313 DOI: 10.3748/wjg.v23.i38.6952] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 09/11/2017] [Accepted: 09/19/2017] [Indexed: 02/06/2023] Open
Abstract
Recurrent acute pancreatitis (RAP) is defined based on the occurrence of two or more episodes of acute pancreatitis. The initial evaluation fails to detect the cause of RAP in 10%-30% of patients, whose condition is classified as idiopathic RAP (IRAP). Idiopathic acute pancreatitis (IAP) is a diagnostic challenge for gastroenterologists. In view of associated morbidity and mortality, it is important to determine the aetiology of pancreatitis to provide early treatment and prevent recurrence. Endoscopic ultrasound (EUS) is an investigation of choice for imaging of pancreas and biliary tract. In view of high diagnostic accuracy and safety of EUS, a EUS based management strategy appears to be a reasonable approach for evaluation of patients with a single/recurrent idiopathic pancreatitis. The most common diagnoses by EUS in IAP is biliary tract disease. The present review aims to discuss the role of EUS in the clinical management and diagnosis of patients with IAP. It elaborates the diagnostic approach to IAP in relation to EUS and other different modalities. Controversial issues in IAP like when to perform EUS, whether to perform after first episode or recurrent episodes, comparison among different investigations and the latest evidence significance are detailed.
Collapse
Affiliation(s)
- Piyush Somani
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut 25001, India
| | - Tagore Sunkara
- Department of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Clinical Affliate of The Mount Sinai Hospital, Brooklyn, NY 11201, United States
| | - Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut 25001, India
| |
Collapse
|
50
|
Montminy EM, Landreneau SW, Karlitz JJ. First report of small cell lung cancer with PTHrP-induced hypercalcemic pancreatitis causing disconnected duct syndrome. World J Clin Oncol 2017; 8:420-424. [PMID: 29067279 PMCID: PMC5638718 DOI: 10.5306/wjco.v8.i5.420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/05/2017] [Accepted: 08/17/2017] [Indexed: 02/06/2023] Open
Abstract
Here we report a patient diagnosed with small cell lung cancer after first presenting with parathyroid hormone-related peptide-induced hypercalcemic pancreatitis and developed walled-off necrosis that resulted in disruption of the main pancreatic duct. Disconnected duct syndrome (DDS) is a rare syndrome that occurs when the main pancreatic duct exocrine flow is disrupted resulting in leakage of pancreatic enzymes and further inflammatory sequela. To date, no prior reports have described DDS occurring with paraneoplastic reactions. Diagnostic imaging techniques and therapeutic interventions are reviewed to provide insight into current approaches to DDS.
Collapse
Affiliation(s)
- Eric M Montminy
- Division of Gastroenterology, Tulane University Medical Center, New Orleans, LA 70112, United States
| | - Stephen W Landreneau
- Division of Gastroenterology, LSU Health Sciences Center, New Orleans, LA 70112, United States
| | - Jordan J Karlitz
- Division of Gastroenterology, Tulane University Medical Center, New Orleans, LA 70112, United States
| |
Collapse
|