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Patel N, Bahirwani J, Bodrya K, Patel D, Schneider Y. Hidden Dangers of Frailty: Higher Mortality, Complications and Costs in Acute Pancreatitis. Dig Dis Sci 2024:10.1007/s10620-024-08480-z. [PMID: 38789672 DOI: 10.1007/s10620-024-08480-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Frailty is a clinically recognizable state of increased vulnerability due to age-related decline in reserve and function across multiple physiologic systems that compromises the ability to cope with acute stress. As frailty is being identified as an important risk factor in outcomes of gastrointestinal pathologies, we aimed to assess outcomes in patients with acute pancreatitis within this cohort. METHOD We conducted a retrospective study using the Nationwide Inpatient Sample (NIS) database. ICD-10 codes were used to inquire for patients admitted with acute pancreatitis between September 2015 through 2017. ICD-10 codes corresponding to the Hospital Frailty Risk Score (HFRS) were used to divide the study sample into 2 cohorts: low risk (< 5 points) and intermediate or high risk (> 5 points). To calculate the points, we fitted a logistic regression model that included membership of the frail group as the binary dependent variable (frail vs. non-frail) and the set of ICD-10 codes as binary predictor variables (1 = present, 0 = absent for each code). To simplify the calculation and interpretation, we multiplied regression coefficients by five to create a points system, so that a certain number of points are awarded for each ICD-10 code and added together to create the final frailty risk score. Multivariate regression analysis was performed to find adjusted mortality. RESULTS Out of a total of 1,267,744 patients admitted with acute pancreatitis, 728,953 (57.5%) were identified as intermediate and high risk (> 5 points) (study cohort) and 538,781 (42.5%) as low risk (< 5 points). The mean age in the study cohort was 64.8 ± 12.6 and that in the low-risk group was 58.6 ± 9.5. Most of the patients in both groups were males and Caucasians; Medicare was the predominant insurance provider. A majority of the admissions in both groups were in an urban teaching hospital and were emergency. (Table 1). The primary outcome was in-hospital mortality which was significantly higher in the study cohort as compared to the low-risk group (4.3% vs. 2.5%, p < 0.0001). The age-adjusted Odds ratio of mortality was 1.72(95% CI (Confidence Interval) 1.65-1.80, p < 0.05). When compared between the two groups; median length of stay (6 vs. 4); hospitalization cost ($14,412 vs. $10,193), disposition to a skilled nursing facility (SNF) (17.1% vs. 8.6%) and need for home health care (HHC) was significantly higher in the study cohort. Complications like septicemia, septic shock, and acute kidney injury were also higher in the study group (Table 2). Table 1 Baseline demographics of the cohort Characteristics Acute pancreatitis with High HES Frailty score (> 5, intermediate + high) Acute pancreatitis with low HES Frailty score (< 5) P-value N = 1,267,744 N = 728,953 (57.5%) N = 538,781 (42.5%) Age Mean years (Mean ± SD) 64.8 ± 12.6 58.6 ± 9.5 < 0.001 Gender < 0.001 Male 59.1% 52.3% Female 40.9% 47.7% *Missing-475 Age groups < 0.001 18-44 3.7% 14.3% 45-64 48% 52.9% 65-84 32.2% 28.7% ≥ 85 16.1% 4.1% Race < 0.001 Caucasians 67.4% 61.9% African Americans 9.6% 16.8% Others 23% 21.3% *Missing-10 Insurance type < 0.001 Medicare 40.9% 36.3% Medicaid 17.2% 24.3% Private 31.8% 27.9% Other 9.9% 11.4% *Missing-75 Active smoking 32.7% 37.9% 0.005 Biliary Stone 36.2% 16.7% < 0.001 Admission Type < 0.001 Emergent 93.7% 94.3% Elective 6.3% 5.7% *Missing-2880 Hospital ownership/control < 0.001 Rural 7.8% 10% Urban nonteaching 26.3% 26.6% Urban teaching 65.9% 63.4% Table 2 Outcomes Outcomes Acute pancreatitis with High HES Frailty score (> 5, intermediate + high) Acute pancreatitis with low HES Frailty score (< 5) P-value In-hospital mortality *Missing-920 4.3% 2.5% < .0001 1.72(1.65-1.80) < .0001 Length of stay, days (Median,IQR) 6(3-8) 4(2-6) < .0001 Total hospitalization cost, $ (Median,IQR) 14,412(8843-20,216) 10,193(6840-13,842) < .0001 In-Hospital Complications ARDS 0.4% 0.3% 0.08 Ventilator dependence respiratory failure 0.23% 0.29% 0.25 Septicemia 15.2% 9.6% < .0001 Septic Shock 6.1% 2.9% < .0001 AKI 24.8% 14.9% < .0001 Disposition < .0001 Discharge to home 58.9% 74.9% Transfer other: includes Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), and another type of facility 17.1% 8.6% Home health care 11.5% 8.1% Against medical advice (AMA) 1.6% 3.4% *Missing-920 CONCLUSION: Using frailty as a construct to identify those who are at greater risk for adverse outcomes, can help formulate interventions to target individualized reversible factors to improve outcomes in patients with acute pancreatitis. Future large-scale prospective studies are warranted to understand the dynamic and longitudinal relationship between pancreatitis and frailty.
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Affiliation(s)
- Nishit Patel
- Department of Gastroenterology, St Luke's University Health Network, 701 ostrum street, Bethlehem, PA, 18015, USA
| | - Janak Bahirwani
- Department of Gastroenterology, St Luke's University Health Network, 701 ostrum street, Bethlehem, PA, 18015, USA.
| | - Krishna Bodrya
- Department of Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Dhruvanshu Patel
- Department of Medicine, St Luke's University Health Network, Bethlehem, PA, USA
| | - Yecheskel Schneider
- Department of Gastroenterology, St Luke's University Health Network, 701 ostrum street, Bethlehem, PA, 18015, USA
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Li J, Gao J, Huang M, Fu X, Fu B. Risk Factors for Death in Patients with Severe Acute Pancreatitis in Guizhou Province, China. Gastroenterol Res Pract 2024; 2024:8236616. [PMID: 38590392 PMCID: PMC11001474 DOI: 10.1155/2024/8236616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/11/2024] [Accepted: 03/16/2024] [Indexed: 04/10/2024] Open
Abstract
Aim To compare the clinical characteristics of survival and nonsurvival patients with severe acute pancreatitis (SAP) and explore the risk of mortality in SAP patients. Methods This was a single-center retrospective study performed in a severe acute pancreatitis diagnosis and treatment center. According to the outcome, SAP patients were divided into survival group and nonsurvival group. One-way ANOVA or independent t-test was used to compare the clinical characteristics of two groups of patients. Multivariate retrospective analysis was used to identify risk factors for mortality in SAP patients. Results A total of 486 SAP patients were included in the study, and the 90-day mortality for SAP patients was 13.58%. The common etiologies of SAP are biliary tract diseases (69.75%) and hyperlipidemia (17.28%). The most common complications caused by SAP were organ failure (55.14%), ARDS (50.62%), AKI (30.45%), sepsis (27.16%), and abdominal fluid collection (27.57%). There were differences in age, complications, and medical intervention between the nonsurvival group and the survival group. The main causes of death were infection (46.97%), abdominal bleeding (28.79%), and organ failure (9.09%). The binary logistic regression analysis showed that there were significant differences in age, AKI, sepsis, abdominal hemorrhage, organ failure, laparotomy, creatinine, and APTT between the nonsurvival group and the survival group. Conclusion Age, AKI, sepsis, abdominal hemorrhage, and organ failure are risk factors for mortality in SAP patients. SAP patients with high creatinine and prolonged APTT upon admission require doctors to be vigilant. The main cause of death in SAP patients is pancreatitis-related organ failure and secondary infection.
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Affiliation(s)
- Jun Li
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, China
- Severe Acute Pancreatitis Diagnosis and Treatment Center of Guizhou Province, Zunyi City, Guizhou Province, China
- Department of Critical Care Medicine, The People's Hospital of Liupanshui City, Liupanshui, Guizhou Province, China
| | - Jingyan Gao
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, China
- Severe Acute Pancreatitis Diagnosis and Treatment Center of Guizhou Province, Zunyi City, Guizhou Province, China
| | - Min Huang
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, China
- Severe Acute Pancreatitis Diagnosis and Treatment Center of Guizhou Province, Zunyi City, Guizhou Province, China
| | - Xiaoyun Fu
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, China
- Severe Acute Pancreatitis Diagnosis and Treatment Center of Guizhou Province, Zunyi City, Guizhou Province, China
| | - Bao Fu
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, China
- Severe Acute Pancreatitis Diagnosis and Treatment Center of Guizhou Province, Zunyi City, Guizhou Province, China
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Zhou W, Liu Q, Wang Z, Yao L, Chen J, Yang X. Analysis of the clinical profile and treatment efficiency of hyperlipidemic acute pancreatitis. Lipids Health Dis 2024; 23:70. [PMID: 38459563 PMCID: PMC10921628 DOI: 10.1186/s12944-024-02057-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/23/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND The incidence of hyperlipidemic acute pancreatitis (HLAP) has been increasing annually. However, population-based morbidity assessments need to be updated. Early, rapid, and effective lipid-lowering may minimize pancreatic injury and improve clinical prognosis. It is essential to choose the proper treatment. However, treatment options for HLAP are controversial, and there is no uniform treatment protocol. METHODS In this retrospective study, 127 patients with hyperlipidemic severe acute pancreatitis (HL-SAP) were registered from January 2018 to December 2022 at the General Hospital of Ningxia Medical University. Medical and radiological records of hospitalized patients were collected to determine clinical features, severity, complications, mortality, recurrence rate, and treatment. Risk factors for HL-SAP were analyzed using multifactorial logistic regression. A propensity score matching method was used to compare the clinical outcomes of standard and plasma exchange therapies. RESULTS In this research, the prevalence of HLAP increased about 1.6 times, and the prevalence of HL-SAP was 50.60%. HL-SAP occurs most often in people between the ages of 30 and 39. Amylase exceeded 110 U/L in 84.3% of patients and 330 U/L in only 47.2%. 83.5% of HL-SAP patients had fatty livers and high body mass index (BMI). A total of 48.0% of patients experienced organ failure, ICU treatment (55.1%), recurrence (33.1%), and death (21.3%). Between the hyperlipidemic group and the biliary group in terms of age, gender, BMI, fatty liver, pleural effusion, abdominal constriction syndrome (ACS), multiple organ dysfunction syndrome (MODS), length of hospital, medical costs, morbidity and mortality, triglyceride, cholesterol, creatinine, blood glucose, D-dimer, amylase, albumin, lactate dehydrogenase, serum phosphorus, serum calcium, oxygenation index, and recurrence rate were statistically significant (P < 0.05). High BMI (P = 0.0038, odds ratio (OR) = 1.336, 95%CI: 0.99-1.804), high C-reactive protein (CRP) (P = 0.022, OR = 1.011, 95%CI: 1.003-1.019), low calcium (P = 0.003, OR = 0.016, 95%CI. 0.001-0.239), low albumin (P = 0.012, OR = 0.045, 95%CI: -0.062-0.192), and high D-dimer (P = 0.041, OR = 0.619, 95%CI: 0.053-2.510) were risk factors for HL-SAP, according to multifactorial logistic regression analysis. Adjusted for propensity score matching (PSM), Serum triglyceride (TG) was significantly lower in both the standard treatment (P < 0.001) and plasma exchange (P < 0.001) groups at 48 h compared with the initial test after the attack. Clearance (83.20% ± 0.0% vs. 84.4% ± 0.0%, P = 0.531), length of hospital stay (19.9 ± 4.9 vs. 19.8 ± 11.1, P = 0.092), and death (26.3% vs. 23.6%, P = 0.791) showed no difference between the two groups. However, the difference in medical costs(P = 0.039)between the two groups was statistically significant. CONCLUSION The incidence of HLAP exhibited a significant increase, remarkable severity, recurrent trend, and mortality. High BMI, high CRP, low calcium, low albumin, and high D-dimer are risk factors for HL-SAP. Compared with standardized treatment, plasma exchange does not improve the prognosis of HL-SAP patients, and standardized treatment is equally effective, safe, and low-cost in early treatment.
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Affiliation(s)
- Weidong Zhou
- The First Clinical Medical College of Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Qinfu Liu
- General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Zhaojun Wang
- General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Liying Yao
- General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Jian Chen
- The First Clinical Medical College of Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Xiaojun Yang
- General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, China.
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Lai T, Li J, Zhou Z, Rao J, Zhu Y, Xia L, Lei Y, Huang X, Ke H, Wu Y, Liu P, Zeng H, Xiong H, Luo L, Chen Y, He W, Zhu Y, Lu N. Etiological Changes and Prognosis of Hospitalized Patients with Acute Pancreatitis Over a 15-Year Period. Dig Dis Sci 2024; 69:56-65. [PMID: 37943383 DOI: 10.1007/s10620-023-08172-0] [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: 03/10/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND The worldwide incidence of acute pancreatitis (AP) is increasing, but the dominant etiology of AP may vary by country. Mixed etiologies are involved in the increase in the number of AP patients. AIMS This study was to analyze the etiological changes and prognosis of AP patients and explore the prognosis of AP patients with mixed etiologies. METHODS Using a retrospective analysis method, AP patients hospitalized from January 2007 to December 2021 were selected from a pancreatic center in Nanchang, China. Trends in the main etiologies were analyzed, and the severity and prognosis of different etiologies were compared. RESULTS A total of 10,071 patients were included. Cholelithiasis (56.0%), hyperlipidemia (25.3%), and alcohol (6.5%) were the top three etiologies. The proportion of acute biliary pancreatitis (ABP) showed a decreasing trend, while the proportion of hypertriglyceridemic pancreatitis (HTGP) and alcoholic AP showed an increasing trend (all ptrend < 0.001). The incidence of organ failure and necrotizing pancreatitis was higher in patients with HTGP than in those with AP induced by other etiologies (all p < 0.05). There was no statistically significant difference in mortality among patients with different etiologies. Patients with AP due to a mixed hypertriglyceridemia-alcoholic etiology had higher ICU admission rates and were more severe than those with AP induced by other mixed etiologies. CONCLUSION In the past 15 years, the proportion of ABP has trended downward, while those of HTGP and alcoholic AP have risen. Among patients with mixed etiologies, those with a mixed hypertriglyceridemia-alcoholic etiology had a worse prognosis.
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Affiliation(s)
- Tianming Lai
- Department of Gastroenterology, Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, 330006, Nanchang, Jiangxi, People's Republic of China
| | - Jiarong Li
- Department of Gastroenterology, Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, 330006, Nanchang, Jiangxi, People's Republic of China
| | - Zhengang Zhou
- Department of Gastroenterology, Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, 330006, Nanchang, Jiangxi, People's Republic of China
| | - Jingwen Rao
- Department of Gastroenterology, Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, 330006, Nanchang, Jiangxi, People's Republic of China
| | - Yong Zhu
- Department of Gastroenterology, Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, 330006, Nanchang, Jiangxi, People's Republic of China
| | - Liang Xia
- Department of Gastroenterology, Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, 330006, Nanchang, Jiangxi, People's Republic of China
| | - Yupeng Lei
- Department of Gastroenterology, Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, 330006, Nanchang, Jiangxi, People's Republic of China
| | - Xin Huang
- Department of Gastroenterology, Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, 330006, Nanchang, Jiangxi, People's Republic of China
| | - Huajing Ke
- Department of Gastroenterology, Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, 330006, Nanchang, Jiangxi, People's Republic of China
| | - Yao Wu
- Department of Gastroenterology, Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, 330006, Nanchang, Jiangxi, People's Republic of China
| | - Pi Liu
- Department of Gastroenterology, Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, 330006, Nanchang, Jiangxi, People's Republic of China
| | - Hao Zeng
- Department of Gastroenterology, Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, 330006, Nanchang, Jiangxi, People's Republic of China
| | - Huifang Xiong
- Department of Gastroenterology, Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, 330006, Nanchang, Jiangxi, People's Republic of China
| | - Lingyu Luo
- Department of Gastroenterology, Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, 330006, Nanchang, Jiangxi, People's Republic of China
| | - Youxiang Chen
- Department of Gastroenterology, Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, 330006, Nanchang, Jiangxi, People's Republic of China
| | - Wenhua He
- Department of Gastroenterology, Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, 330006, Nanchang, Jiangxi, People's Republic of China.
| | - Yin Zhu
- Department of Gastroenterology, Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, 330006, Nanchang, Jiangxi, People's Republic of China
| | - Nonghua Lu
- Department of Gastroenterology, Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, 330006, Nanchang, Jiangxi, People's Republic of China
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Pu W, Tang W, Shen Y, Ji F, Huang J, Liu Y, Zhou J, Yin G. Comparison of different intensive triglyceride-lowering therapies in patients with hyperlipidemic acute pancreatitis. Pancreatology 2023; 23:919-925. [PMID: 37866998 DOI: 10.1016/j.pan.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/13/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVES The goal of this study was to investigate the clinical value of emergent triglyceride (TG)-lowering therapies for hyperlipidemic acute pancreatitis (HLAP). METHODS 126 HLAP patients were assigned randomly to receive either conventional treatment (CT), normal saline (NS) alone, or continuous veno-venous hemofiltration (CVVH) as an intensive TG-lowering therapy. TG levels, clinical outcomes, and inflammatory biomarkers were compared among the three groups. RESULTS Baseline characteristics did not differ significantly among the groups. CVVH removed TG from the plasma and achieved its target TG (<500 mg/dL) in approximately 25 h, compared to 40 h in the NS alone group and no targeted effect within 48 h in the CT group (P < 0.05). Although the majority of clinical outcomes did not differ significantly, an unexpectedly higher incidence of organ failure occurred in the CVVH group compared to the others. Hospital costs, severe AP patients and length of stay were significantly higher in the CVVH group compared to the other groups (P < 0.005). CONCLUSIONS Early CVVH lowers TG levels more efficiently than NS alone or CT therapy, but is not superior in terms of clinical outcomes and costs. NS also lowers TG levels and is significantly less costly than the other two treatments. Further multicenter studies are needed to determine the feasibility of NS alone treatment for HLAP patients.
