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Pancreatitis Pathology and Treatment

Works Count: 101167

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Description

This cluster of papers focuses on the diagnosis and management of pancreatitis, covering topics such as acute and chronic pancreatitis, pancreatic disease burden, endoscopic drainage techniques, severity assessment, genetic factors, inflammatory mediators, organ failure, nutritional support, and epidemiology.

Keywords

Acute Pancreatitis; Chronic Pancreatitis; Pancreatic Disease; Endoscopic Drainage; Severity Assessment; Genetic Factors; Inflammatory Mediators; Organ Failure; Nutritional Support; Epidemiology

Prognostic signs and the role of operative management in acute pancreatitis.

1974-07-01

John H.C. Ranson , Kenneth Rifkind , Daniel F. Roses +3 more

IAP/APA evidence-based guidelines for the management of acute pancreatitis

2013-07-01

BackgroundThere have been substantial improvements in the management of acute pancreatitis since the publication of the International Association of Pancreatology (IAP) treatment guidelines in 2002. A collaboration of the IAP … BackgroundThere have been substantial improvements in the management of acute pancreatitis since the publication of the International Association of Pancreatology (IAP) treatment guidelines in 2002. A collaboration of the IAP and the American Pancreatic Association (APA) was undertaken to revise these guidelines using an evidence-based approach.MethodsTwelve multidisciplinary review groups performed systematic literature reviews to answer 38 predefined clinical questions. Recommendations were graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The review groups presented their recommendations during the 2012 joint IAP/APA meeting. At this one-day, interactive conference, relevant remarks were voiced and overall agreement on each recommendation was quantified using plenary voting.ResultsThe 38 recommendations covered 12 topics related to the clinical management of acute pancreatitis: A) diagnosis of acute pancreatitis and etiology, B) prognostication/predicting severity, C) imaging, D) fluid therapy, E) intensive care management, F) preventing infectious complications, G) nutritional support, H) biliary tract management, I) indications for intervention in necrotizing pancreatitis, J) timing of intervention in necrotizing pancreatitis, K) intervention strategies in necrotizing pancreatitis, and L) timing of cholecystectomy. Using the GRADE system, 21 of the 38 (55%) recommendations, were rated as ‘strong’ and plenary voting revealed ‘strong agreement’ for 34 (89%) recommendations.ConclusionsThe 2012 IAP/APA guidelines provide recommendations concerning key aspects of medical and surgical management of acute pancreatitis based on the currently available evidence. These recommendations should serve as a reference standard for current management and guide future clinical research on acute pancreatitis.

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Mutations in the gene encoding the serine protease inhibitor, Kazal type 1 are associated with chronic pancreatitis

2000-06-01

Heiko Witt , W. A. P. Luck , Hans Christian Hennies +5 more

Course and outcome of chronic pancreatitis. Longitudinal study of a mixed medical-surgical series of 245 patients.

1984-05-01

Ammann Rw , A Akovbiantz , F Largiadèr +1 more

Early Treatment of Acute Biliary Pancreatitis by Endoscopic Papillotomy

1993-01-28

Irene Oi‐Lin Ng , Edward C. S. Lai , Francis P. T. Mok +3 more

Most patients with acute biliary pancreatitis have stones in the biliary tract or ampulla of Vater. Because these stones may be passed spontaneously soon after a patient is admitted to … Most patients with acute biliary pancreatitis have stones in the biliary tract or ampulla of Vater. Because these stones may be passed spontaneously soon after a patient is admitted to the hospital, the importance of early operative removal is not known. We tested the hypothesis that endoscopic papillotomy within 24 hours of admission decreased the incidence of complications in patients with acute biliary pancreatitis.

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Kidney Injury Molecule-1 (KIM-1): A novel biomarker for human renal proximal tubule injury

2002-07-01

Won Kon Han , Véronique Bailly , Rekha Abichandani +2 more

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American College of Gastroenterology Guideline: Management of Acute Pancreatitis

2013-07-30

Scott Tenner , John Baillie , John M. DeWitt +1 more

This guideline presents recommendations for the management of patients with acute pancreatitis (AP). During the past decade, there have been new understandings and developments in the diagnosis, etiology, and early … This guideline presents recommendations for the management of patients with acute pancreatitis (AP). During the past decade, there have been new understandings and developments in the diagnosis, etiology, and early and late management of the disease. As the diagnosis of AP is most often established by clinical symptoms and laboratory testing, contrast-enhanced computed tomography (CECT) and/or magnetic resonance imaging (MRI) of the pancreas should be reserved for patients in whom the diagnosis is unclear or who fail to improve clinically. Hemodynamic status should be assessed immediately upon presentation and resuscitative measures begun as needed. Patients with organ failure and/or the systemic inflammatory response syndrome (SIRS) should be admitted to an intensive care unit or intermediary care setting whenever possible. Aggressive hydration should be provided to all patients, unless cardiovascular and/or renal comorbidites preclude it. Early aggressive intravenous hydration is most beneficial within the first 12-24 h, and may have little benefit beyond. Patients with AP and concurrent acute cholangitis should undergo endoscopic retrograde cholangiopancreatography (ERCP) within 24 h of admission. Pancreatic duct stents and/or postprocedure rectal nonsteroidal anti-inflammatory drug (NSAID) suppositories should be utilized to lower the risk of severe post-ERCP pancreatitis in high-risk patients. Routine use of prophylactic antibiotics in patients with severe AP and/or sterile necrosis is not recommended. In patients with infected necrosis, antibiotics known to penetrate pancreatic necrosis may be useful in delaying intervention, thus decreasing morbidity and mortality. In mild AP, oral feedings can be started immediately if there is no nausea and vomiting. In severe AP, enteral nutrition is recommended to prevent infectious complications, whereas parenteral nutrition should be avoided. Asymptomatic pancreatic and/or extrapancreatic necrosis and/or pseudocysts do not warrant intervention regardless of size, location, and/or extension. In stable patients with infected necrosis, surgical, radiologic, and/or endoscopic drainage should be delayed, preferably for 4 weeks, to allow the development of a wall around the necrosis.

The Epidemiology of Pancreatitis and Pancreatic Cancer

2013-04-24

Dhiraj Yadav , Albert B. Lowenfels

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Acute Necrotizing Pancreatitis: Treatment Strategy According to the Status of Infection

2000-11-01

Markus W. Büchler , Beat Gloor , Christophe Müller +3 more

Objective To determine benefits of conservative versus surgical treatment in patients with necrotizing pancreatitis. Summary Background Data Infection of pancreatic necrosis is the most important risk factor contributing to death … Objective To determine benefits of conservative versus surgical treatment in patients with necrotizing pancreatitis. Summary Background Data Infection of pancreatic necrosis is the most important risk factor contributing to death in severe acute pancreatitis, and it is generally accepted that infected pancreatic necrosis should be managed surgically. In contrast, the management of sterile pancreatic necrosis accompanied by organ failure is controversial. Recent clinical experience has provided evidence that conservative management of sterile pancreatic necrosis including early antibiotic administration seems promising. Methods A prospective single-center trial evaluated the role of nonsurgical management including early antibiotic treatment in patients with necrotizing pancreatitis. Pancreatic infection, if confirmed by fine-needle aspiration, was considered an indication for surgery, whereas patients without signs of pancreatic infection were treated without surgery. Results Between January 1994 and June 1999, 204 consecutive patients with acute pancreatitis were recruited. Eighty-six (42%) had necrotizing disease, of whom 57 (66%) had sterile and 29 (34%) infected necrosis. Patients with infected necrosis had more organ failures and a greater extent of necrosis compared with those with sterile necrosis. When early antibiotic treatment was used in all patients with necrotizing pancreatitis (imipenem/cilastatin), the characteristics of pancreatic infection changed to predominantly gram-positive and fungal infections. Fine-needle aspiration showed a sensitivity of 96% for detecting pancreatic infection. The death rate was 1.8% (1/56) in patients with sterile necrosis managed without surgery versus 24% (7/29) in patients with infected necrosis (P <.01). Two patients whose infected necrosis could not be diagnosed in a timely fashion died while receiving nonsurgical treatment. Thus, an intent-to-treat analysis (nonsurgical vs. surgical treatment) revealed a death rate of 5% (3/58) with conservative management versus 21% (6/28) with surgery. Conclusions These results support nonsurgical management, including early antibiotic treatment, in patients with sterile pancreatic necrosis. Patients with infected necrosis still represent a high-risk group in severe acute pancreatitis, and for them surgical treatment seems preferable.

A Clinically Based Classification System for Acute Pancreatitis

1993-05-01

Edward L. Bradley

• Acute pancreatitis is a protean disease capable of wide clinical variation, ranging from mild discomfort to apocalyptic prostration. Moreover, the inflammatory process may remain localized in the pancreas, spread … • Acute pancreatitis is a protean disease capable of wide clinical variation, ranging from mild discomfort to apocalyptic prostration. Moreover, the inflammatory process may remain localized in the pancreas, spread to regional tissues, or even involve remote organ systems. This variability in presentation and clinical course has plagued the study and management of acute pancreatitis since its original clinical description. In the absence of accepted definitions for acute pancreatitis and its complications, it has not been possible to devise a clinical classification system useful for case management. Following 3 days of group meetings and open discussions, unanimous consensus on a series of definitions and a clinically based classification system for acute pancreatitis was achieved by a diverse group of 40 international authorities from six medical disciplines and 15 countries. The proposed classification system will be of value to practicing clinicians in the care of individual patients and to academicians seeking to compare interinstitutional data. (<i>Arch Surg.</i>1993;128:586-590)

Periacinar stellate shaped cells in rat pancreas: identification, isolation, and culture

1998-07-01

Minoti V. Apte , Paul Haber , Tanya Applegate +5 more

The pathogenesis of pancreatic fibrosis is unknown. In the liver, stellate cells (vitamin A storing cells) play a significant role in the development of fibrosis.To determine whether cells resembling hepatic … The pathogenesis of pancreatic fibrosis is unknown. In the liver, stellate cells (vitamin A storing cells) play a significant role in the development of fibrosis.To determine whether cells resembling hepatic stellate cells are present in rat pancreas, and if so, to compare their number with the number of stellate cells in the liver, and isolate and culture these cells from rat pancreas.Liver and pancreatic sections from chow fed rats were immunostained for desmin, glial fibrillary acidic protein (GFAP), and alpha smooth muscle actin (alpha-SMA). Pancreatic stellate shaped cells were isolated using a Nycodenz gradient, cultured on plastic, and examined by phase contrast and fluorescence microscopy, and by immunostaining for desmin, GFAP, and alpha-SMA.In both liver and pancreatic sections, stellate shaped cells were observed; these were positive for desmin and GFAP and negative for alpha-SMA. Pancreatic stellate shaped cells had a periacinar distribution. They comprised 3.99% of all pancreatic cells; hepatic stellate cells comprised 7.94% of all hepatic cells. The stellate shaped cells from rat pancreas grew readily in culture. Cells cultured for 24 hours had an angular appearance, contained lipid droplets manifesting positive vitamin A autofluorescence, and stained positively for desmin but negatively for alpha-SMA. At 48 hours, cells were positive for alpha-SMA.Cells resembling hepatic stellate cells are present in rat pancreas in a number comparable with that of stellate cells in the liver. These stellate shaped pancreatic cells can be isolated and cultured in vitro.