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Affiliation(s)
- Wan Pu
- Department of Gastroenterology, The First People 's Hospital of Hefei, Hefei, Anhui, 230061, China
| | - Wen Tang
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, China
| | - Yaoliang Shen
- Department of General Medicine, The Changshu First People 's Hospital, Changshu, Jiangsu, 215501, China
| | - Fengjie Ji
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, China
| | - Jiujing Huang
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, China
| | - Yuxin Liu
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, China
| | - Jing Zhou
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, China
| | - Guojian Yin
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, China.
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Zhang L, Mao W, Liu D, Hu B, Lin X, Ran J, Li X, Hu J. Risk factors for drug-related acute pancreatitis: an analysis of the FDA adverse event reporting system (FAERS). Front Pharmacol 2023; 14:1231320. [PMID: 38044938 PMCID: PMC10690789 DOI: 10.3389/fphar.2023.1231320] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/09/2023] [Indexed: 12/05/2023] Open
Abstract
Objective: While several drugs have been linked to acute pancreatitis (AP), the AP-related risk of most drugs remains unclear. This study investigated the risk factors for drug-induced AP by analyzing a large dataset from the FDA Adverse Event Reporting System (FAERS). Methods: The reporting odds ratios (ROR) were used to assess the reports of drug-induced AP from the first quarter of 2004 to the second quarter of 2022. Single-factor, LASSO, and multi-factor regression analysis were performed to explore drug-related AP-related risk factors. Bonferroni correction was applied for the multiple comparisons performed. Results: A total of 264 drugs associated with AP, including antineoplastic drugs (35/264), antidiabetic drugs (28/264), antibacterial drugs (24/264), immunomodulatory drugs (11/264), antipsychotic drugs (6/264), and other drugs (160/264) were retrieved. Multi-factor analysis showed that males, age 41-54 years old, and 36 drugs, including Tigecycline, were risk factors for drug-related AP. The median time to drug-related AP onset was 31 days (interquartile range [IQR] 7-102 days) and about 75% of adverse events occurred within 100 days. Conclusion: These findings may help clinicians to identify drug-related AP at the early stage and can be used to inform future studies of drug-related AP pathogenesis.
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Affiliation(s)
- Lin Zhang
- Department of Pharmacy, The first Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Wei Mao
- Department of Pharmacy, Nanan People’s Hospital of Chongqing, Chongqing, China
| | - Dan Liu
- Department of Pharmacy, The first Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Bin Hu
- Department of Pharmacy, The first Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Xiaofang Lin
- Department of Pharmacy, The first Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Jie Ran
- Department of Pharmacy, The first Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Xingxing Li
- Department of Pharmacy, The first Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Jing Hu
- Department of Pharmacy, The first Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
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Umans DS, Timmerhuis HC, Anten MPGF, Bhalla A, Bijlsma RA, Boxhoorn L, Brink MA, Bruno MJ, Curvers WL, van Eijck BC, Erkelens GW, van Geenen EJM, Hazen WL, Hoge CV, Hol L, Inderson A, Kager LM, Kuiken SD, Perk LE, Quispel R, Römkens TEH, Sperna Weiland CJ, Thijssen AY, Venneman NG, Verdonk RC, van Wanrooij RLJ, Witteman BJ, Besselink MG, van Hooft JE. Prospective multicentre study of indications for surgery in patients with idiopathic acute pancreatitis following endoscopic ultrasonography (PICUS). Br J Surg 2023; 110:1877-1882. [PMID: 37811814 PMCID: PMC10638543 DOI: 10.1093/bjs/znad318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/21/2023] [Accepted: 08/30/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Cholecystectomy in patients with idiopathic acute pancreatitis (IAP) is controversial. A randomized trial found cholecystectomy to reduce the recurrence rate of IAP but did not include preoperative endoscopic ultrasonography (EUS). As EUS is effective in detecting gallstone disease, cholecystectomy may be indicated only in patients with gallstone disease. This study aimed to determine the diagnostic value of EUS in patients with IAP, and the rate of recurrent pancreatitis in patients in whom EUS could not determine the aetiology (EUS-negative IAP). METHODS This prospective multicentre cohort study included patients with a first episode of IAP who underwent outpatient EUS. The primary outcome was detection of aetiology by EUS. Secondary outcomes included adverse events after EUS, recurrence of pancreatitis, and quality of life during 1-year follow-up. RESULTS After screening 957 consecutive patients with acute pancreatitis from 24 centres, 105 patients with IAP were included and underwent EUS. In 34 patients (32 per cent), EUS detected an aetiology: (micro)lithiasis and biliary sludge (23.8 per cent), chronic pancreatitis (6.7 per cent), and neoplasms (2.9 per cent); 2 of the latter patients underwent pancreatoduodenectomy. During 1-year follow-up, the pancreatitis recurrence rate was 17 per cent (12 of 71) among patients with EUS-negative IAP versus 6 per cent (2 of 34) among those with positive EUS. Recurrent pancreatitis was associated with poorer quality of life. CONCLUSION EUS detected an aetiology in a one-third of patients with a first episode of IAP, requiring mostly cholecystectomy or pancreatoduodenectomy. The role of cholecystectomy in patients with EUS-negative IAP remains uncertain and warrants further study.
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Affiliation(s)
- Devica S Umans
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Research and Development, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Hester C Timmerhuis
- Department of Research and Development, St Antonius Hospital, Nieuwegein, the Netherlands
- Department of Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Marie-Paule G F Anten
- Department of Gastroenterology and Hepatology, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - Abha Bhalla
- Department of Gastroenterology and Hepatology, Haga Hospital, The Hague, the Netherlands
| | - Rina A Bijlsma
- Department of Gastroenterology and Hepatology, Martini Hospital, Groningen, the Netherlands
| | - Lotte Boxhoorn
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Research and Development, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Menno A Brink
- Department of Gastroenterology and Hepatology, Meander Medical Centre, Amersfoort, the Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Wouter L Curvers
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands
| | - Brechje C van Eijck
- Department of Gastroenterology and Hepatology, Spaarne Gasthuis, Haarlem, the Netherlands
| | - G Willemien Erkelens
- Department of Gastroenterology and Hepatology, Gelre Hospital, Apeldoorn, the Netherlands
| | - Erwin J M van Geenen
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Wouter L Hazen
- Department of Gastroenterology and Hepatology, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
| | - Chantal V Hoge
- Department of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Lieke Hol
- Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Akin Inderson
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Liesbeth M Kager
- Department of Gastroenterology and Hepatology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Sjoerd D Kuiken
- Department of Gastroenterology and Hepatology, OLVG, Amsterdam, the Netherlands
| | - Lars E Perk
- Department of Gastroenterology and Hepatology, Medical Centre Haaglanden, The Hague, the Netherlands
| | - Rutger Quispel
- Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - Tessa E H Römkens
- Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, Den Bosch, the Netherlands
| | - Christina J Sperna Weiland
- Department of Research and Development, St Antonius Hospital, Nieuwegein, the Netherlands
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Annemieke Y Thijssen
- Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Niels G Venneman
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Robert C Verdonk
- Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Roy L J van Wanrooij
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location Vrije Universiteit, Amsterdam, the Netherlands
| | - Ben J Witteman
- Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede, the Netherlands
| | - Marc G Besselink
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, the Netherlands
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Almohammadi AA, Aljafri OH, Esawi HH, Alzhrani AA, Alharbi MS. The Etiology and Epidemiological Features of Acute Pancreatitis in Saudi Arabia: A Systematic Review. Cureus 2023; 15:e46511. [PMID: 37927657 PMCID: PMC10625166 DOI: 10.7759/cureus.46511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
We aimed to identify the etiology of acute pancreatitis (AP) and its most common causes with its epidemiological features among the Saudi population in 2023 in different regions. In this systematic review, we assessed the etiology and epidemiological features of acute pancreatitis in Saudi Arabia following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guidelines. Inclusion criteria were studies conducted in Saudi Arabia, published in English, and involving participants aged 18 years or older. PubMed and Google Scholar were searched in March 2023 for English articles published between 1985 and 2023 using specific keywords. Two reviewers screened titles, abstracts, and full-text articles for eligibility, with disagreements resolved by a third reviewer. Data on study characteristics, participant demographics, and etiological factors were extracted using a standardized form. Descriptive analysis summarized the etiology of acute pancreatitis in Saudi Arabia based on the extracted data. Out of the 58 studies retrieved for screening, 10 studies were included in the final systematic review, and most of them were done in the Riyadh region. The sum of the sample size was 1,695 participants. In Saudi Arabia, the most prevalent cause of acute pancreatitis is biliary stones. The average mortality rate of acute pancreatitis in reported studies is 2.2%. In conclusion, biliary and idiopathic causes are the most frequent etiologies of AP in some different regions of Saudi Arabia, acute peripancreatic fluid collections and pancreatic pseudocysts are the two most commonly reported complications associated with AP, and the mortality rate of AP in Saudi Arabia may be higher compared to developed countries.
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Affiliation(s)
- Ahmed A Almohammadi
- Preventive Medicine and Public Health, Saudi Commission for Health Specialties, Medina, SAU
| | - Owais H Aljafri
- Preventive Medicine and Public Health, Saudi Commission for Health Specialties, Medina, SAU
| | - Hossam H Esawi
- Preventive Medicine and Public Health, Saudi Commission for Health Specialties, Medina, SAU
| | - Anas A Alzhrani
- Preventive Medicine and Public Health, Saudi Commission for Health Specialties, Medina, SAU
| | - Muteb S Alharbi
- Preventive Medicine and Public Health, Saudi Commission for Health Specialties, Medina, SAU
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9
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Ghiță AI, Pahomeanu MR, Negreanu L. Epidemiological trends in acute pancreatitis: A retrospective cohort in a tertiary center over a seven year period. World J Methodol 2023; 13:118-126. [PMID: 37456974 PMCID: PMC10348081 DOI: 10.5662/wjm.v13.i3.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/04/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Acute pancreatitis (AP) remains a major cause of hospitalization and mortality with important health-related costs worldwide. Using an electronic database of a large tertiary center, we estimated the incidence, etiology, severity and costs of hospitalized AP cases in southern Romania.
AIM To estimate the incidence, cost and tobacco usage of hospitalized AP cases in southern Romania and to update and upgrade the knowledge we have on the etiology, severity (in regard to Revised Atlanta Classification), outcome, morphology and local complications of AP.
METHODS We performed an electronic health care records search on AP patients treated at Emergency University Hospital of Bucharest (Spitalul Universitar de Urgență București) between 2015 and 2022. The incidence, etiology, and severity were calculated; potential risk factors were evaluated, and the hospitalization costs of AP were documented and analyzed. The cohort of this study is part of the BUCharest - Acute Pancreatitis Index registry.
RESULTS A total of 947 consecutive episodes of AP where the patients were hospitalized in the gastroenterology department were analyzed, with 79.45% as 1st episode and the rest recurrent. The majority of the patients were males (68.9%). Alcoholic (45.7%), idiopathic (16.4%) and biliary (15.2%) were the main causes. The incidence was estimated at 29.2 episodes/100000 people. The median length of stay was 7 d. The median daily cost was 747.96 RON (165 EUR). There was a high prevalence of active tobacco smokers (68.5%). The prevalence of severe disease was 11.1%. The admission rate to the intensive care unit was 4.6%, with a mortality rate of 38.6%. The overall mortality was 5.5%.
CONCLUSION We estimated the incidence of AP at 29.2 episodes that required hospitalization per 100000 people. The majority of our cases were found in males (68.9%) and were related to alcohol abuse (45.7%). Out of the cases we were able to find data regarding tobacco usage, the majority were active smokers (68.5%). Most patients had a mild course (54.4%), with a mortality rate of 5.5%. Interstitial AP prevailed (45.3%). The median daily cost of hospitalization was 747.96 RON (165 EUR).
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Affiliation(s)
- Andreea Irina Ghiță
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
| | - Mihai Radu Pahomeanu
- Internal Medicine I & Gastroenterology - University Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest 050098, Romania
| | - Lucian Negreanu
- Internal Medicine I & Gastroenterology - University Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest 050098, Romania
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10
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Barreto SG, Kaambwa B, Venkatesh K, Sasson SC, Andersen C, Delaney A, Bihari S, Pilcher D. Mortality and costs related to severe acute pancreatitis in the intensive care units of Australia and New Zealand (ANZ), 2003-2020. Pancreatology 2023:S1424-3903(23)00100-X. [PMID: 37121877 DOI: 10.1016/j.pan.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/21/2023] [Accepted: 04/17/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND AND OBJECTIVE Comprehensive data on the burden of severe acute pancreatitis (SAP) in global intensive care units (ICUs) and trends over time are lacking. Our objective was to compare trends in hospital and ICU mortality, in-hospital and ICU length of stay, and costs related to ICU admission in Australia and New Zealand (ANZ) for SAP. METHODS We performed a retrospective, observational, cohort study of ICU admissions reported to the ANZ Intensive Care Society Adult Patient Database over three consecutive six-year time periods from 2003 to 2020. RESULTS 12,635 patients with SAP from 189 ICUs in ANZ were analysed. No difference in adjusted hospital mortality (11.4% vs 11.5% vs 11.0%, p = 0.85) and ICU mortality rates (7.5% vs 8.0% vs 8.1%, p = 0.73) were noted over the study period. Median length of hospital admission reduced over time (13.9 days in 2003-08, 13.1 days in 2009-14 and 12.5 days in 2015-20; p < 0.01). No difference in length of ICU stay was noted over the study period (p = 0.13). The cost of managing SAP in ANZ ICUs remained constant over the three time periods. CONCLUSIONS In critically-ill SAP patients in ANZ, no change in mortality has been noted over nearly two decades. There was a slight reduction in hospital stay (1 day), while the length of ICU stay remained unchanged. Given the significant costs related to care of patients with SAP in ICU, these findings highlight the need to prioritise resource allocation for healthcare delivery and targeted clinical research to identify treatments aimed at reducing mortality.