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Chronic pancreatitis: Diagnosis, classification, and new genetic developments

2001-02-01

Babak Etemad , David C. Whitcomb

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The different courses of early- and late-onset idiopathic and alcoholic chronic pancreatitis

1994-11-01

Peter Layer , Hironori Yamamoto , Ludwig Kalthoff +3 more

Hereditary pancreatitis is caused by a mutation in the cationic trypsinogen gene

1996-10-01

David C. Whitcomb , Michael Gorry , Robert A. Preston +7 more

Relations between Pancreatic Enzyme Outputs and Malabsorption in Severe Pancreatic Insufficiency

1973-04-19

Eugene P. DiMagno , Vay Liang W. Go , W.H.J. Summerskill

To investigate the functioning reserve capacity of the exocrine pancreas, we studied the relations of steatorrhea and creatorrhea to lipase and trypsin outputs in 17 patients with chronic pancreatitis and … To investigate the functioning reserve capacity of the exocrine pancreas, we studied the relations of steatorrhea and creatorrhea to lipase and trypsin outputs in 17 patients with chronic pancreatitis and 33 healthy subjects. A standard diet was given, and stools were collected for 48 hours. Total enzyme outputs in response to duodenal perfusion of essential amino acids (78 mM) and intravenously administered cholecystokinin-pancreozymin (0.25 U per kilogram per minute) were compared in patients and in healthy subjects. Steatorrhea was not observed until lipase output was 10 per cent or less of normal; similarly, creatorrhea occurred only when trypsin outputs were less than 10 per cent of normal. These relations demonstrate the large reserve capacity for enzyme secretion by the exocrine pancreas and explain the often late development of steatorrhea and creatorrhea in chronic pancreatitis. (N Engl J Med 288:813–815, 1973)

Identification, culture, and characterization of pancreatic stellate cells in rats and humans

1998-08-01

Max G. Bachem , Erik Schneider , Hans Groß +7 more

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Activation of the NLRP3 inflammasome by islet amyloid polypeptide provides a mechanism for enhanced IL-1β in type 2 diabetes

2010-09-12

Seth L. Masters , Aisling Dunne , Shoba Subramanian +7 more

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Endoscopic Transgastric vs Surgical Necrosectomy for Infected Necrotizing Pancreatitis

2012-03-13

Olaf J. Bakker , Hjalmar C. van Santvoort , Sandra van Brunschot +7 more

Most patients with infected necrotizing pancreatitis require necrosectomy. Surgical necrosectomy induces a proinflammatory response and is associated with a high complication rate. Endoscopic transgastric necrosectomy, a form of natural orifice … Most patients with infected necrotizing pancreatitis require necrosectomy. Surgical necrosectomy induces a proinflammatory response and is associated with a high complication rate. Endoscopic transgastric necrosectomy, a form of natural orifice transluminal endoscopic surgery, may reduce the proinflammatory response and reduce complications.To compare the proinflammatory response and clinical outcome of endoscopic transgastric and surgical necrosectomy.Randomized controlled assessor-blinded clinical trial in 3 academic hospitals and 1 regional teaching hospital in The Netherlands between August 20, 2008, and March 3, 2010. Patients had signs of infected necrotizing pancreatitis and an indication for intervention.Random allocation to endoscopic transgastric or surgical necrosectomy. Endoscopic necrosectomy consisted of transgastric puncture, balloon dilatation, retroperitoneal drainage, and necrosectomy. Surgical necrosectomy consisted of video-assisted retroperitoneal debridement or, if not feasible, laparotomy.The primary end point was the postprocedural proinflammatory response as measured by serum interleukin 6 (IL-6) levels. Secondary clinical end points included a predefined composite end point of major complications (new-onset multiple organ failure, intra-abdominal bleeding, enterocutaneous fistula, or pancreatic fistula) or death.We randomized 22 patients, 2 of whom did not undergo necrosectomy following percutaneous catheter drainage and could not be analyzed for the primary end point. Endoscopic transgastric necrosectomy reduced the postprocedural IL-6 levels compared with surgical necrosectomy (P = .004). The composite clinical end point occurred less often after endoscopic necrosectomy (20% vs 80%; risk difference [RD], 0.60; 95% CI, 0.16-0.80; P = .03). Endoscopic necrosectomy did not cause new-onset multiple organ failure (0% vs 50%, RD, 0.50; 95% CI, 0.12-0.76; P = .03) and reduced the number of pancreatic fistulas (10% vs 70%; RD, 0.60; 95% CI, 0.17-0.81; P = .02).In patients with infected necrotizing pancreatitis, endoscopic necrosectomy reduced the proinflammatory response as well as the composite clinical end point compared with surgical necrosectomy.isrctn.org Identifier: ISRCTN07091918.

Hereditary Pancreatitis and the Risk of Pancreatic Cancer

1997-03-19

Albert B. Lowenfels , Patrick Maisonneuve , Eugene P. DiMagno +4 more

Background: Hereditary pancreatitis is an autosomal-dominant disease, with a variable expression and an estimated penetrance of 80%. The gene for this disease has recently been mapped to chromosome 7q35, and … Background: Hereditary pancreatitis is an autosomal-dominant disease, with a variable expression and an estimated penetrance of 80%. The gene for this disease has recently been mapped to chromosome 7q35, and the defect is believed to be caused by a mutation in the cationic trypsinogen gene. Acute attacks of abdominal pain begin early in life and the disease often progresses to chronic pancreatitis. Although the risk of pancreatic cancer is thought to be increased in more common types of chronic pancreatitis, the frequency of pancreatic cancer in the inherited type of pancreatitis is uncertain. Purpose: The aim of this study was to assess the frequency of pancreatic cancer and other tumors in patients with hereditary form of pancreatitis. Methods: To determine the natural history of hereditary pancreatitis, we invited all members of the American Pancreatic Association and the International Association of Pancreatology to participate in a longitudinal study of this rare form of pancreatitis. The initial criteria for patient eligibility were as follows: early age (⩽30 years) at onset of symptoms, positive family history, and absence of other causes. From April 1995 through February 1996, 37 physicians from 10 countries contributed medical records of 246 (125 males and 121 females) patients thought to have hereditary pancreatitis as the most likely diagnosis. This group included 218 patients where the diagnosis appeared to be highly probable and 28 additional patients where the diagnosis of hereditary pancreatitis was less certain: 25 patients who had relatively late onset of disease and a positive family history and three patients with onset of disease before age 30 years but with an uncertain family history. We reviewed all causes of death and compared the observed to the expected frequency of cancer in this historical cohort of patients with hereditary pancreatitis. The strength of the association between pancreatitis and pancreatic cancer was estimated by the standardized incidence ratio (SIR), which is the ratio of observed pancreatic cancer cases in the cohort to the expected pancreatic cancers in the background population, adjusted for age, sex, and country. Results: The mean age (± standard deviation [SD]) at onset of symptoms of pancreatitis was 13.9 ± 12.2 years. Compared with an expected number of 0.150, eight pancreatic adenocarcinomas developed (mean age ± SD at diagnosis of pancreatic cancer: 56.9 ± 11.2 years) during 8531 person-years of follow-up, yielding an SIR of 53 (95% confidence interval [CI] = 23–105). The frequency of other tumors was not increased: SIR = 0.7 (95% CI = 0.3–1.6). Eight of 20 reported deaths in the cohort were from pancreatic cancer. Thirty members of the cohort have already been tested for the defective hereditary pancreatitis gene: all 30 carry a mutated copy of the trypsinogen gene. The transmission pattern of hereditary pancreatitis was known for 168 of 238 patients without pancreatic cancer and six of eight with pancreatic cancer. Ninety-nine of the 238 patients without pancreatic cancer and six of the patients with pancreatic cancer inherited the disease through the paternal side of the family. The estimated cumulative risk of pancreatic cancer to age 70 years in patients with hereditary pancreatitis approaches 40%. For patients with a paternal inheritance pattern, the cumulative risk of pancreatic cancer is approximately 75%. Conclusions: Patients with hereditary pancreatitis have a high risk of pancreatic cancer several decades after the initial onset of pancreatitis. A paternal inheritance pattern increases the probability of developing pancreatic cancer.

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Endoscopic versus Surgical Drainage of the Pancreatic Duct in Chronic Pancreatitis

2007-02-14

Djuna L. Cahen , Dirk J. Gouma , Yung Nio +7 more

For patients with chronic pancreatitis and a dilated pancreatic duct, ductal decompression is recommended. We conducted a randomized trial to compare endoscopic and surgical drainage of the pancreatic duct. For patients with chronic pancreatitis and a dilated pancreatic duct, ductal decompression is recommended. We conducted a randomized trial to compare endoscopic and surgical drainage of the pancreatic duct.

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A Better Model of Acute Pancreatitis for Evaluating Therapy

1992-01-01

Jan Schmidt , David W. Rattner , Kent Lewandrowski +4 more

Existing models of acute pancreatitis have limitations to studying novel therapy. Whereas some produce mild self-limited pancreatitis, others result in sudden necrotizing injury. The authors developed an improved model providing … Existing models of acute pancreatitis have limitations to studying novel therapy. Whereas some produce mild self-limited pancreatitis, others result in sudden necrotizing injury. The authors developed an improved model providing homogeneous moderately severe injury by superimposing secretory hyperstimulation on minimal intraductal bile acid exposure. Sprague-Dawley rats (n = 231) received low-pressure intraductal glycodeoxycholic acid (GDOC) at very low (5 or 10 mmol/L) concentrations followed by intravenous cerulein. Cerulein or GDOC alone caused only very mild inflammation. However, GDOC combined with cerulein was uniformly associated with more edema (p < 0.0005), acinar necrosis (p < 0.01), inflammation (p < 0.006), and hemorrhage (p < 0.01). Pancreatic injury was further increased and death was potentiated by increasing volume and duration of intraductal low-dose GDOC infusion. There was significant morphologic progression between 6 and 24 hours. The authors conclude that (1) combining minimal intraductal bile acid exposure with intravenous hyperstimulation produces homogeneous pancreatitis of intermediate severity that can be modulated at will; (2) the injury is progressive over at least 24 hours with finite mortality rate; (3) the model provides superior opportunity to study innovative therapy.

Intestinal Alkaline Phosphatase Detoxifies Lipopolysaccharide and Prevents Inflammation in Zebrafish in Response to the Gut Microbiota

2007-12-01

Jennifer Bates , Janie Akerlund , Erika Mittge +1 more

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APACHE-II SCORE FOR ASSESSMENT AND MONITORING OF ACUTE PANCREATITIS

1989-07-01

Michael Larvin , MichaelJ. Mcmahon

Chronic inflammatory sclerosis of the pancreas—An autonomous pancreatic disease?