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Affiliation(s)
- Savio George Barreto
- Division of Surgery and Perioperative Medicine, Flinders Medical Center, Bedford Park, Adelaide, South Australia, Australia; College of Medicine and Public Health, Flinders University, South Australia, Australia.
| | - Billingsley Kaambwa
- College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Karthik Venkatesh
- Malcolm Fisher Department of Intensive Care, The Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; The Kirby Institute, UNSW, Sydney, Australia
| | - Sarah C Sasson
- The Kirby Institute, UNSW, Sydney, Australia; NSW Health Pathology I.C.P.M.R, Westmead Hospital, Sydney, Australia
| | - Christopher Andersen
- Malcolm Fisher Department of Intensive Care, The Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; The Kirby Institute, UNSW, Sydney, Australia; Northern Clinical School, University of Sydney, Sydney, NSW, Australia; The George Institute for Global Health, King Street, Newtown, NSW, 2042, Australia
| | - Anthony Delaney
- Malcolm Fisher Department of Intensive Care, The Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Shailesh Bihari
- College of Medicine and Public Health, Flinders University, South Australia, Australia; Department of ICCU, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
| | - David Pilcher
- Department of Intensive Care, The Alfred Hospital, Commercial Road, Prahran, Melbourne, Victoria, 3004, Australia; The Australian and New Zealand Intensive Care-Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia; The Australian and New Zealand Intensive Care Society (ANZICS), Centre for Outcome and Resource Evaluation (CORE), 277 Camberwell Road, Camberwell, Victoria, 3124, Australia
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11
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Muacevic A, Adler JR, Rashed AM. Egypt's Initial Experience With Robotic-Assisted Cystogastrostomy and Pancreatic Debridement for Large Walled-Off Pancreatic Necrosis: A Report of Two Cases. Cureus 2022; 14:e32005. [PMID: 36589168 PMCID: PMC9798344 DOI: 10.7759/cureus.32005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 11/30/2022] Open
Abstract
Gallstones are the most common cause of acute pancreatitis (AP). Walled-off pancreatic necrosis (WOPN) is one of the sequelae of AP. Endoscopic and laparoscopic techniques for cystogastrostomy have been reported in the literature as treatment options for complicated or symptomatic WOPN. Here, we describe two cases of gallstone-related AP complicated by WOPN treated by robotic-assisted transgastric cystogastrostomy and cholecystectomy.
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12
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Han C, Yang HY, Lv YW, Dong ZQ, Liu Y, Li ZS, Wang D, Hu LH. Global status of acute pancreatitis research in the last 20 years: A bibliometric study. Medicine (Baltimore) 2022; 101:e31051. [PMID: 36254012 PMCID: PMC9575756 DOI: 10.1097/md.0000000000031051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Acute pancreatitis (AP) is a common digestive disease encountered in Emergency Departments that carries a heavy socioeconomic burden. This study was conducted to determine the global status of AP research. Articles related to AP published in 1999 to 2018 were retrieved from the Web of Science (WOS) database and the 20 highest-output countries or regions were determined based on the total number of publications. Correlation analysis of AP research output and the gross domestic product (GDP) of each country or region was conducted. The quantity and quality of research of these 20 highest-output countries were compared to the total output, outputs per capita, and average impact factor (IF). All annual data were analyzed using time-trend analysis. A keyword co-occurrence analysis was conducted to determine the highlights in AP research. In total, 17,698 publications were retrieved, and 16,461 papers (93.0%) of them were from the 20 highest-output countries. A significantly positive correlation was identified between AP research output and the GDP (R = 0.973, P < .001). The 5 highest-output countries were the USA (24.9%), China (12.3%), Germany (7.5%), Japan (6.7%), and the UK (6.1%). Finland ranked 1st in the number of publication per capita, the USA had the highest accumulated IF (25,432.758) and total citations (104,592), Switzerland had the highest average IF (6.723), and Netherland had the highest average citations (51.90). Genetic research and AP-related hyperglycemia were research highlights. Analysis of the global output of research of AP research showed signs of growth. Research output was positively correlated with GDP. For the most productive countries, research quality was stable. Although developing countries lagged behind in output per capita and quality, great progress has been made in the past 2 decades.
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Affiliation(s)
- Chao Han
- Department of Gastroenterology, First Affiliated Hospital of Navy Medical University, Shanghai, China
| | - Huai-Yu Yang
- Department of Gastroenterology, First Affiliated Hospital of Navy Medical University, Shanghai, China
| | - Yan-Wei Lv
- Department of Gastroenterology, First Affiliated Hospital of Navy Medical University, Shanghai, China
| | - Zhi-Qi Dong
- Department of Gastroenterology, Shanghai Fourth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yu Liu
- Department of Gastroenterology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhao-Shen Li
- Department of Gastroenterology, First Affiliated Hospital of Navy Medical University, Shanghai, China
| | - Dan Wang
- Department of Gastroenterology, First Affiliated Hospital of Navy Medical University, Shanghai, China
| | - Liang-Hao Hu
- Department of Gastroenterology, First Affiliated Hospital of Navy Medical University, Shanghai, China
- * Correspondence: Liang-Hao Hu, Department of Gastroenterology, First Affiliated Hospital of Navy Medical University, 168 Changhai Road, Shanghai, China (e-mail: )
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13
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Strand DS, Law RJ, Yang D, Elmunzer BJ. AGA Clinical Practice Update on the Endoscopic Approach to Recurrent Acute and Chronic Pancreatitis: Expert Review. Gastroenterology 2022; 163:1107-1114. [PMID: 36008176 DOI: 10.1053/j.gastro.2022.07.079] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/08/2022] [Accepted: 07/01/2022] [Indexed: 02/07/2023]
Abstract
DESCRIPTION The purpose of this American Gastroenterological Association (AGA) Clinical Practice Update Expert Review is to provide practical, evidence-based guidance to clinicians regarding the role of endoscopy for recurrent acute and chronic pancreatitis. METHODS This expert review was commissioned and approved by the AGA Institute Clinical Practice Updates Committee and the AGA Governing Board to provide guidance on a topic of clinical importance to the AGA membership, underwent internal peer review by the Clinical Practice Updates Committee (CPUC), and external peer review through standard procedures of Gastroenterology. This review is framed around the 8 best practice advice points agreed upon by the authors, based on the results of randomized controlled trials, observational studies, systematic reviews and meta-analyses, as well expert consensus in this field. Best Practice Advice Statements BEST PRACTICE ADVICE 1: After an unrevealing initial evaluation, endoscopic ultrasound is the preferred diagnostic test for unexplained acute and recurrent pancreatitis. Magnetic resonance imaging with contrast and cholangiopancreatography is a reasonable complementary or alternative test to endoscopic ultrasound, based on local expertise and availability. BEST PRACTICE ADVICE 2: The role of endoscopic retrograde cholangiopancreatography (ERCP) for reducing the frequency of acute pancreatitis episodes in patients with pancreas divisum is controversial, but minor papilla endotherapy may be considered, particularly for those with objective signs of outflow obstruction, such as a dilated dorsal pancreatic duct and/or santorinicele. There is no role for ERCP to treat pain alone in patients with pancreas divisum. BEST PRACTICE ADVICE 3: The role of ERCP for reducing the frequency of pancreatitis episodes in patients with unexplained recurrent acute pancreatitis and standard pancreatic ductal anatomy is controversial and should only be considered after a comprehensive discussion of the uncertain benefits and potentially severe procedure-related adverse events. When pursued, ERCP with biliary sphincterotomy alone may be preferable to dual sphincterotomy. BEST PRACTICE ADVICE 4: Surgical intervention should be considered over endoscopic therapy for long-term treatment of patients with painful obstructive chronic pancreatitis. Endoscopic intervention is a reasonable alternative to surgery for suboptimal operative candidates or those who favor a less invasive approach, assuming they are clearly informed that the best practice advice primarily favors surgery. BEST PRACTICE ADVICE 5: When ERCP is pursued, small (≤5mm) main pancreatic duct stones can be treated with pancreatography and conventional stone extraction maneuvers. For larger stones, extracorporeal shockwave lithotripsy and/or pancreatoscopy with intraductal lithotripsy may be required. BEST PRACTICE ADVICE 6: When ERCP is pursued, prolonged stent therapy (6-12 months) is effective for treating symptoms and remodeling main pancreatic duct strictures. The preferred approach is to place and sequentially add multiple plastic stents in parallel (upsizing); emerging evidence suggests that fully covered self-expanding metal stents may have a role for this indication, but additional research is necessary. BEST PRACTICE ADVICE 7: ERCP with stent insertion is the preferred treatment for benign biliary stricture due to chronic pancreatitis. FCSEMS placement is favored over multiple plastic stents whenever feasible, given similar efficacy but significantly reduced need for stent exchange procedures during the treatment course. BEST PRACTICE ADVICE 8: Celiac plexus block should not be routinely performed for the management of pain due to chronic pancreatitis. The decision to proceed with celiac plexus block in selected patients with debilitating pain in whom other therapeutic measures have failed can be considered on a case-by-case basis, but only after discussion of the unclear outcomes of this intervention and its procedural risks.
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Affiliation(s)
- Daniel S Strand
- Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia
| | - Ryan J Law
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Dennis Yang
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida.
| | - B Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina
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14
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McHenry N, Shah I, Ahmed A, Freedman SD, Kothari DJ, Sheth SG. Racial Variations in Pain Management and Outcomes in Hospitalized Patients With Acute Pancreatitis. Pancreas 2022; 51:1248-1250. [PMID: 37078952 DOI: 10.1097/mpa.0000000000002160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
OBJECTIVES Acute pancreatitis (AP) is a common cause of hospitalization. Black AP patients have higher risk for alcoholic etiology and hospitalization than White patients. We evaluated outcomes and treatment disparities by race in hospitalized AP patients. METHODS We retrospectively analyzed Black and White AP patients admitted 2008-2018. Primary outcomes were length of stay, intensive care unit admission, 30-day readmissions, and mortality. Secondary outcomes included pain scores, opioid dosing, and complications. RESULTS We identified 630 White and 186 Black AP patients. Alcoholic AP (P < 0.001), tobacco use (P = 0.013), and alcohol withdrawal (P < 0.001) were more common among Blacks. There were no differences in length of stay (P = 0.113), intensive care unit stay (P = 0.316), 30-day readmissions (P = 0.797), inpatient (P = 0.718) or 1-year (P = 0.071) mortality, complications (P = 0.080), or initial (P = 0.851) and discharge pain scores (P = 0.116). Discharge opioids were prescribed more frequently for Whites (P = 0.001). CONCLUSIONS Hospitalized Black and White AP patients had similar treatment and outcomes. Standardized protocols used to manage care may eliminate racial biases. Disparities in discharge opioid prescriptions may be explained by higher alcohol and tobacco use by Black patients.
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Affiliation(s)
- Nicole McHenry
- From the Digestive Disease Center, Beth Israel Deaconess Medical Center
| | - Ishani Shah
- From the Digestive Disease Center, Beth Israel Deaconess Medical Center
| | - Awais Ahmed
- From the Digestive Disease Center, Beth Israel Deaconess Medical Center
| | | | - Darshan J Kothari
- Division of Gastroenterology and Hepatology, Duke University Medical Center, Durham, NC
| | - Sunil G Sheth
- Pancreas Center, Beth Israel Deaconess Medical Center, Boston, MA
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15
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Jaber S, Garnier M, Asehnoune K, Bounes F, Buscail L, Chevaux JB, Dahyot-Fizelier C, Darrivere L, Jabaudon M, Joannes-Boyau O, Launey Y, Levesque E, Levy P, Montravers P, Muller L, Rimmelé T, Roger C, Savoye-Collet C, Seguin P, Tasu JP, Thibault R, Vanbiervliet G, Weiss E, Jong AD. Pancréatite aiguë grave du patient adulte en soins critiques 2021. ANESTHÉSIE & RÉANIMATION 2022. [DOI: 10.1016/j.anrea.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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16
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Vaccaro MI, Mitchell F, Rivera F, Gonzalez CD. Protein expression in exocrine pancreatic diseases. Focus on VMP1 mediated autophagy. ADVANCES IN PROTEIN CHEMISTRY AND STRUCTURAL BIOLOGY 2022; 132:175-197. [PMID: 36088075 DOI: 10.1016/bs.apcsb.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The exocrine pancreas produces enzymes involved in the digestive process whereas endocrine pancreas mainly regulates glucose metabolism. Diseases of the exocrine pancreas are characterized by high morbidity and mortality. Acute pancreatitis is a painful disease in which pancreatic secretory proteins are prematurely activated causing the digestion of the gland. Pancreatic adenocarcinoma is one of the most malignant cancers due to its resistance to treatment, its late diagnosis and high capacity for metastasis. Autophagy is a catabolic process that aims at degrading cytoplasmic contents and damaged organelles, to preserve cell viability and homeostasis. VMP1 is a transmembrane protein that plays a key role in triggering autophagy and being part of the autophagosome membrane. A specific type of selective autophagy pathway called zymophagy protects the pancreas against self-digestion in the setting of acute pancreatitis by sequestering intracellularly activated zymogen granules. Mitophagy is also responsible for maintaining pancreatitis as a mild disease by preserving mitochondrial function. Dysregulation of these selective autophagic processes by pancreatitis itself constitutes a risk factor for development of severe disease. In pancreatic adenocarcinoma, VMP1 mediated autophagy promotes cancer cell survival and resistance to chemotherapy. Therefore, it is relevant to highlight a role for controlling VMP1 expression and targeting VMP1 molecular pathways to improve exocrine pancreatic diseases prognosis.
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Affiliation(s)
- Maria I Vaccaro
- University of Buenos Aires, CONICET, Institute for Biochemistry and Molecular Medicine, Department of Pathophysiology, Buenos Aires, Argentina; CEMIC University Hospital, Unit of Translational Medical Research, Buenos Aires, Argentina.
| | - Florencia Mitchell
- CEMIC University Institute, School of Medicine, Department of Pharmacology, Buenos Aires, Argentina
| | - Francisco Rivera
- CEMIC University Institute, School of Medicine, Department of Pharmacology, Buenos Aires, Argentina
| | - Claudio D Gonzalez
- CEMIC University Hospital, Unit of Translational Medical Research, Buenos Aires, Argentina; CEMIC University Institute, School of Medicine, Department of Pharmacology, Buenos Aires, Argentina
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Purschke B, Bolm L, Meyer MN, Sato H. Interventional strategies in infected necrotizing pancreatitis: Indications, timing, and outcomes. World J Gastroenterol 2022; 28:3383-3397. [PMID: 36158258 PMCID: PMC9346450 DOI: 10.3748/wjg.v28.i27.3383] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/07/2022] [Accepted: 06/16/2022] [Indexed: 02/06/2023] Open
Abstract
Acute pancreatitis (AP) is one of the most common gastrointestinal diseases and remains a life-threatening condition. Although AP resolves to restitutio ad integrum in approximately 80% of patients, it can progress to necrotizing pancreatitis (NP). NP is associated with superinfection in a third of patients, leading to an increase in mortality rate of up to 40%. Accurate and early diagnosis of NP and associated complications, as well as state-of-the-art therapy are essential to improve patient prognoses. The emerging role of endoscopy and recent trials on multidisciplinary management of NP established the “step-up approach”. This approach starts with endoscopic interventions and can be escalated to other interventional and ultimately surgical procedures if required. Studies showed that this approach decreases the incidence of new multiple-organ failure as well as the risk of interventional complications. However, the optimal interventional sequence and timing of interventional procedures remain controversial. This review aims to summarize the indications, timing, and treatment outcomes for infected NP and to provide guidance on multidisciplinary decision-making.
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Affiliation(s)
- Birte Purschke
- Department of Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Louisa Bolm
- Department of Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Max Nikolaus Meyer
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Hiroki Sato
- Department of Medicine, Asahikawa Medical University, Asahikawa 0788510, Hokkaido, Japan
- Department of Gastroenterology, Asahikawa Kosei Hospital, Asahikawa 0788211, Hokkaido, Japan
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18
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Jaber S, Garnier M, Asehnoune K, Bounes F, Buscail L, Chevaux JB, Dahyot-Fizelier C, Darrivere L, Jabaudon M, Joannes-Boyau O, Launey Y, Levesque E, Levy P, Montravers P, Muller L, Rimmelé T, Roger C, Savoye-Collet C, Seguin P, Tasu JP, Thibault R, Vanbiervliet G, Weiss E, De Jong A. Guidelines for the management of patients with severe acute pancreatitis, 2021. Anaesth Crit Care Pain Med 2022; 41:101060. [PMID: 35636304 DOI: 10.1016/j.accpm.2022.101060] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To provide guidelines for the management of the intensive care patient with severe acute pancreatitis. DESIGN A consensus committee of 22 experts was convened. A formal conflict-of-interest (COI) policy was developed at the beginning of the process and enforced throughout. The entire guideline construction process was conducted independently of any industrial funding (i.e. pharmaceutical, medical devices). The authors were required to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. METHODS The most recent SFAR and SNFGE guidelines on the management of the patient with severe pancreatitis were published in 2001. The literature now is sufficient for an update. The committee studied 14 questions within 3 fields. Each question was formulated in a PICO (Patients Intervention Comparison Outcome) format and the relevant evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology. RESULTS The experts' synthesis work and their application of the GRADE® method resulted in 24 recommendations. Among the formalised recommendations, 8 have high levels of evidence (GRADE 1+/-) and 12 have moderate levels of evidence (GRADE 2+/-). For 4 recommendations, the GRADE method could not be applied, resulting in expert opinions. Four questions did not find any response in the literature. After one round of scoring, strong agreement was reached for all the recommendations. CONCLUSIONS There was strong agreement among experts for 24 recommendations to improve practices for the management of intensive care patients with severe acute pancreatitis.
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Affiliation(s)
- Samir Jaber
- Department of Anaesthesiology and Intensive Care (DAR B), University Hospital Center Saint Eloi Hospital, Montpellier, France; PhyMedExp, Montpellier University, INSERM, CNRS, CHU de Montpellier, Montpellier, France.
| | - Marc Garnier
- Sorbonne Université, GRC 29, DMU DREAM, Service d'Anesthésie-Réanimation et Médecine Périopératoire Rive Droite, Paris, France
| | - Karim Asehnoune
- Service d'Anesthésie, Réanimation chirurgicale, Hôtel Dieu/HME, CHU Nantes, Nantes cedex 1, France; Inserm, UMR 1064 CR2TI, team 6, France
| | - Fanny Bounes
- Toulouse University Hospital, Anaesthesia Critical Care and Perioperative Medicine Department, Toulouse, France; Équipe INSERM Pr Payrastre, I2MC, Université Paul Sabatier Toulouse III, Toulouse, France
| | - Louis Buscail
- Department of Gastroenterology & Pancreatology, University of Toulouse, Rangueil Hospital, Toulouse, France
| | | | - Claire Dahyot-Fizelier
- Anaesthesiology and Intensive Care Department, University hospital of Poitiers, Poitiers, France; INSERM U1070, University of Poitiers, Poitiers, France
| | - Lucie Darrivere
- Department of Anaesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, F-75010, Paris, France
| | - Matthieu Jabaudon
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France; iGReD, Université Clermont Auvergne, CNRS, INSERM, Clermont-Ferrand, France
| | - Olivier Joannes-Boyau
- Service d'Anesthésie-Réanimation SUD, CHU de Bordeaux, Hôpital Magellan, Bordeaux, France
| | - Yoann Launey
- Critical Care Unit, Department of Anaesthesia, Critical Care and Perioperative Medicine, University Hospital of Rennes, Rennes, France
| | - Eric Levesque
- Department of Anaesthesia and Surgical Intensive Care, AP-HP, Henri Mondor Hospital, Créteil, France; Université Paris-Est Creteil, EnvA, DYNAMiC, Faculté de Santé de Créteil, Creteil, France
| | - Philippe Levy
- Service de Pancréatologie et d'Oncologie Digestive, DMU DIGEST, Université de Paris, Hôpital Beaujon, APHP, Clichy, France
| | - Philippe Montravers
- Université de Paris Cité, INSERM UMR 1152 - PHERE, Paris, France; Département d'Anesthésie-Réanimation, APHP, CHU Bichat-Claude Bernard, DMU PARABOL, APHP, Paris, France
| | - Laurent Muller
- Réanimations et surveillance continue, Pôle Anesthésie Réanimation Douleur Urgences, CHU Nîmes Caremeau, Montpellier, France
| | - Thomas Rimmelé
- Département d'anesthésie-réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France; EA 7426: Pathophysiology of Injury-induced Immunosuppression, Pi3, Hospices Civils de Lyon-Biomérieux-Université Claude Bernard Lyon 1, Lyon, France
| | - Claire Roger
- Réanimations et surveillance continue, Pôle Anesthésie Réanimation Douleur Urgences, CHU Nîmes Caremeau, Montpellier, France; Department of Intensive care medicine, Division of Anaesthesiology, Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Céline Savoye-Collet
- Department of Radiology, Normandie University, UNIROUEN, Quantif-LITIS EA 4108, Rouen University Hospital-Charles Nicolle, Rouen, France
| | - Philippe Seguin
- Service d'Anesthésie Réanimation 1, Réanimation chirurgicale, CHU de Rennes, Rennes, France
| | - Jean-Pierre Tasu
- Service de radiologie diagnostique et interventionnelle, CHU de Poitiers, Poitiers, France; LaTim, UBO and INSERM 1101, University of Brest, Brest, France
| | - Ronan Thibault
- Service Endocrinologie-Diabétologie-Nutrition, CHU Rennes, INRAE, INSERM, Univ Rennes, NuMeCan, Nutrition Metabolisms Cancer, Rennes, France
| | - Geoffroy Vanbiervliet
- Department of Digestive Endoscopy, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Emmanuel Weiss
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Clichy, France; University of Paris, Paris, France; Inserm UMR_S1149, Centre for Research on Inflammation, Paris, France
| | - Audrey De Jong
- Department of Anaesthesiology and Intensive Care (DAR B), University Hospital Center Saint Eloi Hospital, Montpellier, France; PhyMedExp, Montpellier University, INSERM, CNRS, CHU de Montpellier, Montpellier, France
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19
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Nesvaderani M, Dhillon BK, Chew T, Tang B, Baghela A, Hancock RE, Eslick GD, Cox M. Gene Expression Profiling: Identification of Novel Pathways and Potential Biomarkers in Severe Acute Pancreatitis. J Am Coll Surg 2022; 234:803-815. [PMID: 35426393 DOI: 10.1097/xcs.0000000000000115] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Determining the risk of developing severe acute pancreatitis (AP) on presentation to hospital is difficult but vital to enable early management decisions that reduce morbidity and mortality. The objective of this study was to determine global gene expression profiles of patients with different acute pancreatitis severity to identify genes and molecular mechanisms involved in the pathogenesis of severe AP. STUDY DESIGN AP patients (n = 87) were recruited within 24 hours of admission to the Emergency Department and were confirmed to exhibit at least 2 of the following features: (1) abdominal pain characteristic of AP, (2) serum amylase and/or lipase more than 3-fold the upper laboratory limit considered normal, and/or (3) radiographically demonstrated AP on CT scan. Severity was defined according to the Revised Atlanta classification. Thirty-two healthy volunteers were also recruited and peripheral venous blood was collected for performing RNA-Seq. RESULTS In severe AP, 422 genes (185 upregulated, 237 downregulated) were significantly differentially expressed when compared with moderately severe and mild cases. Pathway analysis revealed changes in specific innate and adaptive immune, sepsis-related, and surface modification pathways in severe AP. Data-driven approaches revealed distinct gene expression groups (endotypes), which were not entirely overlapping with the clinical Atlanta classification. Importantly, severe and moderately severe AP patients clustered away from healthy controls, whereas mild AP patients did not exhibit any clear separation, suggesting distinct underlying mechanisms that may influence severity of AP. CONCLUSION There were significant differences in gene expression affecting the severity of AP, revealing a central role of specific immunological pathways. Despite the existence of patient endotypes, a 4-gene transcriptomic signature (S100A8, S100A9, MMP25, and MT-ND4L) was determined that can predict severe AP with an accuracy of 64%.
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Affiliation(s)
- Maryam Nesvaderani
- From the Department of Surgery, The Centre for Evidence Based Surgery (Nesvaderani, Eslick, Cox), University of Sydney Nepean Clinical School, Nepean Hospital, Sydney, Australia
| | - Bhavjinder K Dhillon
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, Canada (Dhillon, Baghela, Hancock)
| | - Tracy Chew
- Intensive Care Medicine (Chew, Tang), University of Sydney Nepean Clinical School, Nepean Hospital, Sydney, Australia
- Sydney Informatics Hub, University of Sydney, Sydney, Australia (Chew)
| | - Benjamin Tang
- Intensive Care Medicine (Chew, Tang), University of Sydney Nepean Clinical School, Nepean Hospital, Sydney, Australia
| | - Arjun Baghela
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, Canada (Dhillon, Baghela, Hancock)
| | - Robert Ew Hancock
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, Canada (Dhillon, Baghela, Hancock)
| | - Guy D Eslick
- From the Department of Surgery, The Centre for Evidence Based Surgery (Nesvaderani, Eslick, Cox), University of Sydney Nepean Clinical School, Nepean Hospital, Sydney, Australia
| | - Michael Cox
- From the Department of Surgery, The Centre for Evidence Based Surgery (Nesvaderani, Eslick, Cox), University of Sydney Nepean Clinical School, Nepean Hospital, Sydney, Australia
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20
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İnce AT, Seven G, Koçhan K, Kiremitçi S, Yıldız K, Şentürk H. The course of acute pancreatitis in patients with different BMI groups. Pancreatology 2022; 22:348-355. [PMID: 35322789 DOI: 10.1016/j.pan.2022.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 01/06/2022] [Accepted: 03/08/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To evaluate the risk factors, Atlanta severity score, Balthazar-CTSI score, and disease course in patients of varying weight with acute pancreatitis (AP). METHODS A retrospective evaluation was made of normal weight (NW), overweight (OW), and obese (OB) patients (n:1134) with respect to demographic findings, diabetes (DM)/hypertension, smoking/alcohol use, etiologies, laboratory findings, Balthazar/Atlanta severity scores, and disease outcomes. After consistency and associations among the BMI, Balthazar, and Atlanta groups were evaluated, combined effects of risk factors on mortality, hospital and ICU stays were re-examined statistically. RESULTS In the OB group, mean age (p < 0.001), female gender (p < 0.001), increased BUN(p < 0.027) and Hct (p = 0.039), DM(p < 0.024), and mortality (p < 0.011) were statistically significant. In the non-NW groups, the rates of complications (40.6%/38.6%), mortality (3.7%/4.9%), interventional procedures (36%/39%), and length of hospital stay (11.6%/9.8%) were increased. Obesity constituted 23.7% of severe AP(SAP) and 50% of mortality. There was no significant relationship between Atlanta and Balthazar groups and BMI, nor between Balthazar and moderate AP (MSAP) to SAP. Old age (p = 0.000), male sex (p = 0.05), obesity (p = 0.046), alcohol (p = 0.014), low Hct (p = 0.044), high CRP (p = 0.024), MSAP/SAP (p = 0.02/(p < 0.001), and any complications (p < 0.001) increased the mortality risk. Female gender (p = 0.024), smoking (p = 0.021), hypertriglyceridemia (p = 0.047), idiopathic etiology (p = 0.023), and MSAP/SAP (p < 0.001) associations increased ICU admission. Co-occurrences of higher Balthazar score (p < 0.001), MSAP/SAP (p < 0.001), all kinds of complications (p < 0.001), and recurrence (p = 0.040) increased the hospital stay (≥11 days). CONCLUSIONS Although complications, mortality, longer hospitalization, and interventional procedures were observed more in the overweight and obese, successful prediction of Atlanta severity and Balthazar-CTSI scores based on BMI does not appear to be accurate. OB carries an increased risk for morbidity and mortality. The combined effects of risk factors increased mortality, longer hospital stays, and ICU admission.
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Affiliation(s)
- Ali Tüzün İnce
- Gastroenterology Clinic, Adnan Menderes Bulvarı, Vatan Cad, 34093, Fatih, İstanbul, Turkey.
| | - Gülseren Seven
- Gastroenterology Clinic, Adnan Menderes Bulvarı, Vatan Cad, 34093, Fatih, İstanbul, Turkey
| | - Koray Koçhan
- Gastroenterology Clinic, Adnan Menderes Bulvarı, Vatan Cad, 34093, Fatih, İstanbul, Turkey
| | - Sercan Kiremitçi
- Gastroenterology Clinic, Adnan Menderes Bulvarı, Vatan Cad, 34093, Fatih, İstanbul, Turkey
| | - Kemal Yıldız
- Internal Medicine Clinic, Medicana International Hospital, Beylikdüzü Cd. No:3, 34520, Beylikdüzü, İstanbul, Turkey
| | - Hakan Şentürk
- Gastroenterology Clinic, Adnan Menderes Bulvarı, Vatan Cad, 34093, Fatih, İstanbul, Turkey
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21
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Brown L, Loveday B. Acute pancreatitis in Australian adults: can administrative data help with healthcare planning? ANZ J Surg 2022; 92:8-9. [PMID: 35212119 DOI: 10.1111/ans.17420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Lisa Brown
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Department of Surgery, North Shore Hospital, Auckland, New Zealand
| | - Benjamin Loveday
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Department of General Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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22
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Keyal NK, Singh A, Pokhrel A, Bhujel A, Chaurasia RK. Ulinastatin in the Management of Severe Acute Alcoholic Pancreatitis: A Case Series. JNMA J Nepal Med Assoc 2021; 59:1302-1306. [PMID: 35199800 PMCID: PMC9200027 DOI: 10.31729/jnma.4987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 12/04/2021] [Indexed: 11/02/2022] Open
Abstract
Severe acute alcoholic pancreatitis is a second common form of pancreatitis that requires intensive care unit care and has high morbidity and mortality due to lacking specific treatment. Management of alcoholic pancreatitis is generally non- specific and supportive. We hereby present a case-series of three patients that describes the successful treatment of severe acute alcoholic pancreatitis with ulinastatin and other supportive treatment. From this we want to emphasize that ulinastatin a protease inhibitor can be used in the treatment of alcoholic pancreatitis.
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Affiliation(s)
- Niraj Kumar Keyal
- Department of Critical Care Medicine, B &C Medical College Teaching Hospital & Research center, Birtamod, Jhapa, Nepal,Correspondence: Dr Niraj Kumar Keyal, B & C Medical College and Teaching Hospital, Birtamode, Nepal. , Phone: +977-9855027141
| | - Amit Singh
- Department of General Surgery, B &C Medical College Teaching Hospital & Research center, Birtamod, Jhapa, Nepal
| | - Abishek Pokhrel
- Department of Radiology, B &C Medical College Teaching Hospital & Research Center, Birtamod, Jhapa, Nepal
| | - Amid Bhujel
- Department of Critical Care Medicine, B &C Medical College Teaching Hospital & Research center, Birtamod, Jhapa, Nepal
| | - Rupesh Kumar Chaurasia
- Department of Critical Care Medicine, B &C Medical College Teaching Hospital & Research center, Birtamod, Jhapa, Nepal
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23
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Loosen SH, Essing T, Jördens M, Koch A, Tacke F, Knoefel WT, Bode J, Roderburg C, Luedde T. Current epidemiological trends and in-hospital mortality of acute pancreatitis in Germany: a systematic analysis of standardized hospital discharge data between 2008 and 2017. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 60:310-319. [PMID: 34820807 DOI: 10.1055/a-1682-7621] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acute pancreatitis (AP) represents a common gastrointestinal disorder. Complicated disease courses in particular still represent a major clinical challenge and are associated with high mortality. Evaluation of existing data sets and their careful interpretation can support a rational discussion to optimize outcomes of this common gastrointestinal disease. METHODS We used standardized hospital discharge data provided by the Federal Statistical Office of Germany to evaluate hospital mortality and current developments of AP in Germany between 2008 and 2017. RESULTS In this analysis, 516,618 hospitalized AP cases were included. Main disease etiologies featured biliary (29.9%) and alcoholic (22.7%) AP. The annual frequency of AP increased from 48,858 (2008) to 52,611 (2017), mainly due to a rising incidence of biliary AP. Average hospital mortality was 2.85% and significantly improved over time. While uncomplicated AP had low hospital mortality (1.38%), the presence of organ complications was associated with a mortality of 12.34%. The necessity of mechanical ventilation dramatically increased hospital mortality to 44.06%. Hospital mortality was significantly higher in female patients (3.31%) than males (2.55%) and showed a stepwise increase with patient age. We further identified type 2 diabetes mellitus and obesity as factors associated with increased hospital mortality. Hospital mortality was lowest among patients treated at departments specializing in gastroenterology. Finally, high case volume centers (defined as >98 annual AP cases) had the lowest hospital mortality for patients with complicated courses of AP. CONCLUSION With over 50,000 annual hospitalization cases, AP is one of the most important inpatient treatment indications in gastroenterology in Germany. Overall, AP mortality has improved in recent years, presumably due to improved interdisciplinary treatment concepts. In this study, we identified important clinical and epidemiological risk factors for an unfavorable course, which could help to improve risk prediction and triaging, and thus the management of AP.