1961-07-01

H Sarles , Jean-Claude Sarles , R Muratore +1 more

CONTROLLED TRIAL OF URGENT ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY AND ENDOSCOPIC SPHINCTEROTOMY VERSUS CONSERVATIVE TREATMENT FOR ACUTE PANCREATITIS DUE TO GALLSTONES

1988-10-01

John P. Neoptolemos , N.J.M. London , D James +3 more

Acute pancreatitis: value of CT in establishing prognosis.

1990-02-01

EJ Balthazar , David Robinson , Alec J. Megibow +1 more

The presence and degree of pancreatic necrosis (30%, 50%, or greater than 50%) was evaluated by means of bolus injection of contrast material and dynamic sequential computed tomography (CT) in … The presence and degree of pancreatic necrosis (30%, 50%, or greater than 50%) was evaluated by means of bolus injection of contrast material and dynamic sequential computed tomography (CT) in 88 patients with acute pancreatitis at initial and follow-up examinations. Pancreatic necrosis was defined as lack of enhancement of all or a portion of the gland. Length of hospitalization, morbidity, and mortality in patients with early or late necrosis (22 patients) were evaluated and compared with the same criteria in the rest of the group. Patients with necrosis had a 23% mortality and an 82% complication rate; patients without necrosis had 0% mortality and 6% morbidity. When only the initial assessment was considered, patients with peripancreatic phlegmons and necrosis had 80% morbidity, compared with 36% morbidity in those with phlegmons and no necrosis. Serious complications occurred in patients who initially had or developed more than 30% necrosis. A CT severity index, based on a combination of peripancreatic inflammation, phlegmon, and degree of pancreatic necrosis as seen at initial CT study, was developed. Patients with a high CT severity index had 92% morbidity and 17% mortality; patients with a low CT severity index had 2% morbidity, and none died.

Organ Failure and Infection of Pancreatic Necrosis as Determinants of Mortality in Patients With Acute Pancreatitis

2010-06-11

Maxim S. Petrov , S. Shanbhag , Mandira Chakraborty +2 more

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The early prediction of mortality in acute pancreatitis: a large population-based study

2008-06-03

Bing Wu , R.S. Johannes , Xiaowu Sun +3 more

Identification of patients at risk for mortality early in the course of acute pancreatitis (AP) is an important step in improving outcome.Using Classification and Regression Tree (CART) analysis, a clinical … Identification of patients at risk for mortality early in the course of acute pancreatitis (AP) is an important step in improving outcome.Using Classification and Regression Tree (CART) analysis, a clinical scoring system was developed for prediction of in-hospital mortality in AP. The scoring system was derived on data collected from 17,992 cases of AP from 212 hospitals in 2000-2001. The new scoring system was validated on data collected from 18,256 AP cases from 177 hospitals in 2004-2005. The accuracy of the scoring system for prediction of mortality was measured by the area under the receiver operating characteristic curve (AUC). The performance of the new scoring system was further validated by comparing its predictive accuracy with that of Acute Physiology and Chronic Health Examination (APACHE) II.CART analysis identified five variables for prediction of in-hospital mortality. One point is assigned for the presence of each of the following during the first 24 h: blood urea nitrogen (BUN) >25 mg/dl; impaired mental status; systemic inflammatory response syndrome (SIRS); age >60 years; or the presence of a pleural effusion (BISAP). Mortality ranged from >20% in the highest risk group to <1% in the lowest risk group. In the validation cohort, the BISAP AUC was 0.82 (95% CI 0.79 to 0.84) versus APACHE II AUC of 0.83 (95% CI 0.80 to 0.85).A new mortality-based prognostic scoring system for use in AP has been derived and validated. The BISAP is a simple and accurate method for the early identification of patients at increased risk for in-hospital mortality.

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A Step-up Approach or Open Necrosectomy for Necrotizing Pancreatitis

2010-04-21

Hjalmar C. van Santvoort , Marc G. Besselink , Olaf J. Bakker +7 more

Necrotizing pancreatitis with infected necrotic tissue is associated with a high rate of complications and death. Standard treatment is open necrosectomy. The outcome may be improved by a minimally invasive … Necrotizing pancreatitis with infected necrotic tissue is associated with a high rate of complications and death. Standard treatment is open necrosectomy. The outcome may be improved by a minimally invasive step-up approach.In this multicenter study, we randomly assigned 88 patients with necrotizing pancreatitis and suspected or confirmed infected necrotic tissue to undergo primary open necrosectomy or a step-up approach to treatment. The step-up approach consisted of percutaneous drainage followed, if necessary, by minimally invasive retroperitoneal necrosectomy. The primary end point was a composite of major complications (new-onset multiple-organ failure or multiple systemic complications, perforation of a visceral organ or enterocutaneous fistula, or bleeding) or death.The primary end point occurred in 31 of 45 patients (69%) assigned to open necrosectomy and in 17 of 43 patients (40%) assigned to the step-up approach (risk ratio with the step-up approach, 0.57; 95% confidence interval, 0.38 to 0.87; P=0.006). Of the patients assigned to the step-up approach, 35% were treated with percutaneous drainage only. New-onset multiple-organ failure occurred less often in patients assigned to the step-up approach than in those assigned to open necrosectomy (12% vs. 40%, P=0.002). The rate of death did not differ significantly between groups (19% vs. 16%, P=0.70). Patients assigned to the step-up approach had a lower rate of incisional hernias (7% vs. 24%, P=0.03) and new-onset diabetes (16% vs. 38%, P=0.02).A minimally invasive step-up approach, as compared with open necrosectomy, reduced the rate of the composite end point of major complications or death among patients with necrotizing pancreatitis and infected necrotic tissue. (Current Controlled Trials number, ISRCTN13975868.)

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The internal secretion of the pancreas