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Affiliation(s)
- Sven H Loosen
- Clinic for Gastroenterology, Hepatology and Infectious Disease, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Tobias Essing
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Markus Jördens
- Clinic for Gastroenterology, Hepatology and Infectious Disease, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Alexander Koch
- Medizinische Klinik III, Universitätsklinikum Aachen (RWTH), Aachen, Germany
| | - Frank Tacke
- Charité University Medicine Berlin, Department of Hepatology and Gastroenterology, Berlin, Germany
| | - Wolfram T Knoefel
- Department of General, Visceral and Pediatric Surgery, University of Düsseldorf, Düsseldorf, Germany
| | - Johannes Bode
- Klinik für Gastroenterologie, Hepatologie und Infektiologie Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Christoph Roderburg
- Clinic for Gastroenterology, Hepatology and Infectious Disease, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Tom Luedde
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
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24
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Nalisa M, Nweke EE, Smith MD, Omoshoro-Jones J, Devar JWS, Metzger R, Augustine TN, Fru PN. Chemokine receptor 8 expression may be linked to disease severity and elevated interleukin 6 secretion in acute pancreatitis. World J Gastrointest Pathophysiol 2021; 12:115-133. [PMID: 34877026 PMCID: PMC8611186 DOI: 10.4291/wjgp.v12.i6.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/08/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is an inflammatory disease, which presents with epigastric pain and is clinically diagnosed by amylase and lipase three times the upper limit of normal. The 2012 Atlanta classification stratifies the severity of AP as one of three risk categories namely, mild AP (MAP), moderately severe AP (MSAP), and severe AP (SAP). Challenges in stratifying AP upon diagnosis suggest that a better understanding of the underlying complex pathophysiology may be beneficial.
AIM To identify the role of the chemokine receptor 8 (CCR8), expressed by T-helper type-2 Lymphocytes and peritoneal macrophages, and its possible association to Interleukin (IL)-6 and AP stratification.
METHODS This study was a prospective case-control study. A total of 40 patients were recruited from the Chris Hani Baragwanath Academic Hospital and the Charlotte Maxeke Johannesburg Academic Hospital. Bioassays were performed on 29 patients (14 MAP, 11 MSAP, and 4 SAP) and 6 healthy controls as part of a preliminary study. A total of 12 mL of blood samples were collected at Day (D) 1, 3, 5, and 7 post epigastric pain. Using multiplex immunoassay panels, real-time polymerase chain reaction (qRT-PCR) arrays, and multicolour flow cytometry analysis, immune response-related proteins, genes, and cells were profiled respectively. GraphPad Prism™ software and fold change (FC) analysis was used to determine differences between the groups. P<0.05 was considered significant.
RESULTS The concentration of IL-6 was significantly different at D3 post epigastric pain in both the MAP group and MSAP group with P = 0.001 and P = 0.013 respectively, in a multiplex assay. When a FC of 2 was applied to identify differentially expressed genes using RT2 Profiler, CCR8 was shown to increase steadily with disease severity from MAP (1.33), MSAP (38.28) to SAP (1172.45) median FC. Further verification studies using RT-PCR showed fold change increases of CCR8 in MSAP and SAP ranging from 1000 to 1000000 times when represented as Log10, compared to healthy control respectively at D3. The findings also showed differing lymphocyte and monocyte cell frequency between the groups. With monocyte population frequency as high as 70% in MSAP at D3.
CONCLUSION The higher levels of CCR8 and IL-6 in the severe patients and immune cell differences compared to MAP and controls provide an avenue for exploring AP stratification to improve management.
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Affiliation(s)
- Mwangala Nalisa
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, Gauteng, South Africa
| | - Ekene Emmanuel Nweke
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, Gauteng, South Africa
| | - Martin D Smith
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, Gauteng, South Africa
- Department of Surgery, Chris Hani Baragwanath Academic Hospital, Johannesburg 1864, Gauteng, South Africa
| | - Jones Omoshoro-Jones
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, Gauteng, South Africa
- Department of Surgery, Chris Hani Baragwanath Academic Hospital, Johannesburg 1864, Gauteng, South Africa
| | - John WS Devar
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, Gauteng, South Africa
- Department of Surgery, Chris Hani Baragwanath Academic Hospital, Johannesburg 1864, Gauteng, South Africa
| | - Rebecca Metzger
- Institut für Immunologie, Ludwig-Maximilians-Universität München, München 80539, Germany
| | - Tanya N Augustine
- School of Anatomical Sciences, Faculty of Health Science, University of the Witwatersrand, Johannesburg 2193, Gauteng, South Africa
| | - Pascaline N Fru
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, Gauteng, South Africa
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25
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Wicks M, Barr EL, Maple-Brown L. Pancreatitis and Post-Pancreatitis Diabetes in Central Australia. Intern Med J 2021; 53:568-576. [PMID: 34779564 DOI: 10.1111/imj.15620] [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: 08/12/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pancreatitis and diabetes are common among Aboriginal people of Central Australia. The contribution of pancreatitis to the development of Post-Pancreatitis Diabetes-Mellitus (PPDM) is not known. AIMS To describe among Aboriginal and non-Aboriginal people living in Central Australia, (i) the prevalence and aetiology of Acute (AP) and Chronic Pancreatitis (CP) and, (ii) diagnosis of new onset diabetes after pancreatitis. METHODS Retrospective medical record review of patients ≥ 15 years admitted to hospitals in the Central Australia Health Service between 2009 and 2018 with pancreatitis. Prevalence as a proportion of the resident population and aetiology of AP and CP were determined. Diagnosis of new onset diabetes after admission with pancreatitis was assessed. RESULTS Of the 638 patients assessed, 73% were Aboriginal and 48% female. The annual prevalence in 2009 and 2018 for AP was 171 and 203 per 100 000 persons, and for CP was 206 and 114 per 100 000 persons, respectively. Rates were high in Aboriginal people. Alcohol aetiology was most common in Aboriginal people at (66%) and biliary aetiology in non-Aboriginal people (37%). A diagnosis of diabetes after pancreatitis was detected in 125 of 438 (29%) patients who did not have diabetes diagnosis previously recorded, and 20 of the 22 tested for diabetes-associated antibodies were negative, fitting criteria for PPDM. CONCLUSION Prevalence of AP and CP in Central Australia was higher in Aboriginal than non-Aboriginal people. Few patients with diabetes recorded after pancreatitis had appropriate PPDM diagnostic testing. Inter-disciplinary education on the diagnosis of PPDM is required. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Mary Wicks
- Menzies School of Health Research, Alice Springs
| | - Elizabeth Lm Barr
- Menzies School of Health Research, Charles Darwin University NT, Australia.,Baker Heart and Diabetes Institute Vic, Australia
| | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University NT, Australia.,Department of Endocrinology, Royal Darwin Hospital
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26
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Morton A. Review article: Diagnosing acute pancreatitis in diabetes mellitus. Emerg Med Australas 2021; 34:6-8. [PMID: 34655153 DOI: 10.1111/1742-6723.13882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 11/29/2022]
Abstract
Acute pancreatitis is a common reason for presentation to EDs. The criteria for diagnosis of acute pancreatitis are defined by the revised Atlanta classification. Patients with diabetes mellitus are at increased risk of acute pancreatitis. Uncomplicated diabetes mellitus, complications such as ketoacidosis and newer medications used in the treatment of hyperglycaemia may all be associated with elevated serum lipase and amylase in the absence of acute pancreatitis. Checkpoint inhibitors may also precipitate acute type 1 diabetes mellitus and be associated with elevated lipase and amylase. Finally, individuals with diabetes mellitus are at increased risk of hypertriglyceridaemic pancreatitis, which may be associated with falsely normal lipase and amylase because of laboratory interference. Awareness of these factors in individuals with diabetes mellitus presenting to EDs with symptoms suggestive of acute pancreatitis is important for accurate diagnosis.
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Affiliation(s)
- Adam Morton
- Endocrinology and Obstetric Medicine, Mater Health, Brisbane, Queensland, Australia
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27
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Comparative analysis of epidemiology, etiology, and outcomes between elderly and young and middle-aged acute pancreatitis patients: a retrospective, single-center study. Eur J Gastroenterol Hepatol 2021; 33:1254-1259. [PMID: 33177384 DOI: 10.1097/meg.0000000000001993] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the etiology and epidemiology of the patients with first-attack acute pancreatitis of two-age groups. METHODS This is a retrospective comparative study of 2965 patients aged 18 years and older with first-attack acute pancreatitis between 2013 and 2018 in the Affiliated Hospital of Southwest Medical University. Patients divided into the elderly group (age > or = 60 years) and the young and middle-aged group (age <60 years). The etiology tendency and clinical characteristics were analyzed. RESULTS In the elderly group, the proportions of women to men was higher compared with the young and middle-aged group (1.48 vs. 0.69, P < 0.001). The primary etiology of acute pancreatitis in two groups were biliary tract diseases. The main etiology of the young and middle-aged group among men was alcohol and among women was biliary disease. Comparing with the young and middle-aged group, the elderly patients had a higher proportion of hypertension, ischemic heart disease, and cerebrovascular disease (P < 0.001). Meanwhile, the proportions of system inflammatory reaction syndrome, multiple organ dysfunction syndrome (MODS), and shock were also higher in the elderly group (P < 0.001). Mortality in the elderly group and the young and middle-aged group was 1.69 and 0.72%, respectively. CONCLUSIONS Biliary tract diseases were the predominant etiological factor in two groups. The two groups had different etiological proportions according to gender, complications, comorbidities, and outcomes. Furthermore, elderly patients are more likely to with complications, comorbidities, and highly mortality rate. We should pay more attention to realize the characteristics of acute pancreatitis at different ages.
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Yawar B, Marzouk A, Ali H, Asim A, Ghorab T, Bahli Z, Abousamra M, Fleville S. Acute Pancreatitis During COVID-19 Pandemic: An Overview of Patient Demographics, Disease Severity, Management and Outcomes in an Acute District Hospital in Northern Ireland. Cureus 2021; 13:e18520. [PMID: 34659920 PMCID: PMC8496563 DOI: 10.7759/cureus.18520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 01/08/2023] Open
Abstract
Background Acute pancreatitis (AP) is a common disease requiring admissions under surgical and critical care units. The two most common causes are alcohol and gallstones. Coronavirus disease 2019 (COVID-19) pandemic had a significant impact on service delivery and patient management throughout all surgical specialties. In this study, the primary aim was to ascertain the incidence of COVID-19 in acute pancreatitis patients. Secondary objectives were to study aetiology, demographics, severity, 30-day mortality, outcomes and management of acute pancreatitis patients from 1st March, 2020 till 31st August, 2020. Methods A retrospective observational review of all patients admitted under the General Surgical team was performed. Information regarding demographics, severity of AP (using Glasgow score, Atlanta classification and CT severity index score), ICU admission and organ support, treatment modalities and follow-up data for outcomes was collected based on data collection tool used by COVID-PAN study and results were compared to outcomes results of COVID-PAN study. Results Forty-three (43) patients were admitted with AP. Only one patient (2.3%) was diagnosed with COVID-19 at the time of pancreatitis. Gallstones were noted to be the most common cause of AP in our population. Mortality was 7% (3 patients). Five patients (11%) needed ITU admission due to organ dysfunction. Three patients (7%) developed ARDS. Conclusion The overall incidence of COVID-19 in pancreatitis in our population of the study was low. The incidence of COVID-19 during the first wave in Derry/Londonderry area was low and this may explain why the incidence was low in our study as well. Patients with AP in our target population were mostly elderly, one in five had moderate to severe or severe pancreatitis and in 16.3% the aetiology could not be identified. As observed in other centres globally, urgent cholecystectomy for gallstone pancreatitis faced significant delays with no patients being offered index cholecystectomy and only 4 out of 19 patients having undergone interval cholecystectomy within six months of index admission for gallstone pancreatitis in our centre.
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Affiliation(s)
- Bakhat Yawar
- General Surgery, The Western Trust Health & Social Care Jobs in Northern Ireland (HSCNI) (Altnagelvin Area Hospital), Derry/Londonderry, GBR
| | - Ahmed Marzouk
- General Surgery, The Western Trust Health & Social Care Jobs in Northern Ireland (HSCNI) (Altnagelvin Area Hospital), Derry/Londonderry, GBR
| | - Heba Ali
- Radiology, The Western Trust Health & Social Care Jobs in Northern Ireland (HSCNI) (Altnagelvin Area Hospital), Derry/Londonderry, GBR
| | - Ayeisha Asim
- Geriatrics, The Western Trust Health & Social Care Jobs in Northern Ireland (HSCNI) (Altnagelvin Area Hospital), Derry/Londonderry, GBR
| | - Tamer Ghorab
- General Surgery, The Western Trust Health & Social Care Jobs in Northern Ireland (HSCNI) (Altnagelvin Area Hospital), Derry/Londonderry, GBR
| | - Zahid Bahli
- General Surgery, The Western Trust Health & Social Care Jobs in Northern Ireland (HSCNI) (Altnagelvin Area Hospital), Derry/Londonderry, GBR
| | - Mohammad Abousamra
- General Surgery, The Western Trust Health & Social Care Jobs in Northern Ireland (HSCNI) (Altnagelvin Area Hospital), Derry/Londonderry, GBR
| | - Samara Fleville
- General Surgery, The Western Trust Health & Social Care Jobs in Northern Ireland (HSCNI) (Altnagelvin Area Hospital), Derry/Londonderry, GBR
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González-Benjumea P, García del Pino B, Rodríguez-Padilla Á, Balongo García R. Pancreatitis aguda necrosante secundaria a hernia de hiato grado IV complicada: Presentación de un caso y revisión de la literatura. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. En las hernias paraesofágicas tipo IV se produce la herniación del estómago junto a otros órganos abdominales. La herniación del páncreas es muy infrecuente.
Caso clínico. Varón de 57 años que acude por dolor torácico, disnea e intolerancia al decúbito. En la tomografía computarizada toracoabdominal se observa hernia diafragmática que contiene colon transverso, intestino delgado y páncreas, con reticulación de la grasa alrededor del mismo, compatible con pancreatitis aguda.
Conclusión. La asociación de hernia hiatal con páncreas herniado y pancreatitis es extremadamente infrecuente. El diagnóstico se estableció mediante tomografía computarizada y el tratamiento fue conservador, con cirugía diferida de la hernia de hiato.
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Cheng C, Masoud JA, McCray ET, Sun C, Momodu I. ACUTE PANCREATITIS AND TYPE 2 DIABETES MELLITUS: GLP-1 RECEPTOR AGONIST OR IDIOPATHIC, A DIAGNOSTIC DILEMMA, A CASE REPORT WITH LITERATURE REVIEW. Gastroenterol Nurs 2021; 44:353-356. [PMID: 34269709 DOI: 10.1097/sga.0000000000000602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/21/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Ce Cheng
- Ce Cheng, DO, is Resident Physician, The University of Arizona College of Medicine/Banner University Medical Center at South Campus, Tucson
- John Azat Masoud, BS, is Medical Student, Campbell University School of Osteopathic Medicine, Buies Creek, North Carolina
- Edwin Thomas McCray, BS, is Medical Student, Campbell University School of Osteopathic Medicine, Buies Creek, North Carolina
- Chenyu Sun, MD, MSc, is Resident Physician, AMITA Health Saint Joseph Hospital Chicago, Chicago, Illinois
- Ifeanyi Momodu, MD, MPH, FACP, is Attending Physician, Campbell University School of Osteopathic Medicine, Buies Creek, North Carolina; and Cape Fear Valley Medical Center, Fayetteville, North Carolina
| | - John Azat Masoud
- Ce Cheng, DO, is Resident Physician, The University of Arizona College of Medicine/Banner University Medical Center at South Campus, Tucson
- John Azat Masoud, BS, is Medical Student, Campbell University School of Osteopathic Medicine, Buies Creek, North Carolina
- Edwin Thomas McCray, BS, is Medical Student, Campbell University School of Osteopathic Medicine, Buies Creek, North Carolina
- Chenyu Sun, MD, MSc, is Resident Physician, AMITA Health Saint Joseph Hospital Chicago, Chicago, Illinois
- Ifeanyi Momodu, MD, MPH, FACP, is Attending Physician, Campbell University School of Osteopathic Medicine, Buies Creek, North Carolina; and Cape Fear Valley Medical Center, Fayetteville, North Carolina
| | - Edwin Thomas McCray
- Ce Cheng, DO, is Resident Physician, The University of Arizona College of Medicine/Banner University Medical Center at South Campus, Tucson
- John Azat Masoud, BS, is Medical Student, Campbell University School of Osteopathic Medicine, Buies Creek, North Carolina
- Edwin Thomas McCray, BS, is Medical Student, Campbell University School of Osteopathic Medicine, Buies Creek, North Carolina
- Chenyu Sun, MD, MSc, is Resident Physician, AMITA Health Saint Joseph Hospital Chicago, Chicago, Illinois
- Ifeanyi Momodu, MD, MPH, FACP, is Attending Physician, Campbell University School of Osteopathic Medicine, Buies Creek, North Carolina; and Cape Fear Valley Medical Center, Fayetteville, North Carolina
| | - Chenyu Sun
- Ce Cheng, DO, is Resident Physician, The University of Arizona College of Medicine/Banner University Medical Center at South Campus, Tucson
- John Azat Masoud, BS, is Medical Student, Campbell University School of Osteopathic Medicine, Buies Creek, North Carolina
- Edwin Thomas McCray, BS, is Medical Student, Campbell University School of Osteopathic Medicine, Buies Creek, North Carolina
- Chenyu Sun, MD, MSc, is Resident Physician, AMITA Health Saint Joseph Hospital Chicago, Chicago, Illinois
- Ifeanyi Momodu, MD, MPH, FACP, is Attending Physician, Campbell University School of Osteopathic Medicine, Buies Creek, North Carolina; and Cape Fear Valley Medical Center, Fayetteville, North Carolina
| | - Ifeanyi Momodu
- Ce Cheng, DO, is Resident Physician, The University of Arizona College of Medicine/Banner University Medical Center at South Campus, Tucson
- John Azat Masoud, BS, is Medical Student, Campbell University School of Osteopathic Medicine, Buies Creek, North Carolina
- Edwin Thomas McCray, BS, is Medical Student, Campbell University School of Osteopathic Medicine, Buies Creek, North Carolina
- Chenyu Sun, MD, MSc, is Resident Physician, AMITA Health Saint Joseph Hospital Chicago, Chicago, Illinois
- Ifeanyi Momodu, MD, MPH, FACP, is Attending Physician, Campbell University School of Osteopathic Medicine, Buies Creek, North Carolina; and Cape Fear Valley Medical Center, Fayetteville, North Carolina
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Porges T, Shafat T, Sagy I, Schwarzfuchs D, Rahmani Tzvi-Ran I, Jotkowitz A, Barski L. Clinical Characteristics and Prognosis of Idiopathic Acute Pancreatitis. Rambam Maimonides Med J 2021; 12:RMMJ.10442. [PMID: 34270401 PMCID: PMC8284986 DOI: 10.5041/rmmj.10442] [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] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Acute pancreatitis is a serious diagnosis with an increasing incidence in the Western world. In this study we sought to investigate the incidence of idiopathic AP and to compare clinical and prognostic characteristics of idiopathic cases with cases of AP with known etiology. METHODS In this retrospective study of adult hospitalized patients diagnosed with acute pancreatitis between 2012 and 2015, a comparison was made between admissions of patients with known etiology and those for whom no cause was found. Primary outcome was defined as composite outcome of 30-day mortality and complications. RESULTS Among 560 admissions of 437 patients with a primary diagnosis of acute pancreatitis, the main factors identified were gallstones (51.2%) and idiopathic pancreatitis (35.9%), with alcohol ranked third at only 4.8%. Mortality rate within 30 days of hospitalization was 2.9% and within one year was 7.1%. Use of lipid-lowering, anti-hypertensive, and anti-diabetic medications was more frequent among patients with "idiopathic" disease (70%, 68%, and 33% versus 59%, 56%, and 27%, respectively). Patients admitted with idiopathic AP, in comparison to patients with known AP etiology, had milder disease with shorter hospital stay (3 days versus 4, respectively), and less re-admission in 30 days (7.5% versus 21.2%). Idiopathic AP patients had better prognosis in terms of 30-day death and complication (HR 0.33, 95% CI 0.08-0.40, P<0.001). CONCLUSION Idiopathic disease is common among acute pancreatitis patients; the two study groups differed in severity of disease and prognosis. Common use of medications with doubtful value suggests possible under-diagnosis of drug-induced acute idiopathic pancreatitis.
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Affiliation(s)
- Tzvika Porges
- Internal Medicine Division F, Soroka University Medical Center, Beer-Sheva, Israel
| | - Tali Shafat
- Internal Medicine Division F, Soroka University Medical Center, Beer-Sheva, Israel
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Iftach Sagy
- Internal Medicine Division F, Soroka University Medical Center, Beer-Sheva, Israel
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
- Rheumatologic Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Dan Schwarzfuchs
- Department of Emergency Medicine, Soroka University Medical Center, Beer-Sheva, Israel
| | | | - Alan Jotkowitz
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Leonid Barski
- Internal Medicine Division F, Soroka University Medical Center, Beer-Sheva, Israel
- To whom correspondence should be addressed. E-mail:
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Gou A, Liu Z, Xiao Z, Li G, Xu Y, Song S, Guo K, Ma G. A narrative review of a type of pancreatitis worthy of attention: acute pancreatitis associated with pancreatic tumors-current problems and future thinking. Gland Surg 2021; 10:2304-2312. [PMID: 34422601 PMCID: PMC8340334 DOI: 10.21037/gs-21-400] [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: 05/20/2021] [Accepted: 07/15/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Our purpose is to explain the onset, diagnosis, and treatment of pancreatic tumor-associated pancreatitis (PTP), and inform clinicians about the management of PTP. It is hoped that clinicians can gain some experience and inspiration from this review, so that patients can obtain better treatment results. BACKGROUND Acute pancreatitis (AP) is an inflammatory disease, and pancreatic tumors are one of the causes of pancreatitis. When pancreatic tumors and pancreatitis exist at the same time, and there is a "connection" between them, this type of pancreatitis is referred to as PTP. The manifestations of PTP can be as follows: (I) AP is the first symptom of pancreatic tumors; (II) pancreatitis is found in patients after pancreatic tumor diagnosis or during pancreatic tumor surgery. Because pancreatic tumors are not one of the most common causes of pancreatitis, PTP has not attracted the attention of researchers and clinicians, and there is no consistent and clear understanding of the diagnosis and treatment of PTP. METHODS From the online database PubMed (https://pubmed.ncbi.nlm.nih.gov/) and Web of Science (https://webofknowledge.com/), we use specific retrieval strategies to retrieve relevant articles, and we review and discuss them. CONCLUSIONS What we need to realize is that PTP is different from ordinary AP. It has its own characteristics in terms of diagnosis and treatment, which requires the attention of clinicians. More importantly, future research should design the best diagnosis and treatment algorithms for PTP.
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Affiliation(s)
- Anjiang Gou
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Zhe Liu
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Zhihuan Xiao
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Guichen Li
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Yuanhong Xu
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Shaowei Song
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Kejian Guo
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Gang Ma
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
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Factors Associated with Fluid Sequestration in Patients with Acute Pancreatitis: A Prospective Study in Tertiary Centre Hospital in Nepal. Gastroenterol Res Pract 2021; 2021:5579267. [PMID: 34257644 PMCID: PMC8253623 DOI: 10.1155/2021/5579267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 06/03/2021] [Accepted: 06/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background Acute pancreatitis (AP) is associated with extensive fluid sequestration. The aim of this study was to determine association of fluid sequestration at 48 hours after hospital admission (FS48) in AP patients with demographics, clinical parameters, and outcomes of AP. Methods A prospective observational study was carried out on all adult patients with AP admitted to Tribhuvan University Teaching Hospital, Nepal, from January to September 2017. FS48 was calculated as the difference between fluid input and output in the first 48 hours of admission. The Kruskal-Wallis test with post hoc Dunn's test examined the difference in FS48 between mild AP, moderately severe AP, and severe AP. Linear regression analysis was used to evaluate association between FS48 with patients' characteristics and outcomes of AP. Outcomes of AP assessed included pancreatic necrosis, persistent organ failure, length of stay, and in-hospital mortality. Results Eighty patients (median age 44 years; 57% male) with a median FS48 of 1610 mL were evaluated. The median FS48 for mild AP, moderately severe AP, and severe AP were 1,180 mL, 2,380 mL, and 3,500 mL, respectively. There was a significant difference in pairwise comparisons between mild AP and moderately severe AP, along with mild AP and severe AP. Younger age, other etiology, and higher creatinine were independently associated with increased FS48. Increased FS48 was significantly associated with pancreatic necrosis, persistent organ failure, and in-hospital mortality. Conclusions In our study population, younger age and higher creatinine were predictors of increased FS48. Increased FS48 was associated with poorer outcomes of AP.
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Sun C, Li Z, Shi Z, Li G. Current diagnosis and treatment of acute pancreatitis in China: a real-world, multicenter study. BMC Gastroenterol 2021; 21:210. [PMID: 33964868 PMCID: PMC8105912 DOI: 10.1186/s12876-021-01799-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/26/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Efficacy of pancreatic enzyme inhibitors in acute pancreatitis (AP) is unclear in China. AIMS We aimed to present the current status of AP and evaluate the efficacy of pancreatic enzyme inhibitors in a larger population in China. METHOD A retrospective, cross-sectional, real-world, multicenter analysis of a large dataset of patients presenting with AP from four hospitals of China over a two-year period was performed. Data were collected from the existing clinical records and the patients were grouped into medication group (somatostatin or octreotide or somatostatin and octreotide) and no medication group. Pair wise propensity score matching was performed for comparing somatostatin, octreotide and somatostatin/octreotide. The end points were incidence of disease complications, organ failure, hospitalization duration, and recovery time taken (hours) for serum amylase/serum lipase to normalcy. RESULTS A total of 3900 patients were recruited and 2775 patients were included for analysis. A total of 1100, 661, 676 and 338 patients received either somatostatin or octreotide or somatostatin and octreotide or no medication, respectively. The incidence of complications (7.6% vs 13.6%), organ failure (4.5% vs 7.4%), and the instances of entering ICU (9.3% vs 13.3%) were higher in unmedicated group. Complications at discharge (2.91 times), organ failure (2.53 times), and hospitalization stay were higher in octreotide-treated patients compared with somatostatin-treated patients. In comparison to the octreotide group, the serum amylase/lipase recovery time was shorter in the somatostatin group. CONCLUSION This real-world study suggested that the use of pancreatic enzyme inhibitors was positively associated with greater clinical efficacy in AP patients and somatostatin might be more effective than octreotide in real-world settings in China.
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Affiliation(s)
- Chuandong Sun
- Department of Surgery, The Affiliated Hospital of Qingdao University, Shandong, People's Republic of China
| | - Zhu Li
- Department of Surgery, The Affiliated Hospital of Guizhou Medical University, Guizhou, People's Republic of China
| | - Zheng Shi
- Department of Surgery, The First Affiliated Hospital of Fujian Medical University, Fujian, People's Republic of China
| | - Guichen Li
- Department of Surgery, The First Hospital of China Medical University, No. 155 Najing North Street, Heping District, Shenyang, Liaoning Province, People's Republic of China.
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Uncovering the Pharmacology of Xiaochaihu Decoction in the Treatment of Acute Pancreatitis Based on the Network Pharmacology. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6621682. [PMID: 33824873 PMCID: PMC8007340 DOI: 10.1155/2021/6621682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/05/2021] [Accepted: 03/03/2021] [Indexed: 12/31/2022]
Abstract
Background Xiaochaihu decoction (XD) has demonstrated the pharmacodynamics on acute pancreatitis. This study was aimed at investigating the material and molecular basis of Xiaochaihu decoction. Methods Firstly, compounds of seven herbs containing XD were collected from the TCMSP, ETCM, and BATMAN-TCM databases, and the putative targets of pancreatitis were obtained from the OMIM, TTD, and GeneCards databases. Then, the PPI network was constructed according to the matching results between XD potential targets and pancreatic neoplasm targets. Furthermore, enrichment analysis on GO and KEGG by DAVID utilized bioinformatics resources. Finally, molecular docking was performed to simulate the interaction between the active compound of XD and putative targets. In an in vitro experiment, AR42J cells were induced by LPS and then treated with Quercetin (25, 50, and 100 μM) or XCHD. The IL-6, TNF-α, and IL-1β levels were detected by ELISA kit, MAPK3 and TP53 mRNA expressions were measured by qRT-PCR, and the proteins of MAPK3 and TP53 expressions were measured by WB. Results A total of 196 active ingredients and 91 putative targets were selected. The PPI network analysis demonstrated that Quercetin was the candidate agent and MAPK3, IL-6, and TP53 were the potential targets for the XD treatment of acute pancreatitis. The KEGG analysis revealed that pathways in cancers, TNF signaling way, and MAPK signaling way might play an important role in pancreatitis therapy. And molecular docking results showed that Quercetin combined well with MAPK3, IL-6, and TP53. An in vitro experiment indicated that XCHD and Quercetin inhibited the IL-6, TNF-α, and IL-1β levels and MAPK3 and TP53. Conclusion This study illustrated that XCHD and Quercetin contained in XD played an important role in the treatment of acute pancreatitis by acting on the key genes of MPAK3, IL-6, and TP53 which were associated with inflammation and apoptosis.
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Pokras S, Ray M, Zheng S, Ding Y, Chen CC. The Short- and Long-Term Burden of Acute Pancreatitis in the United States: A Retrospective Cohort Study. Pancreas 2021; 50:330-340. [PMID: 33835963 DOI: 10.1097/mpa.0000000000001757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This retrospective cohort study assessed short- and long-term economic, clinical burden, and productivity impacts of acute pancreatitis (AP) in the United States. METHODS United States claims data from patients hospitalized for AP (January 1, 2011-September-30, 2016) were sourced from MarketScan databases. Patients were categorized by index AP severity: severe intensive care unit (ICU), severe non-ICU, and other hospitalized patients. RESULTS During index, 41,946 patients were hospitalized or visited an emergency department for AP. For inpatients, median (interquartile range) AP-related total cost was $13,187 ($12,822) and increased with AP severity (P < 0.0001). During the postindex year, median AP-related costs were higher (P < 0.0001) for severe ICU versus severe non-ICU and other hospitalized patients. Hours lost and costs due to absence and short-term disability were similar between categories. Long-term disability costs were higher (P = 0.005) for severe ICU versus other hospitalized patients. Factors associated with higher total all-cause costs in the year after discharge included AP severity, length of hospitalization, readmission, AP reoccurrence, progression to chronic pancreatitis, or new-onset diabetes (P < 0.0001). CONCLUSIONS An AP event exerts substantial burden during hospitalization and involves long-term clinical and economic consequences, including loss of productivity, which increase with index AP event severity.
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Affiliation(s)
- Shibani Pokras
- From the Value Evidence & Outcomes, GSK, Collegeville, PA
| | - Markqayne Ray
- Health Outcomes, Policy, and Economics Program (HOPE), Rutgers University, New Brunswick, NJ
| | - Shan Zheng
- From the Value Evidence & Outcomes, GSK, Collegeville, PA
| | - Yao Ding
- Real World Evidence, IQVIA, Plymouth Meeting, PA
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Drake M, Dodwad SJM, Davis J, Kao LS, Cao Y, Ko TC. Sex-Related Differences of Acute and Chronic Pancreatitis in Adults. J Clin Med 2021; 10:300. [PMID: 33467580 PMCID: PMC7830423 DOI: 10.3390/jcm10020300] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/12/2021] [Accepted: 01/12/2021] [Indexed: 02/06/2023] Open
Abstract
The incidence of acute and chronic pancreatitis is increasing in the United States. Rates of acute pancreatitis (AP) are similar in both sexes, but chronic pancreatitis (CP) is more common in males. When stratified by etiology, women have higher rates of gallstone AP, while men have higher rates of alcohol- and tobacco-related AP and CP, hypercalcemic AP, hypertriglyceridemic AP, malignancy-related AP, and type 1 autoimmune pancreatitis (AIP). No significant sex-related differences have been reported in medication-induced AP or type 2 AIP. Whether post-endoscopic retrograde cholangiopancreatography pancreatitis is sex-associated remains controversial. Animal models have demonstrated sex-related differences in the rates of induction and severity of AP, CP, and AIP. Animal and human studies have suggested that a combination of risk factor profiles, as well as genes, may be responsible for the observed differences. More investigation into the sex-related differences of AP and CP is desired in order to improve clinical management by developing effective prevention strategies, diagnostics, and therapeutics.