1922-02-01

Fredrick Banting , C. H. Best

Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial

2008-02-01

Marc G. Besselink , Hjalmar C. van Santvoort , Erik Buskens +7 more

Practice Guidelines in Acute Pancreatitis

2006-10-01

Peter A. Banks , Martin L. Freeman

INTRODUCTION Guidelines for the diagnosis and treatment of acute pancreatitis were published by the American College of Gastroenterology in 1997 (1). These and subsequent guidelines (2–7) have undergone periodic review … INTRODUCTION Guidelines for the diagnosis and treatment of acute pancreatitis were published by the American College of Gastroenterology in 1997 (1). These and subsequent guidelines (2–7) have undergone periodic review (6, 8–13) in accordance with advances that have been made in the diagnosis and treatment of acute pancreatitis. Guidelines for clinical practice are intended to apply to all health-care providers who take care of patients with acute pancreatitis and are intended to be flexible, and to suggest preferable (but not the only) approaches. Because there is a wide range of choices in any health-care situation, the physician should select the course best suited to the individual patient and the clinical situation. These guidelines have been developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee, and approved by the Board of Trustees. The world literature in English was reviewed using a MEDLINE search and also using the Cochrane Library. The ratings of levels of evidence for these guidelines are indicated in Table 1. The final recommendations are based on the data available at the time of the publication of this document and may be updated with appropriate scientific development at a later time. The following guidelines are intended for adult and not pediatric patients. The main diagnostic guidelines include an assessment of risk factors of severity at admission and determination of severity. The major treatment guidelines include supportive care, fluid resuscitation, transfer to intensive care unit, enteral feeding, use of antibiotics, treatment of infected pancreatic necrosis, treatment of sterile pancreatic necrosis, treatment of associated pancreatic duct disruptions, and role of magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasound (EUS), and endoscopic retrograde cholangiopancreatography (ERCP) with biliary sphincterotomy for detection and treatment of choledocholithiasis in biliary pancreatitis.Table 1: Ratings of Evidence Used for This GuidelinePATHOPHYSIOLOGY The pathophysiology of acute pancreatitis is generally considered in three phases. In the first phase, there is premature activation of trypsin within pancreatic acinar cells. A variety of mechanisms have been proposed including disruption of calcium signaling in acinar cells (14–18), cleavage of trypsinogen to trypsin by the lysosomal hydrolase cathepsin-B, and decreased activity of the intracellular pancreatic trypsin inhibitor (17, 18). Once trypsin is activated, it activates a variety of injurious pancreatic digestive enzymes. In the second phase, there is intrapancreatic inflammation through a variety of mechanisms and pathways (16, 18–28). In the third phase, there is extrapancreatic inflammation including acute respiratory syndrome (ARDS) (16, 19–21, 29). In both phases, there are four important steps mediated by cytokines and other inflammatory mediators: 1) activation of inflammatory cells, 2) chemoattraction of activated inflammatory cells to the microcirculation, 3) activation of adhesion molecules allowing the binding of inflammatory cells to the endothelium, and 4) migration of activated inflammatory cells into areas of inflammation. In the majority of patients, acute pancreatitis is mild. In 10–20%, the various pathways that contribute to increased intrapancreatic and extrapancreatic inflammation result in what is generally termed systemic inflammatory response syndrome (SIRS) (Table 2). In some instances, SIRS predisposes to multiple organ dysfunction and/or pancreatic necrosis. The factors that determine severity are not clearly understood, but appear to involve a balance between proinflammatory and anti-inflammatory factors. Recent evidence suggests that the balance may be tipped in favor of proinflammatory factors by genetic polymorphisms of inflammatory mediators that increase severity of acute pancreatitis (27, 30, 31).Table 2: Systemic Inflammatory Response Syndrome (SIRS)CLINICAL CONSIDERATIONS Clinical Diagnosis It has been estimated that in the United States there are 210,000 admissions for acute pancreatitis each year (13). Most patients with acute pancreatitis experience abdominal pain that is located generally in the epigastrium and radiates to the back in approximately half of cases. The onset may be swift with pain reaching maximum intensity within 30 min, is frequently unbearable, and characteristically persists for more than 24 h without relief. The pain is often associated with nausea and vomiting. Physical examination usually reveals severe upper abdominal tenderness at times associated with guarding (32). There is general acceptance that a diagnosis of acute pancreatitis requires two of the following three features: 1) abdominal pain characteristic of acute pancreatitis, 2) serum amylase and/or lipase ≥3 times the upper limit of normal, and 3) characteristic findings of acute pancreatitis on CT scan. This definition allows for the possibility that an amylase and/or lipase might be <3 times the upper limit of normal in acute pancreatitis. In a patient with abdominal pain characteristic of acute pancreatitis and serum enzyme levels that are lower than 3 times the upper limit of normal, a CT scan must be performed to confirm a diagnosis of acute pancreatitis. In addition, this definition allows for the possibility that presence of abdominal pain cannot be assessed in some patients with severely altered mental status due to acute or chronic illness. In general, both amylase and lipase are elevated during the course of acute pancreatitis. The serum lipase may remain elevated slightly longer than amylase. The height of the serum amylase and/or lipase does not correlate with the severity of acute pancreatitis. It is usually not necessary to measure both serum amylase and lipase. Serum lipase may be preferable because it remains normal in some nonpancreatic conditions that increase serum amylase including macroamylasemia, parotitis, and some carcinomas. In general, serum lipase is thought to be more sensitive and specific than serum amylase in the diagnosis of acute pancreatitis. Daily measurement of serum amylase or lipase after the diagnosis of acute pancreatitis has limited value in assessing the clinical progress of the illness or ultimate prognosis (32). If serum amylase and/or lipase remain elevated for several weeks, possibilities include persisting pancreatic/peripancreatic inflammation, blockage of the pancreatic duct, or development of a pseudocyst. The differential diagnosis of acute pancreatitis is broad and includes mesenteric ischemia or infarction, perforated gastric or duodenal ulcer, biliary colic, dissecting aortic aneurysm, intestinal obstruction, and possibly inferior wall myocardial infarction. In severe pancreatitis, the patients appear toxic and quite ill. In mild pancreatitis, the patients generally appear uncomfortable but not as ill (32). A detailed discussion of the approach to determining the etiology of acute pancreatitis is beyond the scope of this paper. During the initial hospitalization for acute pancreatitis, reasonable attempts to determine etiology are appropriate, and in particular those causes that may affect acute management. Relevant historical clues include any previous diagnosis of biliary tract disease or gallstones, cholecystectomy, other biliary or pancreatic surgery, acute or chronic pancreatitis or their complications, use of ethanol, medications and the timing of their initiation, recent abdominal trauma, weight loss or other symptoms suggesting a malignancy, or a family history of pancreatitis. Blood tests within the first 24 h should include liver chemistries, calcium, and triglycerides. Abdominal ultrasound is usually performed at the time of admission to assess for gallstones as the etiology rather than to establish the diagnosis of acute pancreatitis. Detection of common bile duct stones by ultrasound is limited by poor sensitivity, although specificity is quite high if they are identified. Dilation of the common bile duct alone is neither sensitive nor specific for the detection of common bile duct stones. Occasionally, the pancreas is well enough seen by abdominal ultrasound to reveal features that are consistent with the diagnosis of acute pancreatitis including diffuse glandular enlargement, hypoechoic texture of the pancreas reflective of edema, and ascites. Contrast-enhanced CT scan (and in particular a contrast-enhanced thin-section multidetector-row CT scan) is the best imaging technique to exclude conditions that masquerade as acute pancreatitis, to diagnose the severity of acute pancreatitis, and to identify complications of pancreatitis (33–35). Findings on CT scan that confirm the diagnosis of acute pancreatitis include enlargement of the pancreas with diffuse edema, heterogeneity of pancreatic parenchyma, peripancreatic stranding, and peripancreatic fluid collections. With the use of IV contrast, a diagnosis of pancreatic necrosis can be established. In addition, contrast-enhanced CT scan may give clues as to the etiology of acute pancreatitis: for example, a common bile duct stone may occasionally be directly visualized, pancreatic calcifications may indicate underlying chronic pancreatitis due to alcohol or other causes, a pancreatic mass may suggest malignancy, and diffuse dilation of the pancreatic duct or a cystic lesion may suggest intraductal papillary mucinous neoplasia or cystic neoplasm. The role of magnetic resonance imaging (MRI) and MRCP in the diagnosis of acute pancreatitis and establishment of severity is undergoing evaluation. These techniques are superior to CT scan in delineating pancreatic ductal anatomy (36–38) and detecting choledocholithiasis (39). Definitions The International Symposium, held in Atlanta, GA, in 1992, established a clinically based classification system for acute pancreatitis (40, 41). The goal was to establish international standards of definitions of acute pancreatitis and its complications to make possible valid comparisons of severity of illness and results of therapy and also to establish criteria for patient selection in randomized prospective trials. According to the Atlanta Symposium, acute pancreatitis was defined as an acute inflammatory process of the pancreas that may also involve peripancreatic tissues and/or remote organ systems. Criteria for severity included organ failure (particularly shock, pulmonary insufficiency, and renal failure) and/or local complications (especially pancreatic necrosis but also including abscess and pseudocyst). Early predictors of severity within 48 h of initial hospitalization included Ranson signs and APACHE-II points (Table 3).Table 3: Severe Acute Pancreatitis as Defined by Atlanta SymposiumInterstitial pancreatitis was defined as focal or diffuse enlargement of the pancreas with enhancement of the parenchyma that is either homogeneous or slightly heterogeneous in response to IV contrast. There may be inflammatory changes in peripancreatic fatty tissue characterized by a hazy appearance. Pancreatic necrosis was defined as diffuse or focal areas of nonviable pancreatic parenchyma that was typically associated with peripancreatic fat necrosis. The criteria for the CT diagnosis of necrosis included focal or diffuse well-marginated zones of nonenhanced pancreatic parenchyma greater than 3 cm in size or greater than 30% of the pancreas. It was recognized that pancreatic necrosis could be either sterile or infected and that infected necrosis was characterized by the presence of bacteria (and/or fungi) within the necrotic tissue. An extrapancreatic fluid collection was defined as pancreatic fluid that extravasates out of the pancreas during acute pancreatitis into the anterior pararenal spaces and other areas as well. Fluid collections may occur both with interstitial and necrotizing pancreatitis. Most fluid collections remain sterile and disappear during the recovery period. A pancreatic pseudocyst was defined as a collection of pancreatic juice enclosed by a nonepithelialized wall that occurs as a result of acute pancreatitis, pancreatic trauma, or chronic pancreatitis. It is generally believed that a period of at least 4 wk is required from the onset of acute pancreatitis to form a well-defined wall composed of granulation and fibrous tissue. Pancreatic pseudocysts contain considerable pancreatic enzymes and are usually sterile. According to the Atlanta Symposium, an infected pancreatic pseudocyst should be termed a pancreatic abscess. A pancreatic abscess may also occur when an area of pancreatic necrosis undergoes secondary liquefaction and then becomes infected. Mild acute pancreatitis was defined as pancreatitis associated with minimal organ dysfunction and an uneventful recovery. Severe pancreatitis was defined as pancreatitis associated with organ failure and/or local complications (necrosis, abscess, or pseudocyst). Organ failure was defined as shock, pulmonary insufficiency, renal failure, or gastrointestinal bleeding (Table 4). There were a number of additional systemic complications that were identified as characteristic of severe acute pancreatitis including disseminated intravascular coagulation (platelets ≤100,000/mm3, fibrinogen ≤100 mg/dL, fibrin split products >80 μg/mL), or a severe metabolic disturbance (serum calcium ≤7.5 mg/dL).Table 4: Organ Failure as Defined by Atlanta SymposiumThe Atlanta Symposium was an important initiative in establishing a clinically based classification system. However, it is now clear some of the information included in the classification was subject to different interpretations, and that criteria of severity as defined by the Atlanta Symposium have not been used in a uniform fashion in recent publications (3, 10, 13, 25, 27, 31, 42–165). In addition, there is new scientific information that should be included in a revised classification. Areas of major concern are as follows: In the Atlanta Symposium, a uniform threshold was not established for serum amylase and/or lipase for the diagnosis of acute pancreatitis. In recently published articles, the threshold varied from ≥2 times to ≥4 times the upper limit of normal. In the Atlanta Symposium, criteria for severe pancreatitis included organ failure and/or local complications (Table 3). This broad definition describes a heterogeneous group of patients with varying levels of severity. For example, the prognosis of pancreatic necrosis is more serious than a pseudocyst or pancreatic abscess. Also, almost all patients with necrotizing pancreatitis without organ failure survive, whereas those with multisystem organ failure have a median mortality of 47% (48, 66, 68, 83, 120, 163, 164). There was no distinction between transient and persistent organ failure. Patients with persistent organ failure have a more serious prognosis than those with transient organ failure (71, 72, 151). Criteria for organ failure that were established have not been used in a uniform fashion. Some reports have restricted organ failure to shock, hypotension, renal failure, and gastrointestinal bleeding (10, 13, 44, 46, 50–52, 57, 73, 74, 83, 84, 89, 140, 145, 148). Other reports have altered thresholds for organ failure, or have included additional criteria, or have used alternative or nonspecified scoring systems (3, 25, 31, 43, 45, 47, 48, 53, 54, 56, 58–61, 64, 66–69, 77–80, 82, 86–88, 90–95, 97–100, 102, 103, 105–112, 114, 119–123, 125–129, 134–136, 138, 139, 142, 143, 146, 147, 149–153, 155, 156, 159–161, 165). A revision of the Atlanta criteria will undoubtedly delete gastrointestinal bleeding (which is rarely encountered in acute pancreatitis) and will retain shock, hypotension, and renal failure as the important components of organ failure. In addition, a revision will likely include one of the formal scoring systems for organ failure that are currently available. In the Atlanta Symposium, pancreatic necrosis was considered as either greater than 30% of the pancreas or greater than 3 cm in size. These are, in effect, two different definitions. Because of the variability in the minimum criteria used for the presence of necrosis, it is difficult to compare studies from different institutions (10, 13, 25, 27, 31, 44–60, 62–64, 66–74, 77–92, 98, 100–102, 104–107, 113, 115, 116, 119–121, 126–129, 131, 133–135, 137, 138, 140, 142–148, 150, 153, 154, 156, 157, 159, 161). A revision of the Atlanta criteria will undoubtedly provide a uniform threshold for the diagnosis of pancreatic necrosis. Regarding the term pancreatic pseudocyst, a distinction was not made between two relatively distinctive entities. The first is a collection of pancreatic juice enclosed by a nonepithelialized wall that occurs mostly near the pancreas. While the contents may also include peripancreatic necrotic material, the contents are usually mostly fluid. The second type of pancreatic pseudocyst is that which takes place within the confines of the pancreas and involves pancreatic necrotic tissue with variable amounts of pancreatic fluid. This entity, frequently termed “organized necrosis” (166), is a distinct clinical entity that poses substantially greater management challenges (167). Additional terminology will be needed to separate these two conditions. Overview of Acute Pancreatitis Overall, 85% of patients have interstitial pancreatitis; 15% (range 4–47%) have necrotizing pancreatitis (25, 44, 46, 50, 68, 83, 86, 128, 140, 169). Among patients with necrotizing pancreatitis, 33% (range 16–47%) have infected necrosis (62, 66, 68, 83, 91, 111, 113, 117, 118, 120, 121, 147, 159, 169, 170). Approximately 10% of patients with interstitial pancreatitis experience organ failure, but in the majority it is transient with a very low mortality. Median prevalence of organ failure in necrotizing pancreatitis is 54% (range 29–78%) (31, 50, 54, 82, 83, 120, 147, 148). Prevalence of organ failure is the same or somewhat higher in infected necrosis (34–89%) than in sterile necrosis (45–73%) (66, 83, 138, 161). The overall mortality in acute pancreatitis is approximately 5%: 3% in interstitial pancreatitis, 17% in necrotizing pancreatitis (30% in infected necrosis, 12% in sterile necrosis) (Table 5).Table 5: Mortality in Acute PancreatitisThe mortality in the absence of organ failure is 0 (50, 66, 68, 83), with single organ failure is 3% (range 0–8%) (66, 83, 163), with multisystem organ failure 47% (range 28–69%) (48, 66, 68, 83, 120, 163, 164). Although older literature suggested that 80% of deaths occur after several weeks of illness as a result of infected necrosis, more recent surveys have shown considerable variation with several reports showing a reasonably even distribution of early deaths (within 1–2 wk) versus later deaths (46, 72, 76, 150, 151, 163), a few showing the majority of deaths within the first 2 wk (67, 75), and others showing the majority of deaths after the first 2 wk (59, 89, 135). These variations reflect a variety of influences including percentage of very ill patients referred to a reporting hospital compared to patients admitted directly. Deaths within the first 2 wk are generally attributed to organ failure; deaths after this interval are generally caused by infected necrosis or complications of sterile necrosis. DIAGNOSTIC GUIDELINE I: LOOK FOR RISK FACTORS OF SEVERITY AT ADMISSION Older age (>55), obesity (BMI >30), organ failure at admission, and pleural effusion and/or infiltrates are risk factors for severity that should be noted at admission. Patients with these characteristics may require treatment in a highly supervised area, such as a step-down unit or an intensive care unit. Level of evidence: III The importance of establishing risk factors of severity of acute pancreatitis at admission is several-fold: to transfer those patients who are most likely to have a severe episode to a step-down unit or an intensive care unit for closer supervision, to allow physicians to compare results of optimal therapy, and to facilitate the identification of seriously ill patients for inclusion in randomized prospective trials. A variety of potential risk factors have been investigated as follows. It is intuitive that older individuals would have more severe pancreatitis because of comorbid disease. In many (50, 55, 60, 67, 70, 75, 83, 86–88, 91, 128) but not all (31, 46, 53, 61, 165, 168) reports, older age (generally ≥55 yr of age) has correlated with a more severe prognosis. There have been a variety of studies that have sought to determine whether obesity is a risk factor for severity in acute pancreatitis (56–60, 75, 87, 88). A recent meta-analysis concluded that obese patients (defined as those with a BMI >30) had more systemic and local complications but not greater mortality (57). In one recent report, the combination of APACHE-II and obesity (a classification termed APACHE-O) measured within the first 24 h of admission improved the prediction of severity in patients with acute pancreatitis (58). Several reports have pointed out that patients with organ failure at admission have a higher mortality than those who do not experience organ failure at admission (50, 61, 69, 71, 72, 83, 163). The progression of single organ failure to multisystem organ failure is a major determinant in the high mortality associated with organ failure at admission (83). Survival among patients with organ failure at admission has also been shown to correlate with the duration of organ failure (71, 72, 151). When organ failure is corrected within 48 h, mortality was close to 0. When organ failure persisted for more than 48 h, mortality was 36% (72). Several reports have pointed out that a pleural effusion obtained on chest X-ray within the first 24 h of admission correlates with greater severity in terms of necrosis or organ failure (84) or greater mortality (75, 86). Additionally, the presence of infiltrates on chest X-ray within 24 h has been associated with greater mortality (75, 85, 86). Several reports have indicated that gender has no prognostic significance (31, 46, 73, 83, 87, 91, 165). Furthermore, etiology has also been shown to have no prognostic significance (46, 53, 60, 61, 75, 83, 87, 91, 168) other than one report that indicated that patients with alcoholic pancreatitis in their first episode of pancreatitis have a greater need for intubation and greater prevalence of pancreatic necrosis (74). In three reports (82, 83, 171), almost all deaths in acute pancreatitis occurred during the first two episodes, fewer in the third episode. Studies in the future should stratify patients on the basis of number of prior episodes to confirm this observation. In one report (172), but not in another (83), a short interval between onset of symptoms and hospitalization correlated with more severe disease, presumably because abdominal pain was particularly intense among patients with early spread of inflammatory changes in the retroperitoneum and elsewhere that would cause early third space losses. DIAGNOSTIC GUIDELINE II: DETERMINATION OF SEVERITY BY LABORATORY TESTS AT ADMISSION OR ≤48 H The two tests that are most helpful at admission in distinguishing mild from severe acute pancreatitis are APACHE-II score and serum hematocrit. It is recommended that APACHE-II scores be generated during the first 3 days of hospitalization and thereafter as needed to help in this distinction. It is also recommended that serum hematocrit be obtained at admission, 12 h after admission, and 24 h after admission to help gauge adequacy of fluid resuscitation. Level of evidence: III The APACHE-II severity of disease classification system includes a variety of physiologic variables, age points, and chronic health points, which can be measured at admission and daily as needed to help identify patients with severe pancreatitis (1, 7, Table 6). A variety of reports have correlated a higher APACHE-II at admission and during the first 72 h with a higher mortality (<4% with an APACHE-II <8 and 11–18% with an APACHE-II >8) (31, 46, 52, 72, 83, 128, 147). There are some limitations in the ability of the APACHE-II score to stratify patients for disease severity. For example, in one report, there was no sharp cutoff between interstitial and necrotizing pancreatitis (52). In three reports, APACHE-II scores were not statistically different among patients with sterile and infected necrosis (66, 83, 134). In one recent report, APACHE-II generated within the first 24 h had a positive predictive value of only 43% and negative predictive value of 86% for severe acute pancreatitis as compared to the 48-h Ranson score of 48% and 93%, respectively (53). The advantage of the APACHE-II score was the availability of this information within the first 24 h and daily (53). In general, an APACHE-II score that increases during the first 48 h is strongly suggestive of the development of severe pancreatitis, whereas an APACHE-II that decreases within the first 48 h strongly suggests mild pancreatitis.Table 6: APACHE II Score APACHE II score = (acute physiology score) + (age points) + (chronic health points) Acute Physiology ScoreRanson signs have been used for many years to assess severity of acute pancreatitis but have the disadvantage of requiring a full 48 h for a complete evaluation. In general, when Ranson signs are <3, mortality is 0–3% (46, 86, 145); when ≥3, 11–15% (46, 86, 145); when ≥6, 40% (46). However, a more recent comprehensive evaluation of 110 studies concluded that Ranson signs provided very poor predictive power of severity of acute pancreatitis (173). In two studies, the Ranson score was the same in sterile and infected necrosis (66, 134). There have been studies that have attempted to correlate severity of pancreatitis with one or more serum measurements that are available at admission. In one study, creatinine at admission >2.0 mg/dL and a blood glucose >250 mg/dL were associated with a greater mortality (39% and 16%, respectively) (46). In two additional studies, serum creatinine >2.0 mg/dL within 24 h of admission was also associated with a greater mortality (75, 86). In another study, serum glucose >125 mg/dL at admission correlated with a variety of parameters including longer hospital stay but not organ failure, length of intensive care, or mortality (140). The addition of an obesity score to the standard APACHE-II (so-called APACHE-O score) appears to increase accuracy of APACHE-II for severity. In this scoring system, a point is added to the APACHE-II score when the BMI is 26–30 and 2 points are added when the BMI is greater than 30 (58). In severe acute pancreatitis, there is considerable extravasation of intravascular fluid into third spaces as a result of inflammatory mediators as well as local inflammation caused by widespread enzyme-rich pancreatic exudate. The reduction in intravascular volume, which can be detected by an increased serum hematocrit, can lead to decrease in the perfusion of the microcirculation of the pancreas and result in pancreatic necrosis. As such, hemoconcentration has been proposed as a reliable predictor of necrotizing pancreatitis (82). In this report, hematocrit ≥44 at admission and failure of admission hematocrit to decrease at 24 h were the best predictors of necrotizing pancreatitis. In another study, patients who presented with hemoconcentration and then had a further increase in hematocrit at 24 h were at particularly high risk of pancreatic necrosis, whereas 41% of patients whose hematocrit decreased by 24 h did not develop pancreatic necrosis (172). Other reports have not confirmed that hemoconcentration at admission or at 24 h is a risk factor for severe acute pancreatitis (44, 75). However, there is agreement that the likelihood of necrotizing pancreatitis is very low in the absence of hemoconcentration at admission (44, 82). Hence, the absence of hemoconcentration at admission or during the first 24 h is strongly suggestive of a benign clinical course. C-reactive protein (CRP) is an acute phase reactant. Plasma levels greater than 150 mg/L within the first 72 h of disease correlate with the presence of necrosis with a sensitivity and specificity that are both >80%. Because the peak is generally 36–72 h after admission, this test is not helpful at admission in assessing severity (16, 77, 79). A variety of additional tests, including urinary trypsinogen activation peptide, serum trypsinogen-2, serum amyloid A, and calcitonin precursors, have shown promise at admission in distinguishing mild from severe pancreatitis in many (77–80, 159) but not all (165) reports. None of these tests is available commercially. DIAGNOSTIC GUIDELINE III: DETERMINATION OF SEVERITY DURING HOSPITALIZATION Pancreatic necrosis and organ failure are the two most important markers of severity in acute pancreatitis. The distinction between interstitial and necrotizing pancreatitis can be reliably made after 2–3 days of hospitalization by contrast-enhanced CT scan. Level of evidence: III A. Imaging Studies CONTRAST-ENHANCED CT SCAN. Many patients with acute pancreatitis do not require a CT scan at admission or at any time during the hospitalization. For example, a CT scan is usually not essential in patients with recurrent mild pancreatitis caused by alcohol. A reasonable indication for a CT scan at admission (but not necessarily a CT with IV contrast) is to distinguish acute pancreatitis from another serious intra-abdominal condition, such as a perforated ulcer. A reasonable indication for a contrast-enhanced CT scan a few days after admission is to distinguish interstitial from necrotizing pancreatitis when there is clinical evidence of increased severity. The distinction between interstitial and necrotizing pancreatitis can be made much more readily when a contrast-enhanced CT scan is obtained on the second or third day after admission rather than at the time of admission (34). Additiona

Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation

2002-06-01

Emil J. Balthazar

Treatment of patients with acute pancreatitis is based on the initial assessment of disease severity. Severe pancreatitis occurs in 20%–30% of all patients with acute pancreatitis and is characterized by … Treatment of patients with acute pancreatitis is based on the initial assessment of disease severity. Severe pancreatitis occurs in 20%–30% of all patients with acute pancreatitis and is characterized by a protracted clinical course, multiorgan failure, and pancreatic necrosis. Early staging is based on the presence and degree of systemic failure (cardiovascular, pulmonary, renal) and on the presence and extent of pancreatic necrosis. Individual laboratory indexes (markers of pancreatic injury, markers of inflammatory response), while promising, have not yet gained clinical acceptance. Numeric grading systems with sensitivities of about 70% are commonly used today as indicators of organ failure and disease severity. Contrast material–enhanced computed tomography is used in addition to help evaluate local pancreatic morphology and the presence and extent of pancreatic necrosis. Advantages and limitations of the clinical, laboratory, and imaging prognostic indexes are analyzed and discussed. © RSNA, 2002

AGA Institute Technical Review on Acute Pancreatitis

2007-05-01

Chris E. Forsmark , John Baillie

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Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus

2012-10-25

Peter A. Banks , Thomas L. Bollen , Christos Dervenis +5 more

<h3>Background and objective</h3> The Atlanta classification of acute pancreatitis enabled standardised reporting of research and aided communication between clinicians. Deficiencies identified and improved understanding of the disease make a revision … <h3>Background and objective</h3> The Atlanta classification of acute pancreatitis enabled standardised reporting of research and aided communication between clinicians. Deficiencies identified and improved understanding of the disease make a revision necessary. <h3>Methods</h3> A web-based consultation was undertaken in 2007 to ensure wide participation of pancreatologists. After an initial meeting, the Working Group sent a draft document to 11 national and international pancreatic associations. This working draft was forwarded to all members. Revisions were made in response to comments, and the web-based consultation was repeated three times. The final consensus was reviewed, and only statements based on published evidence were retained. <h3>Results</h3> The revised classification of acute pancreatitis identified two phases of the disease: early and late. Severity is classified as mild, moderate or severe. Mild acute pancreatitis, the most common form, has no organ failure, local or systemic complications and usually resolves in the first week. Moderately severe acute pancreatitis is defined by the presence of transient organ failure, local complications or exacerbation of co-morbid disease. Severe acute pancreatitis is defined by persistent organ failure, that is, organ failure >48 h. Local complications are peripancreatic fluid collections, pancreatic and peripancreatic necrosis (sterile or infected), pseudocyst and walled-off necrosis (sterile or infected). We present a standardised template for reporting CT images. <h3>Conclusions</h3> This international, web-based consensus provides clear definitions to classify acute pancreatitis using easily identified clinical and radiologic criteria. The wide consultation among pancreatologists to reach this consensus should encourage widespread adoption.