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Affiliation(s)
| | | | | | | | - Yanna Cao
- Department of Surgery, UT Health Houston, Houston, TX 77030, USA; (M.D.); (S.-J.M.D.); (J.D.); (L.S.K.)
| | - Tien C. Ko
- Department of Surgery, UT Health Houston, Houston, TX 77030, USA; (M.D.); (S.-J.M.D.); (J.D.); (L.S.K.)
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Hegab YH, Hassan AO, Metwalli AEM, Awad JR, Orban YA. Adherence to the evidence-based guidelines in the management of acute biliary pancreatitis: A case series. Int J Surg Case Rep 2020; 77:906-914. [PMID: 33395922 PMCID: PMC7749290 DOI: 10.1016/j.ijscr.2020.11.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/27/2020] [Accepted: 11/29/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is considered one of the most common gastrointestinal disorders; the annual worldwide incidence for AP is 4.9-73.4 cases / 100,000 people and the total mortality rate is 4-8%, increasing to 33% in patients with infected necrosis. This study aims to assess the outcome of providing standardized evidence-based care to patients with acute biliary pancreatitis. METHODS Thirty patients diagnosed with acute biliary pancreatitis, were enrolled in this study and managed according to the Japanese guidelines, 2015 with a complementary scope on other recent guidelines. RESULTS Out of 30 patients in the study, 60% were females. Twenty-five cases were presented in the early phase of the disease while the rest presented in the late phase. Gallstones were the commonest cause (80%). The complications encountered were a systemic complication in one case, organ failure in three cases, and the local complications in the form of fluid collections in (43.3%) of cases.Out of 30 patients, 6 patients had an intervention. The main approach was minimally invasive techniques (4 cases), Open approach was performed in 2 cases. The total mortality rate was 10%. Most mild cases were discharged within one week from admission. Cases readmitted with recurrent attacks of acute pancreatitis were 3 cases, one male and 2 females. CONCLUSION By applying guidelines in the management of acute biliary pancreatitis, we can reduce disease-related morbidity and mortality. Besides, we can reduce the costs of medical services with the proper investment of healthcare resources.
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Affiliation(s)
| | - Ahmed Osama Hassan
- Department of Pediatric Surgery, Faculty of Medicine, Zagazig University, Egypt.
| | | | - Joseph Ri Awad
- Department of Surgery, Faculty of Medicine, Zagazig University, Egypt.
| | - Yasser A Orban
- Department of Surgery, Faculty of Medicine, Zagazig University, Egypt.
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Zhang X, Cao Y, Pan CK, Han QY, Guo YQ, Song T, Qi ZD, Huang R, Li M, Yang ZY, Zheng JB, Hou GY, Li JY, Wang SC, Liu YS, Liu RJ, Gao Y, Wang HL. Effect of initiation of renal replacement therapy on mortality in acute pancreatitis patients. Medicine (Baltimore) 2020; 99:e23413. [PMID: 33217887 PMCID: PMC7676528 DOI: 10.1097/md.0000000000023413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This study aims to explore effect of initiation of renal replacement therapy (RRT) on mortality in acute pancreatitis (AP) patients. In this study, a total of 92 patients from the surgical intensive care unit (SICU) of the Second Affiliated Hospital of Harbin Medical University who were diagnosed with AP and underwent RRT or not between January 2014 and December 2018 were included in this retrospective study. Demographic and clinical data were obtained on admission to SICU. Patients were divided into early initiation of RRT group (n = 44) and delayed initiation of RRT group (n = 48). Duration of mechanical ventilation (MV), intra-peritoneal pressure, vasopressors infusion, body temperature, procalcitonin, creatinine, platelet counts, length of hospital stay and prognosis were recorded during hospitalization, and then compared between groups. Patients with delayed initiation of RRT exhibited significantly higher APACHE II score, SOFA score and lower GCS score than those with early initiation of RRT (P < 0.001, <0.001, = 0.04, respectively). No difference in the rest of the baseline data and vasopressors infusion was found. Dose of Norepinephrine, maximum and mean PCT, maximum and mean creatinine, maximum and mean intra-peritoneal pressure, length of hospital stay, prognosis of ICU and hospitalization showed significant difference between groups. Early initiation of RRT may be beneficial for AP patients, which can provide some insight and support for patients' treatment in clinic.
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Affiliation(s)
- Xing Zhang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Yang Cao
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Chang-Kun Pan
- Department of Critical Care Medicine, the Cancer Hospital of Jiamusi, Jiamusi
| | - Qiu-Yuan Han
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Ya-Qi Guo
- Department of Anesthesiology, the Affiliated Hospital of Qingdao University, Qingdao
| | - Ting Song
- Department of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University
| | - Zhi-Dong Qi
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Rui Huang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Ming Li
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Zhen-Yu Yang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Jun-Bo Zheng
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Gui-Ying Hou
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Jia-Yu Li
- Department of Critical Care Medicine, the Cancer Hospital of Harbin Medical University, Harbin
| | - Si-Cong Wang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Yan-Song Liu
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Rui-Jin Liu
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Yang Gao
- Department of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Hong-Liang Wang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin
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Alkareemy EAR, Ahmed LAW, El-Masry MA, Habib HA, Mustafa MH. Etiology, clinical characteristics, and outcomes of acute pancreatitis in patients at Assiut University Hospital. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2020. [DOI: 10.1186/s43162-020-00025-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Acute pancreatitis is one of the main causes of acute abdomen. It may cause multi-organ failure or even death. High morbidity and mortality are associated with it. The research study aimed at evaluating the clinical characteristics and results of acute pancreatitis in our community.
Results
Mean age of patients was 50.96 ± 9.71 years and 30 (60%) patients were males. Gallstone was the most frequent etiology (56%) followed by idiopathic pancreatitis (26%). The majority of patients improved and only four patients died. Old age, presence of comorbidities, and leucocytosis were risk factors for a severe attack while old ages, presence of comorbidities, severe pancreatitis, and presence of complications were associated with mortality.
Conclusion
Acute pancreatitis could have serious outcomes if not correctly and early managed. It is recommended to perform multicenter studies with a large sample of patients. A multi-disciplinary team is required to assess idiopathic pancreatitis.
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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.
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Boxhoorn L, Voermans RP, Bouwense SA, Bruno MJ, Verdonk RC, Boermeester MA, van Santvoort HC, Besselink MG. Acute pancreatitis. Lancet 2020; 396:726-734. [PMID: 32891214 DOI: 10.1016/s0140-6736(20)31310-6] [Citation(s) in RCA: 378] [Impact Index Per Article: 94.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/20/2020] [Accepted: 05/29/2020] [Indexed: 02/07/2023]
Abstract
Acute pancreatitis is an unpredictable and potentially lethal disease. The prognosis mainly depends on the development of organ failure and secondary infection of pancreatic or peripancreatic necrosis. In the past 10 years, treatment of acute pancreatitis has moved towards a multidisciplinary, tailored, and minimally invasive approach. Despite improvements in treatment and critical care, severe acute pancreatitis is still associated with high mortality rates. In this Seminar, we outline the latest evidence on diagnostic and therapeutic strategies for acute pancreatitis.
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Affiliation(s)
- Lotte Boxhoorn
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Rogier P Voermans
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Stefan A Bouwense
- Department of Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Robert C Verdonk
- Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, St Antonius Hospital, Nieuwegein, Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
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Umans DS, Timmerhuis HC, Hallensleben ND, Bouwense SA, Anten MPG, Bhalla A, Bijlsma RA, Boermeester MA, Brink MA, Hol L, Bruno MJ, Curvers WL, van Dullemen HM, van Eijck BC, Erkelens GW, Fockens P, van Geenen EJM, Hazen WL, Hoge CV, Inderson A, Kager LM, Kuiken SD, Perk LE, Poley JW, Quispel R, Römkens TE, van Santvoort HC, Tan AC, Thijssen AY, Venneman NG, Vleggaar FP, Voorburg AM, van Wanrooij RL, Witteman BJ, Verdonk RC, Besselink MG, van Hooft JE. Role of endoscopic ultrasonography in the diagnostic work-up of idiopathic acute pancreatitis (PICUS): study protocol for a nationwide prospective cohort study. BMJ Open 2020; 10:e035504. [PMID: 32819938 PMCID: PMC7440829 DOI: 10.1136/bmjopen-2019-035504] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 06/10/2020] [Accepted: 07/15/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Idiopathic acute pancreatitis (IAP) remains a dilemma for physicians as it is uncertain whether patients with IAP may actually have an occult aetiology. It is unclear to what extent additional diagnostic modalities such as endoscopic ultrasonography (EUS) are warranted after a first episode of IAP in order to uncover this aetiology. Failure to timely determine treatable aetiologies delays appropriate treatment and might subsequently cause recurrence of acute pancreatitis. Therefore, the aim of the Pancreatitis of Idiopathic origin: Clinical added value of endoscopic UltraSonography (PICUS) Study is to determine the value of routine EUS in determining the aetiology of pancreatitis in patients with a first episode of IAP. METHODS AND ANALYSIS PICUS is designed as a multicentre prospective cohort study of 106 patients with a first episode of IAP after complete standard diagnostic work-up, in whom a diagnostic EUS will be performed. Standard diagnostic work-up will include a complete personal and family history, laboratory tests including serum alanine aminotransferase, calcium and triglyceride levels and imaging by transabdominal ultrasound, magnetic resonance imaging or magnetic resonance cholangiopancreaticography after clinical recovery from the acute pancreatitis episode. The primary outcome measure is detection of aetiology by EUS. Secondary outcome measures include pancreatitis recurrence rate, severity of recurrent pancreatitis, readmission, additional interventions, complications, length of hospital stay, quality of life, mortality and costs, during a follow-up period of 12 months. ETHICS AND DISSEMINATION PICUS is conducted according to the Declaration of Helsinki and Guideline for Good Clinical Practice. Five medical ethics review committees assessed PICUS (Medical Ethics Review Committee of Academic Medical Center, University Medical Center Utrecht, Radboud University Medical Center, Erasmus Medical Center and Maastricht University Medical Center). The results will be submitted for publication in an international peer-reviewed journal. TRIAL REGISTRATION NUMBER Netherlands Trial Registry (NL7066). Prospectively registered.
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Affiliation(s)
- Devica S Umans
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Research and Development, Saint Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
| | - Hester C Timmerhuis
- Research and Development, Saint Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
- Department of Surgery, Saint Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
| | - Nora D Hallensleben
- Research and Development, Saint Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Stefan A Bouwense
- Department of Surgery, Maastricht UMC+, Maastricht, Limburg, The Netherlands
| | - Marie-Paule Gf Anten
- Department of Gastroenterology and Hepatology, Franciscus Gasthuis en Vlietland, Rotterdam, Zuid-Holland, The Netherlands
| | - Abha Bhalla
- Department of Gastroenterology and Hepatology, HagaZiekenhuis, Den Haag, Zuid-Holland, The Netherlands
| | - Rina A Bijlsma
- Department of Gastroenterology and Hepatology, Martini Ziekenhuis, Groningen, Groningen, The Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Menno A Brink
- Department of Gastroenterology and Hepatology, Meander MC, Amersfoort, Utrecht, The Netherlands
| | - Lieke Hol
- Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, Zuid-Holland, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Wouter L Curvers
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, North Brabant, The Netherlands
| | - Hendrik M van Dullemen
- Department of Gastroenterology and Hepatology, UMCG, Groningen, Groningen, The Netherlands
| | - Brechje C van Eijck
- Department of Gastroenterology and Hepatology, Spaarne Gasthuis, Haarlem, Noord-Holland, The Netherlands
| | - G Willemien Erkelens
- Department of Gastroenterology and Hepatology, Gelre Ziekenhuizen, Apeldoorn, Gelderland, The Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Erwin J M van Geenen
- Department of Gastroenterology and Hepatology, Radboud university medical center, Nijmegen, the Netherlands
| | - Wouter L Hazen
- Department of Gastroenterology and Hepatology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Noord-Brabant, The Netherlands
| | - Chantal V Hoge
- Department of Gastroenterology and Hepatology, Maastricht UMC+, Maastricht, Limburg, The Netherlands
| | - Akin Inderson
- Department of Gastroenterology and Hepatology, LUMC, Leiden, Zuid-Holland, The Netherlands
| | - Liesbeth M Kager
- Department of Gastroenterology and Hepatology, Noordwest Ziekenhuisgroep, Alkmaar, Noord-Holland, The Netherlands
| | - Sjoerd D Kuiken
- Department of Gastroenterology and Hepatology, OLVG, Amsterdam, Noord-Holland, The Netherlands
| | - Lars E Perk
- Department of Gastroenterology and Hepatology, Medisch Centrum Haaglanden, Den Haag, Zuid-Holland, The Netherlands
| | - Jan-Werner Poley
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Rutger Quispel
- Department of Gastroenterology and Hepatology, Reinier de Graaf Groep, Delft, Zuid-Holland, The Netherlands
| | - Tessa Eh Römkens
- Department of Gastroenteroloy and Hepatology, Jeroen Bosch Hospital, 's-Hertogenbosch, Noord-Brabant, The Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, Saint Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Adriaan Citl Tan
- Department of Gastroenterology and Hepatology, Canisius Wilhelmina Hospital, Nijmegen, Gelderland, The Netherlands
| | - Annemieke Y Thijssen
- Department of Gastroenterology and Hepatology, Albert Schweitzer Ziekenhuis, Dordrecht, Zuid-Holland, The Netherlands
| | - Niels G Venneman
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, Overijssel, The Netherlands
| | - Frank P Vleggaar
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Annet McJ Voorburg
- Department of Gastroenterology and Hepatology, Diakonessenhuis Utrecht Zeist Doorn, Utrecht, Utrecht, The Netherlands
| | - Roy Lj van Wanrooij
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Ben J Witteman
- Department of Gastroenterology and Hepatology, Ziekenhuis Gelderse Vallei, Ede, Gelderland, The Netherlands
| | - Robert C Verdonk
- Department of Gastroenterology and Hepatology, Saint Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
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Tian F, Li H, Wang L, Li B, Aibibula M, Zhao H, Feng N, Lv J, Zhang G, Ma X. The diagnostic value of serum C-reactive protein, procalcitonin, interleukin-6 and lactate dehydrogenase in patients with severe acute pancreatitis. Clin Chim Acta 2020; 510:665-670. [PMID: 32828732 DOI: 10.1016/j.cca.2020.08.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Acute pancreatitis (AP) is an inflammatory disease with rapid progression. In severe cases, it can cause systemic inflammatory response syndrome (SIRS), multiple organ failure (POF) and even death. The study aimed to investigate the diagnostic value of C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6) and lactate dehydrogenase (LDH) in patients with severe AP. METHODS AP patients (n = 153) divided into mild AP patients (n = 81) and severe AP patients (n = 72) were selected from June 2014 to June 2016. The demographic information (age, sex) and the hematological parameters (WBC, PLT, CRP, PCT, IL-6, LDH and so on) were analyzed. RESULTS Significant differences were found out of CRP, PCT, IL-6 and LDH values between AP patients and controls (P < 0.05), even those results had significant difference between MAP group and SAP group (P < 0.05). In SAP group, the cut-off values of CRP, PCT, IL-6 and LDH were 16.62, 2.29, 16.66, 273.04; sensitivity 55.6%, 77.8%, 80.2%, 82.7%; specificity 73%, 94%, 85%, 96% and AUC 0.637, 0.929, 0.886, 0.919, respectively. The AUC of combined detection of CRP, PCT, IL-6 and LDH was 0.989 (95%CI). CONCLUSION The combined detection of CRP, PCT, IL-6 and LDH has a high diagnostic value for judging the severity of AP.
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Affiliation(s)
- Fengming Tian
- Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China; State Key Laboratory of Pathogenesis, Prevention, Treatment of Central Asian High Incidence Diseases, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Huijun Li
- State Key Laboratory of Pathogenesis, Prevention, Treatment of Central Asian High Incidence Diseases, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China; Department of Blood Transfusion, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang 830001, PR China
| | - Liang Wang
- State Key Laboratory of Pathogenesis, Prevention, Treatment of Central Asian High Incidence Diseases, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Bin Li
- Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China; State Key Laboratory of Pathogenesis, Prevention, Treatment of Central Asian High Incidence Diseases, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Maidinaimu Aibibula
- Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China; State Key Laboratory of Pathogenesis, Prevention, Treatment of Central Asian High Incidence Diseases, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Hui Zhao
- State Key Laboratory of Pathogenesis, Prevention, Treatment of Central Asian High Incidence Diseases, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Ning Feng
- State Key Laboratory of Pathogenesis, Prevention, Treatment of Central Asian High Incidence Diseases, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Jie Lv
- Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China; State Key Laboratory of Pathogenesis, Prevention, Treatment of Central Asian High Incidence Diseases, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Guojun Zhang
- Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, PR China.
| | - Xiumin Ma
- Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China; State Key Laboratory of Pathogenesis, Prevention, Treatment of Central Asian High Incidence Diseases, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China; College of Basic Medicine of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China.