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Studies of pancreatic alpha cell function in normal and diabetic subjects

1970-04-01

Roger H. Unger , E Aguilar-Parada , Walter A. Müller +1 more

The development of a glucagon radioimmunoassay with a relatively high degree of specificity for pancreatic glucagon made possible studies of alpha cell function in healthy nondiabetic subjects and in patients … The development of a glucagon radioimmunoassay with a relatively high degree of specificity for pancreatic glucagon made possible studies of alpha cell function in healthy nondiabetic subjects and in patients with diabetes mellitus. In the former group mean fasting plasma glucagon averaged 108 mumug/ml (SEM +/-10). In 12 juvenile-type diabetics fasting glucagon averaged 110 (+/-9) and in 33 adult-type diabetics the average was 114 (+/-8). The diabetic averages did not differ significantly from the nondiabetic subjects; however, when hyperglycemia was induced by glucose infusion in the nondiabetic subjects so as to simulate the fasting hyperglycemia of the diabetics, mean glucagon fell to 57 mumug (+/-8), which was significantly below the diabetic mean. In 28 healthy subjects the infusion of arginine elicited a rise in glucagon of at least 100 mumug/ml with a peak level averaging 331 mumug/ml (+/-22) at 40 min. This response to arginine was diminished but not abolished during hyperglycemia induced by simultaneous glucose infusion. In everyone of 45 diabetic subjects tested the infusion of arginine elicited a rise in glucagon of at least 140 mumug/ml to levels significantly greater than in nondiabetics. The peak glucagon level in juvenile-type diabetics averaged 458 mumug/ml (SEM +/-36) and in adult-type diabetics averaged 452 mumug/ml (SEM +/-38). The glucagon response to arginine was unrelated to duration of diabetes, to body weight, type of diabetic treatment, or to other known factors. Marked hyperresponsiveness of glucagon to arginine infusion was observed in two patients with advanced Kimmelsteil-Wilson disease. Glucagon levels were markedly elevated in certain patients with severe diabetic ketoacidosis before treatment with insulin. The findings suggest that alpha cell function is inappropriately increased in diabetes mellitus and could play a significant role in the diabetic syndrome.

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Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis

1998-03-01

Alastair Windsor , Shamsher S. Kanwar , anfang Li +6 more

In patients with major trauma and burns, total enteral nutrition (TEN) significantly decreases the acute phase response and incidence of septic complications when compared with total parenteral nutrition (TPN). Poor … In patients with major trauma and burns, total enteral nutrition (TEN) significantly decreases the acute phase response and incidence of septic complications when compared with total parenteral nutrition (TPN). Poor outcome in acute pancreatitis is associated with a high incidence of systemic inflammatory response syndrome (SIRS) and sepsis.To determine whether TEN can attenuate the acute phase response and improve clinical disease severity in patients with acute pancreatitis.Glasgow score, Apache II, computed tomography (CT) scan score, C reactive protein (CRP), serum IgM antiendotoxin antibodies (EndoCAb), and total antioxidant capacity (TAC) were determined on admission in 34 patients with acute pancreatitis. Patients were stratified according to disease severity and randomised to receive either TPN or TEN for seven days and then re-evaluated.SIRS, sepsis, organ failure, and ITU stay, were globally improved in the enterally fed patients. The acute phase response and disease severity scores were significantly improved following enteral nutrition (CRP: 156 (117-222) to 84 (50-141), p < 0.005; APACHE II scores 8 (6-10) to 6 (4-8), p < 0.0001) without change in the CT scan scores. In parenterally fed patients these parameters did not change but there was an increase in EndoCAb antibody levels and a fall in TAC. Enterally fed patients showed no change in the level of EndoCAb antibodies and an increase in TAC.TEN moderates the acute phase response, and improves disease severity and clinical outcome despite unchanged pancreatic injury on CT scan. Reduced systemic exposure to endotoxin and reduced oxidant stress also occurred in the TEN group. Enteral feeding modulates the inflammatory and sepsis response in acute pancreatitis and is clinically beneficial.

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IAP Guidelines for the Surgical Management of Acute Pancreatitis

2002-01-01

Waldemar Uhl , Andrew L. Warshaw , C W Imrie +7 more

The Role of Cytokines in the Pathogenesis of Acute Pancreatitis

1998-01-01

Jim C. Norman

Prognostic factors in acute pancreatitis.

1984-12-01

Stephen Blamey , C W Imrie , Jennifer O’Neill +2 more

Prognostic factor scoring systems provide one method of predicting severity of acute pancreatitis. This paper reports the prospective assessment of a system using nine factors available within 48 hours of … Prognostic factor scoring systems provide one method of predicting severity of acute pancreatitis. This paper reports the prospective assessment of a system using nine factors available within 48 hours of admission. This assessment does not include patient data used to compile the system. Of 405 episodes of acute pancreatitis occurring in a seven year period, 72% had severity correctly predicted by the system; 31% of 131 episodes with three or more factors present were severe and 8% of 274 episodes with less than three factors were severe. Assessment of individual factors revealed only one which did not predict severity. A scoring system based on the other eight factors correctly predicted severity in 79% of episodes. Prognostic factor scoring systems (i) alert the clinician to potentially severe disease, (ii) allow comparison of severity within and between patient series and (iii) will allow rational selection of patients for trials of new treatment.

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UK guidelines for the management of acute pancreatitis

2005-04-14

DiagnosisN *The correct diagnosis of acute pancreatitis should be made in all patients within 48 hours of admission (recommendation grade C).N The aetiology of acute pancreatitis should be determined in … DiagnosisN *The correct diagnosis of acute pancreatitis should be made in all patients within 48 hours of admission (recommendation grade C).N The aetiology of acute pancreatitis should be determined in at least 80% of cases and no more than 20% should be classified as idiopathic (recommendation grade B).N Although amylase is widely available and provides acceptable accuracy of diagnosis, where lipase estimation is available it is preferred for the diagnosis of acute pancreatitis (recommendation grade A).N Where doubt exists, imaging may be used: ultrasonography is often unhelpful and pancreatic imaging by contrast enhanced computed tomography provides good evidence for the presence or absence of pancreatitis (recommendation grade C). AssessmentN The definitions of severity, as proposed in the Atlanta criteria, should be used.However, organ failure present within the first week, which resolves within 48 hours, should not be considered an indicator of a severe attack of acute pancreatitis (recommendation grade B).N Available prognostic features which predict complications in acute pancreatitis are clinical impression of severity, obesity, or APACHE II.8 in the first 24 hours of admission, and C reactive protein .150mg/l, Glasgow score 3 or more, or persisting organ failure after 48 hours in hospital (recommendation grade B).N Patients with persisting organ failure, signs of sepsis, or deterioration in clinical status 6-10 days after admission will require computed tomography (recommendation grade B). Prevention of complicationsN The evidence to enable a recommendation about antibiotic prophylaxis against infection of pancreatic necrosis is conflicting and difficult to interpret.Some trials show benefit, others do not.At present there is no consensus on this issue.N If antibiotic prophylaxis is used, it should be given for a maximum of 14 days (recommen-dation grade B).Further studies are needed (recommendation grade C).

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Acute Pancreatitis

2006-05-17

David C. Whitcomb

A 56-year-old woman presents with severe epigastric abdominal pain and vomiting of 14 hours' duration, symptoms that developed shortly after dinner the previous evening. She has no history of alcohol … A 56-year-old woman presents with severe epigastric abdominal pain and vomiting of 14 hours' duration, symptoms that developed shortly after dinner the previous evening. She has no history of alcohol use, takes no medications, and has no family history of pancreatitis. On physical examination, she has a heart rate of 110 beats per minute and moderate epigastric abdominal tenderness without peritoneal signs. The white-cell count is 16,500 per cubic millimeter, and the hematocrit is 49 percent. Amylase, lipase, alanine aminotransferase, and lactate dehydrogenase levels are elevated. Calcium, albumin, triglyceride, and electrolyte values are normal. How should this patient be further evaluated and treated?

2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

2018-01-31

Robert D. Brook , Sanjay Rajagopalan

American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis

2018-02-03

Seth D. Crockett , Sachin Wani , Timothy B. Gardner +7 more

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2019 WSES guidelines for the management of severe acute pancreatitis

2019-06-13

Ari Leppäniemi , Matti Tolonen , Antonio Tarasconi +7 more

Although most patients with acute pancreatitis have the mild form of the disease, about 20–30% develops a severe form, often associated with single or multiple organ dysfunction requiring intensive care. … Although most patients with acute pancreatitis have the mild form of the disease, about 20–30% develops a severe form, often associated with single or multiple organ dysfunction requiring intensive care. Identifying the severe form early is one of the major challenges in managing severe acute pancreatitis. Infection of the pancreatic and peripancreatic necrosis occurs in about 20–40% of patients with severe acute pancreatitis, and is associated with worsening organ dysfunctions. While most patients with sterile necrosis can be managed nonoperatively, patients with infected necrosis usually require an intervention that can be percutaneous, endoscopic, or open surgical. These guidelines present evidence-based international consensus statements on the management of severe acute pancreatitis from collaboration of a panel of experts meeting during the World Congress of Emergency Surgery in June 27–30, 2018 in Bertinoro, Italy. The main topics of these guidelines fall under the following topics: Diagnosis, Antibiotic treatment, Management in the Intensive Care Unit, Surgical and operative management, and Open abdomen.

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Acute pancreatitis

2015-01-21

P. G. Lankisch , Minoti V. Apte , Peter A. Banks

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Acute pancreatitis

2020-09-01

Lotte Boxhoorn , Rogier P. Voermans , Stefan A.W. Bouwense +5 more

Acute Pancreatitis

1994-04-28

William M. Steinberg , Scott Tenner

From mild disease to multiorgan failure and sepsis, acute pancreatitis is a disorder that has numerous causes, an obscure pathogenesis, few effective remedies, and an often unpredictable outcome. In 1925, … From mild disease to multiorgan failure and sepsis, acute pancreatitis is a disorder that has numerous causes, an obscure pathogenesis, few effective remedies, and an often unpredictable outcome. In 1925, Moynihan aptly described the dramatic nature of acute pancreatitis as the "most terrible of all calamities that occur in connection with the abdominal viscera. The suddenness of its onset, the illimitable agony which accompanies it, and the mortality attendant upon it render it the most formidable of catastrophes"1. Just over 100 years ago, Reginald Fitz2 described many of the modern clinical and pathologic features of severe acute pancreatitis3. . . .

Bacterial contamination of pancreatic necrosis

1986-08-01

H. G. Beger , R. Bittner , Silvia Block +1 more

Role of Interleukin-6 Mediated T Cell Activation in Experimental Acute Pancreatitis

2025-06-25

Juliane Glaubitz , Anna Zimdahl , Sebastian Zeißig +2 more | Inflammation

Metabolic surgery reduces CRC disease progression through circulating bile acid diversion

2025-06-25

Claudia Laessle , Bernhard Mauerer , Lisa Marx +7 more | Science Translational Medicine

Obesity is a global epidemic characterized by energy disequilibrium, metabolic disorders, and fat mass development that greatly affect the health status of individuals. There is evidence that the intake of … Obesity is a global epidemic characterized by energy disequilibrium, metabolic disorders, and fat mass development that greatly affect the health status of individuals. There is evidence that the intake of a high-fat diet and overweight are associated with the incidence of colorectal cancer (CRC). Metabolic surgery has been associated with improvements in obesity-related comorbidities and a reduction in the overall cancer risk. However, the underlying mechanism by which metabolic surgery reduces the risk of CRC remains unknown. To understand the antitumoral mechanism of bariatric surgery, we analyzed the development of CRC after Roux-en-Y gastric bypass (RYGB) surgery in an RYGB-CRC mouse model. Here, we showed that RYGB surgery substantially reduced primary tumorigenesis and prevented metastasis. This protective effect was mediated by bile acid (BA) exclusion from the proximal small intestine, leading to BA diversion in the preceding parts of the gastrointestinal tract and in circulation. The diverted BA profile in RYGB mice showed antitumoral and antimetastatic effects that were verified by BA exclusion of the proximal small bowel without the systemic metabolic installations of RYGB surgery by a cholecystointestinal shunt (CIS) surgery. RYGB surgery thus leads to reduced primary BAs and elevated secondary BAs in circulation. In a translational study involving patients with CRC with metachronous liver metastases, we confirmed that reduced primary BA concentrations in the serum were associated with prolonged time to metastasis, underscoring the critical role of BAs in CRC progression and metastatic development.

Endoscopic Ultrasonographic Findings of Pancreatic Parenchyma and Ductal System in Patient with Chronic Pancreatitis

2025-06-25

Roshan Kafle , Ramila Shrestha , Mukesh S Paudel +2 more | Nepal Medical College Journal

Chronic pancreatitis is a progressive inflammatory disorder characterized by irreversible morphological changes in the pancreas, leading to persistent abdominal pain, malabsorption, and diabetes mellitus due to endocrine and exocrine insufficiency. … Chronic pancreatitis is a progressive inflammatory disorder characterized by irreversible morphological changes in the pancreas, leading to persistent abdominal pain, malabsorption, and diabetes mellitus due to endocrine and exocrine insufficiency. A total of 53 patients diagnosed with chronic pancreatitis were evaluated using endoscopic ultrasonography (EUS) at Bir Hospital focusing on both pancreatic parenchymal and ductal changes. Biliary abnormalities were also recorded. EUS revealed that increased parenchymal echogenicity was the most common finding, present in 69.8% of cases. Pancreatic atrophy was observed in 20.8%, while intra-parenchymal calcifications appeared in 30.2% of patients. Cystic collections were found in 24.5%, and hyperechoic strands without shadowing were noted in 35.8%. Hyperechoic foci without shadowing were seen in 5.7% of cases. Ductal findings were also prominent, with a dilated main pancreatic duct (MPD) in 58.5% of patients and intraductal stones present in 34.0%. Irregular MPD contours were noted in 15.1%, while dilated side branches were less common, found in only 1.9%. Additionally, biliary involvement was observed in a subset of patients, with dilated common bile duct (CBD) and CBD stones both present in 7.5% of cases, and distal CBD narrowing in 17.0%. EUS is an effective tool for evaluation of pancreatic parenchymal and ductal changes in chronic pancreatitis.

Analysis of Influencing Factors of Acute Pancreatitis Complicated with Persistent Inflammation and Construction of a Prediction Model

2025-06-24

Yue Zou , Kunpeng Li , Ping Geng | Pancreas

Objective: To investigate the contributing factors for the development of systemic inflammatory response syndrome (SIRS) in acute pancreatitis (AP) patients and subsequently develop a novel nomogram prediction model. Methods: A … Objective: To investigate the contributing factors for the development of systemic inflammatory response syndrome (SIRS) in acute pancreatitis (AP) patients and subsequently develop a novel nomogram prediction model. Methods: A multivariate logistic regression analysis was conducted to determine independent predictors of SIRS, where the variables were chosen based on statistical significance from univariate analysis. Based on their presence, 238 AP patients were grouped into non-sIRS (n=170) and sIRS (n=68). Logistic regression analysis identified independent predictors of sIRS complications. We then developed a visual nomogram prediction model alongside a logistic regression model. The model’s predictive power cut-off was determined by receiver operating characteristic (ROC) curve analysis, providing sensitivity, specificity, and predictive accuracy. Results: The study found that in the cohort of acute pancreatitis (AP) patients, systemic inflammatory response syndrome (SIRS) incidence was 28.6%. From our analysis, we determined that red blood cell distribution width (RDW), fibrinogen (FIB), amylase (AMY), blood glucose (Glu), and lactate dehydrogenase (LDH) were independent risk factors for SIRS. Additionally, we calculated the area under the ROC curve (AUC) for our prediction model of SIRS reached 0.816, which exceeded the AUCs of the individual risk indicators (RDW, FIB, AMY, Glu, LDH) and the bedside index of severity in acute pancreatitis (BISAP) score. In addition, we conducted a correlation analysis to validate the relationships among the predictive factors and to eliminate possible multicollinearity. The calibration curve plot showed that the nomogram agreed well between the predicted SIRS and actual risks. Finally, the clinical decision curve for our model also indicated its clinical utility by guiding decision-making for timely interventions at a threshold probability range of 0.4 to 1. Conclusion: The model predicted non-SIRS with a critical value ≥0.332, a sensitivity of 71.3% and specificity of 87.1%, and a Kappa value of 0.56. These results indicate that this prediction model is based on admission data, with recommended additional validation assessments at multiple time points (e.g., 24, 48, and 72 h) to characterize the progression of SIR’s risk fully. Overall, this nomogram prediction model provides an efficient and simple means to predict SIRS for patients with AP.

Effect of Sevelamer versus Bifidobacterium longum on Insulin Sensitivity in Subjects with Obesity

2025-06-24

Eric Baeuerle , Manpreet Kaur Semwal , Jia Nie +7 more

ABSTRACT Objective To test whether interventions with putative lipopolysaccharide (LPS)-lowering effects including sevelamer and a synbiotic (Bifidobacterium longum+oligofructose) improve insulin sensitivity in subjects with obesity. Methods We randomized 22 lean … ABSTRACT Objective To test whether interventions with putative lipopolysaccharide (LPS)-lowering effects including sevelamer and a synbiotic (Bifidobacterium longum+oligofructose) improve insulin sensitivity in subjects with obesity. Methods We randomized 22 lean and 28 human subjects with obesity to receive sevelamer, synbiotic, or placebo orally for 4 weeks. Peripheral insulin sensitivity was measured with an insulin clamp. Plasma cholesterol, endotoxemia markers, intestinal permeability, stool bacterial taxonomic content and plasma metabolites also were assessed. Results At baseline, subjects with obesity had lower insulin sensitivity and elevated plasma LDL-C concentrations. Sevelamer improved insulin sensitivity and lowered LDL-C in these subjects. Intestinal enrichment of Bifidobacterium longum had no effect on insulin sensitivity or lipids in either group. Markers of endotoxemia and intestinal permeability did not change with any intervention. Plasma metabolomics revealed that sevelamer increases several metabolites, many of them previously linked with positive changes in glucose and lipid metabolism, including biliary acids, amino acids (citrulline, betaine), NAD+ precursors (trigonelline) and xenobiotics (genistein, umbelliferone). Conclusion Sevelamer improves insulin sensitivity and LDL-C in subjects with obesity, but these effects are independent of changes in circulating LPS. Sevelamer increases the levels of multiple metabolites that collectively may mediate improvements in glucose homeostasis and lipids caused by this drug.

Association Between Metabolic Syndrome and Choledocholithiasis: An Observational, Analytical, Retrospective Cross-Sectional Study Conducted at a Second-Level Hospital in Ciudad Juárez From January 2024 to February 2025

2025-06-24

Yolocuauhtli Salazar , Emiliano Gómez Montañez , Jorge Salazar | Cureus

Transparietal Gastric Drainage of Walled-Off Pancreatic Necrosis Using an Endoscopic Technique With the Hot Axios Stent: A Case Report

2025-06-24

Silvia Fernanda Anaya Meza , Andrés David De León Murillo , Alejandro Alfonso Bedoya Rinaldi +3 more | Cureus

The Prevalence and Characteristics of Autoimmune Pancreatitis among Patients Presenting with Pancreatitis to a Quaternary Referral Centre in Melbourne, Australia

2025-06-23

Dilini Abeywickrama , Michael MacIsaac , Simon Hew | Pancreas

Anti‐Inflammatory Effect of Dopamine D2 Receptor Agonist Cabergoline Against L‐Arginine‐Induced Acute Pancreatitis in Rats

2025-06-23

Randa A. Zaghloul , Dalia H. El‐Kashef , Medhat Taha +1 more | Journal of Biochemical and Molecular Toxicology

Severe acute pancreatitis (SAP) is an inflammatory disorder of the pancreas that may extend to other organs resulting in systemic injury. Unfortunately, there is no specific treatment beyond supportive management. … Severe acute pancreatitis (SAP) is an inflammatory disorder of the pancreas that may extend to other organs resulting in systemic injury. Unfortunately, there is no specific treatment beyond supportive management. Therefore, the current study explores the role of cabergoline (CAB) against l-arginine (l-arg)-induced SAP and systemic injury. Thirty male, adult, Sprague-Dawley rats were arbitrarily allocated into five groups; Normal, CAB (rats received CAB [0.5 mg/kg, orally], SAP [rats were intraperitoneally injected with 50% l-arg at 250 mg/100 g, 50% w/v, pH 7.4, twice with 1 h interval]), SAP + CAB-L, and SAP + CAB-H (rats received CAB [0.1 and 0.5 mg/kg, orally, respectively, for 7 days then were injected with l-arg twice with 1 h interval]). The results indicated that CAB significantly mitigated l-arg-induced damage to the pancreas, lung, liver, and kidney as observed through histopathological examination. Oral administration of CAB (0.5 mg/kg) significantly reduced the serum activities of amylase, lipase, ALT, AST, and the level of creatinine (p < 0.001), and ameliorated pancreatic oxidative stress marked by pancreatic levels of MDA and GSH (p < 0.001), compared to the SAP group. Moreover, CAB (0.5 mg/kg) significantly reduced inflammation as indicated by reduced levels of TNF-α, IL-6, -1β, and NLRP3 (p < 0.001, 0.001, 0.01, and 0.001, respectively). Additionally, CAB reduced the levels of TLR4, NF-κB, NLRP3, and caspase-1 in the pancreatic tissues upon comparison with the SAP group. In conclusion, CAB could offer a new avenue for the prevention of SAP and systemic inflammation mitigation.