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Khamaysi I, Hamo-Giladi DB, Abassi Z. Heparanase in Acute Pancreatitis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1221:703-719. [PMID: 32274733 DOI: 10.1007/978-3-030-34521-1_29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Acute pancreatitis (AP) is one of the most common diseases in gastroenterology, affecting 2% of all hospitalized patients. Nevertheless, neither the etiology nor the pathophysiology of the disease is fully characterized, and no specific or effective treatment has been developed. Heparanase (Hpa) is an endoglycosidase that cleaves heparan sulfate (HS) side chains of heparan sulfate proteoglycans (HSPGs) into shorter oligosaccharides, activity that is highly implicated in cell invasion associated with cancer metastasis and inflammation. Given that AP is a typical inflammatory disease, we investigated whether Hpa plays a role in AP. Our results provide keen evidence that Hpa expression and activity are significantly increased following cerulein-induced AP in wild type mice. In parallel to the classic manifestations of AP, namely elevation of amylase and lipase levels, pancreas edema and inflammation as well as induction of cytokines and signaling molecules, have been detected in this experimental model of the disease. Noteworthy, these features were far more profound in transgenic mice overexpressing heparanase (Hpa-Tg), suggesting that these mice can be utilized as a model system to reveal the molecular mechanism by which Hpa functions in AP. Further support for the involvement of Hpa in the pathogenesis of AP emerged from our observation that treatment of experimental AP with PG545 or SST0001(= Ronepastat), two potent Hpa inhibitors, markedly attenuated the biochemical, histological and immunological manifestations of the disease. Hpa, therefore, emerges as a potential new target in AP, and Hpa inhibitors are hoped to prove beneficial in AP along with their promising efficacy as anti-cancer compounds.
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Affiliation(s)
- Iyad Khamaysi
- Department of Gastroenterology, Advanced Endoscopy Procedures Unit, Rambam Health Care Campus, Haifa, Israel.
| | | | - Zaid Abassi
- Laboratory Medicine, Rambam Health Care Campus, Haifa, Israel
- Department of Physiology, The Ruth & Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Di Mauro D, Wijesurendere CN, Attanasio A, Fulgenzi CAM, Elkhuffash I, Ricciardi E, Wajed S, Manzelli A. Outcome of acute pancreatitis in octogenarians: A retrospective study. JGH OPEN 2020; 4:461-465. [PMID: 32514454 PMCID: PMC7273716 DOI: 10.1002/jgh3.12279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 10/16/2019] [Accepted: 10/19/2019] [Indexed: 12/17/2022]
Abstract
Background and Aim Acute pancreatitis (AP) is a common disease, but data on outcomes in octogenarians are scarce in the literature. The aim of this study is to analyze results from patients aged 80 years old and over who were treated for AP at a single center. Methods Patients aged 80 years and older diagnosed with AP from April 2010 to October 2015 were considered. Demographics, American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), serum biochemistry at 24 and 48 h after admission, and revised Atlanta severity score were analyzed and correlated with hospital mortality rate and length of stay using the multiple regression and Kaplan–Meier tests. Results A total of 100 consecutive patients were included in the study. There were 52 women, and the mean age was 87.5 years (range 80–95). Gallstones were the most common cause of AP (69.7%). The ASA score was ≥III in 51 patients. Eight patients had severe, disease and all of them died in hospital. A CCI > 4 was associated with higher disease severity and mortality (P < 0.00001). The median hospital stay was 9 days (range 1–59). Longer hospital stay was associated with serum C‐reactive protein ≥242 mg/L (P = 0.01) and serum albumin ≤30 g/L (P = 0.01) at 48 h. Over a 5‐year period, 22% of patients were readmitted to hospital with recurrent AP. Gallstones were the main cause of disease (63.6%). Conclusions AP in octogenarians has low mortality. Higher death rate is associated with disease severity. In the presence of gallstone disease, cholecystectomy is recommended whenever possible as the risk of disease recurrence is significant.
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Affiliation(s)
- Davide Di Mauro
- Department of Upper GI Surgery Royal Devon and Exeter NHS Foundation Trust Exeter UK
| | | | - Andrea Attanasio
- Department of Upper GI Surgery Royal Devon and Exeter NHS Foundation Trust Exeter UK
| | - Claudia A M Fulgenzi
- Department of Upper GI Surgery Royal Devon and Exeter NHS Foundation Trust Exeter UK
| | | | - Edoardo Ricciardi
- Department of Upper GI Surgery Royal Devon and Exeter NHS Foundation Trust Exeter UK
| | - Shahjehan Wajed
- Department of Upper GI Surgery Royal Devon and Exeter NHS Foundation Trust Exeter UK
| | - Antonio Manzelli
- Department of Upper GI Surgery Royal Devon and Exeter NHS Foundation Trust Exeter UK
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Butler RJ, Grieve DA. Index cholecystectomy rates in mild gallstone pancreatitis: a single-centre experience. ANZ J Surg 2020; 90:2011-2014. [PMID: 32338824 DOI: 10.1111/ans.15887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 02/03/2020] [Accepted: 03/12/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Gallstone pancreatitis (GSP) has evidence-based guidelines regarding management. Both the International Association of Pancreatology/American Pancreatology Association and American College of Gastroenterology recommend index admission cholecystectomy (IAC) in patients presenting with mild GSP. The aim of this study was to examine guideline adherence and GSP recurrence rate when IAC was not performed. A comparison between admitting specialty was also performed to examine the difference in compliance rates. METHODS A retrospective chart review was conducted on all patients who presented to the Sunshine Coast Hospital and Health Service with GSP from December 2013 to December 2016. Patient demographics, timing of surgery, admitting specialty, laboratory and imaging results were recorded. RESULTS A total of 95 patients were identified with a first presentation of mild GSP during the study period. Of whom, 66 (69.5%) underwent IAC and 29 (30.5%) were discharged prior to cholecystectomy with 10 of those patients receiving index admission endoscopic sphincterotomy. Five patients (17%) who did not receive IAC were readmitted with gallstone-related complications with the mean time to re-presentation of 12.8 days (range 7-21 days). Patients were more likely to receive IAC when admitted under surgery compared with gastroenterology (76% versus 20%, P < 0.001). CONCLUSION Two out of three patients presenting with mild GSP underwent IAC in accordance with evidence-based management guidelines. Patients should be admitted under a surgical service to prevent delay in definitive management.
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Affiliation(s)
- Reuban J Butler
- Department of General Surgery, Sunshine Coast University Hospital, Sunshine Coast Region, Queensland, Australia
| | - David A Grieve
- Department of General Surgery, Sunshine Coast University Hospital, Sunshine Coast Region, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Li M, Xing XK, Lu ZH, Guo F, Su W, Lin YJ, Wang DH. Comparison of Scoring Systems in Predicting Severity and Prognosis of Hypertriglyceridemia-Induced Acute Pancreatitis. Dig Dis Sci 2020; 65:1206-1211. [PMID: 31515723 DOI: 10.1007/s10620-019-05827-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/04/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND In China, hyperlipidemia is the second major reason of acute pancreatitis. AIMS Comparison of Scoring Systems in identification patients at risk for severe acute pancreatitis (SAP), pancreatic necrosis (PNec), and infected pancreatic necrosis (IPN) early in the course of hypertriglyceridemia-induced acute pancreatitis (HTG-AP). METHODS Predictive accuracy of scoring systems was measured by the area under the receiver operating characteristic curve (AUC) in a retrospective study. Pairwise AUC comparisons were performed to calculate the difference between scoring systems. RESULTS A total of 238 patients diagnosed with HTG-AP were included. Sixty patients (25.2%) were classified as SAP. Twenty-nine patients (12.2%) had evidence of PNec. Nine patients (3.8%) were diagnosed with IPN. One patient (0.4%) died during hospitalization. In predicting SAP in HTG-AP, the AUCs of APACHE-II, SOFA, SIRS, Ranson's, BISAP, and MMS were 0.77, 0.83, 0.73, 0.88, 0.83, and 0.85, respectively; in predicting PNec, were 0.75, 0.77, 0.75, 0.86, 0.80, and 0.75, respectively; and in predicting IPN, were 0.92, 0.86, 0.76, 0.85, 0.84, and 0.87, respectively. Pairwise AUC comparisons revealed that Ranson's, MMS, BISAP, and SOFA had higher accuracy than SIRS, Ranson's and MMS had higher accuracy than APACHE-II in predicting SAP; Ranson's had the same accuracy with BISAP, but higher than other four criteria in predicting PNec; APACHE-II had higher accuracy than SIRS in predicting IPN. CONCLUSIONS APACHE-II had high performance in predicting IPN, and all other score systems had medium performance in predicting SAP, PNec, and IPN in HTG-AP. Each score has its merit and weakness; BISAP may be the best criterion in predicting severity and prognosis of HTG-AP.
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Affiliation(s)
- Man Li
- Department of Critical Care Medicine, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Xiao-Kang Xing
- Department of Critical Care Medicine, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Zhi-Hua Lu
- Department of Critical Care Medicine, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Feng Guo
- Department of Critical Care Medicine, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, China.
| | - Wei Su
- Department of Critical Care Medicine, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Yong-Jun Lin
- Department of Critical Care Medicine, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Dong-Hai Wang
- Department of Critical Care Medicine, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, China
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Hallensleben ND, Umans DS, Bouwense SAW, Verdonk RC, Romkens TEH, Witteman BJ, Schwartz MP, Spanier MB, Laheij R, van Santvoort HC, Besselink MG, van Hooft JE, Bruno MJ. The diagnostic work-up and outcomes of 'presumed' idiopathic acute pancreatitis: A post-hoc analysis of a multicentre observational cohort. United European Gastroenterol J 2020; 8:340-350. [PMID: 32213015 PMCID: PMC7184667 DOI: 10.1177/2050640619890462] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/28/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION After standard diagnostic work-up, the aetiology of acute pancreatitis remains unknown in 16-27% of cases, a condition referred to as idiopathic acute pancreatitis (IAP). Determining the aetiology of pancreatitis is essential, as it may direct treatment in the acute phase and guides interventions to prevent recurrent pancreatitis. METHODS Between 2008 and 2015, patients with acute pancreatitis were registered prospectively in 19 Dutch hospitals. Patients who had a negative initial diagnostic work-up with regard to the underlying aetiology of their pancreatitis were labelled 'presumed' IAP. The aim of this study was to assess the use of diagnostic modalities and their yield to establish an aetiology in 'presumed' IAP, and to assess recurrence rates both with and without treatment. RESULTS Out of the 1632 registered patients, 191 patients had a first episode of 'presumed' IAP, of whom 176 (92%) underwent additional diagnostic testing: CT (n = 124, diagnostic yield 8%), EUS (n = 62, yield 35%), MRI/MRCP (n = 56, yield 33%), repeat ultrasound (n = 97, yield 21%), IgG4 (n = 54, yield 9%) and ERCP (n = 15, yield 47%). In 64 of 176 patients (36%) an aetiological diagnosis was established, mostly biliary (n = 39). In 13 out of 176 of patients (7%) a neoplasm was diagnosed. If additional diagnostic workup revealed an aetiology, the recurrence rate was lower in the treated patients than in the patients without a definite aetiology (15% versus 43%, p = 0.014). CONCLUSION Additional diagnostic testing revealed an aetiology in one-third of 'presumed' IAP patients. The aetiology found was mostly biliary, but occasionally neoplasms were found. Identification of an aetiology with subsequent treatment reduced the rate of recurrence.
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Affiliation(s)
- Nora D Hallensleben
- Department of Gastroenterology, Erasmus
MC University Medical Centre, Rotterdam, the Netherlands
- Department of Research and Development,
St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Devica S Umans
- Department of Research and Development,
St. Antonius Hospital, Nieuwegein, the Netherlands
- Department of Gastroenterology,
Amsterdam UMC, Amsterdam, the Netherlands
| | - Stefan AW Bouwense
- Department of Surgery, Radboud
University Medical Centre, Nijmegen, the Netherlands
| | - Robert C Verdonk
- Department of Gastroenterology, St
Antonius Hospital, Nieuwegein, the Netherlands
| | - Tessa EH Romkens
- Department of Gastroenterology, Jeroen
Bosch Hospital, ‘s Hertogenbosch, the Netherlands
| | - Ben J Witteman
- Department of Gastroenterology, Gelderse
Vallei Hospital, Ede, the Netherlands
| | - Matthijs P Schwartz
- Department of Gastroenterology, Meander
Medical Centre, Amersfoort, the Netherlands
| | - Marcel B Spanier
- Department of Gastroenterology,
Rijnstate Hospital, Arnhem, the Netherlands
| | - Robert Laheij
- Department of Gastroenterology, St.
Elisabeth – Tweesteden Hospital, Tilburg, the Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, St. Antonius
Hospital, Nieuwegein, the Netherlands
- Department of Surgery, University
Medical Centre, Utrecht, the Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC,
Amsterdam, the Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology,
Amsterdam UMC, Amsterdam, the Netherlands
| | - Marco J Bruno
- Department of Gastroenterology, Erasmus
MC University Medical Centre, Rotterdam, the Netherlands
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50
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Umans DS, Hallensleben ND, Verdonk RC, Bouwense SAW, Fockens P, van Santvoort HC, Voermans RP, Besselink MG, Bruno MJ, van Hooft JE. Recurrence of idiopathic acute pancreatitis after cholecystectomy: systematic review and meta-analysis. Br J Surg 2019; 107:191-199. [PMID: 31875953 PMCID: PMC7003758 DOI: 10.1002/bjs.11429] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/26/2019] [Accepted: 10/04/2019] [Indexed: 12/12/2022]
Abstract
Background Occult biliary disease has been suggested as a frequent underlying cause of idiopathic acute pancreatitis (IAP). Cholecystectomy has been proposed as a strategy to prevent recurrent IAP. The aim of this systematic review was to determine the efficacy of cholecystectomy in reducing the risk of recurrent IAP. Methods PubMed, Embase and Cochrane Library databases were searched systematically for studies including patients with IAP treated by cholecystectomy, with data on recurrence of pancreatitis. Studies published before 1980 or including chronic pancreatitis and case reports were excluded. The primary outcome was recurrence rate. Quality was assessed using the Newcastle–Ottawa Scale. Meta‐analyses were undertaken to calculate risk ratios using a random‐effects model with the inverse‐variance method. Results Overall, ten studies were included, of which nine were used in pooled analyses. The study population consisted of 524 patients with 126 cholecystectomies. Of these 524 patients, 154 (29·4 (95 per cent c.i. 25·5 to 33·3) per cent) had recurrent disease. The recurrence rate was significantly lower after cholecystectomy than after conservative management (14 of 126 (11·1 per cent) versus 140 of 398 (35·2 per cent); risk ratio 0·44, 95 per cent c.i. 0·27 to 0·71). Even in patients in whom IAP was diagnosed after more extensive diagnostic testing, including endoscopic ultrasonography or magnetic resonance cholangiopancreatography, the recurrence rate appeared to be lower after cholecystectomy (4 of 36 (11 per cent) versus 42 of 108 (38·9 per cent); risk ratio 0·41, 0·16 to 1·07). Conclusion Cholecystectomy after an episode of IAP reduces the risk of recurrent pancreatitis. This implies that current diagnostics are insufficient to exclude a biliary cause.
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Affiliation(s)
- D S Umans
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - N D Hallensleben
- Department of Gastroenterology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.,Department of Research and Development, St Antonius Hospital, Nieuwegein, the Netherlands
| | - R C Verdonk
- Department of Gastroenterology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - S A W Bouwense
- Department of Surgery, MUMC+, Maastricht, the Netherlands
| | - P Fockens
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - H C van Santvoort
- Department of Surgery, St Antonius Hospital, Nieuwegein, the Netherlands.,Department of Surgery, UMC Utrecht, Utrecht, the Netherlands
| | - R P Voermans
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M G Besselink
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M J Bruno
- Department of Gastroenterology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - J E van Hooft
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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