Mesenchymal Stem Cells Derived from Different Adipose Tissue Depots Ameliorate Severe Acute Pancreatitis by Inhibiting NF-κB/NLRP3/Caspase-1 Pathways

2025-06-23

Ao Wang , Yu An , Xuefei Wang +7 more | Stem Cell Reviews and Reports

Comparison of Outcomes Between Early and Delayed Cholecystectomy in Acute Biliary Pancreatitis Patients

2025-06-23

Ihtisham Ul Haq , Naveed Ahmad , Muhammad Attaullah Khan +3 more | Medical Forum Monthly

Objective: To compare the outcomes of early versus delayed cholecystectomy in patients with ABP to guide clinical decision-making. Study Design: Prospective comparative study Place and Duration of Study: This study … Objective: To compare the outcomes of early versus delayed cholecystectomy in patients with ABP to guide clinical decision-making. Study Design: Prospective comparative study Place and Duration of Study: This study was conducted at the Department of General Surgery, Lady Reading Hospital, Peshawar, from August 2022 to February 2023. Methods: A total of 120 patients were included, divided into two groups: early cholecystectomy (n=60) and delayed cholecystectomy (n=60). Data on demographics, clinical outcomes, and complications were collected and analyzed using SPSS version 26. Results: The groups were comparable in baseline characteristics. ‘The early cholecystectomy group had a significantly shorter hospital stay’ (5.09 ± 0.90 vs. 8.89 ± 1.79 days; p<0.001). ICU admissions were higher in the early group (81.7% vs. 43.3%; p<0.001), but mortality and recurrence rates were similar between groups. Postoperative complications, bile leaks (71.7% vs. 46.7%; p=0.005), and surgical site infections (65.0% vs. 33.3%; p=0.001) were more common in the early group. Conclusion: Early cholecystectomy reduces hospital stay and prevents recurrent pancreatitis but is associated with higher postoperative complications. Careful patient selection and perioperative management are essential. Delayed cholecystectomy remains an option for patients with severe inflammation or high surgical risk. These findings contribute to optimizing ABP management strategies.

Global burden and characterization of hypertriglyceridemia-induced acute pancreatitis: results from a systematic review and a multi-center cohort study

2025-06-23

Zhengyang Fan , Yuelun Zhang , Jianing Li +7 more | Science China Life Sciences

To compare and characterize hypertriglyceridemia-induced acute pancreatitis (HTG-AP) across the geographical regions, we conducted a systematic review and a multi-center cohort study. We conducted a systematic review and random effects … To compare and characterize hypertriglyceridemia-induced acute pancreatitis (HTG-AP) across the geographical regions, we conducted a systematic review and a multi-center cohort study. We conducted a systematic review and random effects meta-analysis of studies reporting HTG-AP. Also, we separately characterized HTG-AP in a multi-center retrospective cohort study involving eight centers in China. The key outcomes of interest included the pooled proportion of HTG-AP and its severity parameters after adjusting for the effect of confounding factors through logistic regression. Our systematic review identified 110 studies from 15 countries accounting for 3,057,428 participants (35% female, median age 50 years). The pooled proportion of HTG-AP was 11.6% globally while the Eastern and Western countries reported the proportions as 16.3% and 5.4%, respectively (P<0.01). The pooled mortality rate was remarkably higher in Eastern countries (4.1%) than in Western countries (1.0%) (P<0.01). 3,224 participants (37% female, median age 48 years) were included in our multi-center cohort study, and the proportion of HTG-AP was much higher at 35.9% with a nearly three-fold higher mortality rate compared with acute pancreatitis (AP) due to other etiologies (odds ratio (OR): 2.77, 95% confidence interval (CI): 1.60 to 4.81). The proportion of patients with HTG-AP is remarkably higher in Eastern countries, particularly China, than in Western countries. Furthermore, compared with other causes of AP, HTG-AP has a poorer prognosis and may warrant aggressive management.

A prospective study on the outcomes of endotherapy for pancreatic divisum in patients of recurrent acute pancreatitis

2025-06-23

Amol Vadgaonkar , Nagesh Kamat , Ankit Dalal +4 more | Endoscopy International Open

Background Minor papilla endotherapy success rate is highly variable for pancreatic divisum (PD) among recurrent acute pancreatitis (RAP) patients due to frequent relapses. So, we assessed the effectiveness and predictors … Background Minor papilla endotherapy success rate is highly variable for pancreatic divisum (PD) among recurrent acute pancreatitis (RAP) patients due to frequent relapses. So, we assessed the effectiveness and predictors of successful endotherapy. Methods This is a prospective observational study of patients with RAP who underwent minor papilla sphincterotomy and prophylactic stenting for PD. Technical success was minor papilla cannulation and successful procedural completion. The primary and secondary outcomes were improvement in recurrent episodes of pain with a reduction in visual analogue scale (VAS) score of >50% from baseline and occurrence of chronic pancreatitis (CP) at 12 months, respectively. Predictors of success were assessed by logistic regression. Results Ninety-four patients, with a median (IQR) age of 29.5(23.7-40.2) years; the majority male, 62(65.9%), successfully underwent endotherapy. The typical clinical presentation was abdominal pain in 87(92.5%) patients. The primary outcome was achieved in 65(69.1%) patients. The average number of ERCP sessions was two; technical success was achieved in 88(93.6%) patients. PostERCP pancreatitis was the most common adverse event in 10(10.6%) patients. The signs of CP were seen in 11(11.7%) patients, and the mean follow-up period was 12.8±1.3 months. The presence of smoking [AOR 0.027, p=0.001] and recurrent attacks of RAP after index ERCP [AOR 0.169, p<0.001] had a lower odds of successful endotherapy outcomes. Conclusions Minor papilla endotherapy for RAP significantly improved the VAS score at 12 months among 69.1% of patients with acceptable adverse events. Early CP was seen in 11.7% of patients. (Unique identifier: CTRI/2019/05/019332).

Endoscopic Ultrasound‐guided Drainage With Lumen‐apposing Metal Stent versus Plastic Stent for the Treatment of Pancreatic Pseudocyst: A Systematic Review and Meta‐analysis

2025-06-22

André Orsini Ardengh , Thiago Arantes de Carvalho Visconti , Marcelo Klotz Dall'Agnol +7 more | DEN Open

Pancreatic pseudocyst (PP), following acute or chronic pancreatitis, may become symptomatic or persist beyond 6-8 weeks, requiring drainage. Endoscopic ultrasonography-guided drainage (EUS-D) is the preferred method, using double pigtail plastic … Pancreatic pseudocyst (PP), following acute or chronic pancreatitis, may become symptomatic or persist beyond 6-8 weeks, requiring drainage. Endoscopic ultrasonography-guided drainage (EUS-D) is the preferred method, using double pigtail plastic stents (DPPS) or self-expandable metallic stents (SEMS), such as lumen-apposing metal stents (LAMS). This meta-analysis compares DPPS and LAMS in EUS-D for PP, focusing on technical success, clinical success, adverse events (AEs), recurrence, and procedure time. A search strategy was conducted in MEDLINE, Embase, Lilacs, and Cochrane databases according to PRISMA guidelines. Random-effect models were used for statistical analysis based on intention-to-treat. Heterogeneity was assessed using the I2 test. The risk of bias was assessed using the Risk of Bias in Non-randomized Studies-of Exposures tool. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation Tool. Ten studies were included: one prospective cohort and nine retrospective cohorts, conducted between 2014 and 2024. A total of 502 patients with PP were treated with EUS-D. The clinical success rate was higher using LAMS (Risk ratio [RR] = 1.05; 95% confidence interval [CI]: 1.01; 1.09; I2 = 0%), with shorter procedure time (Mean difference = -16.30; 95% CI: -27.65; -4.94; I2 = 86%) compared to DPPS. No statistical difference was observed for early and late AEs, recurrence, or technical success. The study demonstrated that LAMS has a higher clinical success rate and a shorter procedure time compared to DPPS. There is no difference in terms of early and late AEs, recurrence, and technical success.

Surgical Outcomes of Laparoscopic Cystogastrostomy For Pancreatic Pseudocysts: A Retrospective Study

2025-06-21

Rafique Umer Harvitkar , Seshu Kumar Bylapudi , Ioannis Hannadjas +7 more | Cureus

SARS-CoV-2 causes gastric damage: structural and ultrastructural evaluation

2025-06-21

E Yilmaz , Engin Alp Onen , Hasan Serdar Mutlu +2 more | Journal of Molecular Histology

Systematic Review and Meta-analysis of the Clinical Efficacy of Octreotide in Combination with Ulinastatin in the Treatment of Acute Pancreatitis

2025-06-20

Long-Xun Zhu , Yong Chen , Xiangfan Chen +2 more | Drugs in R&D

Acute pancreatitis (AP) is a serious disease characterized by local inflammatory responses in the pancreas. The annual incidence rate of acute pancreatitis is 4.9-73.4 per 100,000 people. Among these, approximately … Acute pancreatitis (AP) is a serious disease characterized by local inflammatory responses in the pancreas. The annual incidence rate of acute pancreatitis is 4.9-73.4 per 100,000 people. Among these, approximately 20% develop into moderately severe acute pancreatitis (MSAP) or severe acute pancreatitis (SAP), with a mortality rate of 13-35%. The aim of this study is to evaluate the efficacy and safety of octreotide in combination with ulinastatin in the treatment of acute pancreatitis using meta-analysis. Chinese and English databases, including China National Knowledge Infrastructure Database (CNKI), WanFang database (WANFANG), Chinese Scientific Journals Full-text Database (VIP database), PubMed, Medline, and Web of Science, were searched for randomized controlled trials (RCTs) about octreotide in combination with ulinastatin in the treatment of acute pancreatitis from January 2019 to April 2024. Retrieved literature was screened independently by two researchers, and the methodological quality of included publications was evaluated according to bias risk assessment tool recommended by Cochrane 5.1. Data were statistically analyzed by using RevMan5.3 software. A total of 3026 patients from 30 studies in accordance with the criteria were included, including experimental group (n = 1516) and control group (n = 1510). Meta-analysis results showed that octreotide combined with ulinastatin could increase the effective rate of treatment for acute pancreatitis (relative risk (RR) = 1.23, 95% CI 1.19-1.27, P < 0.00001). The time in the experimental group for hospitalization (standardized mean difference (SMD) = -2.00, 95% CI [-2.67, -1.34], P < 0.00001), disappearance of abdominal pain (SMD = -1.75, 95% CI [-2.21, -1.29], P < 0.00001), disappearance of nausea and vomiting (SMD = -2.03, 95% CI [-2.93, -1.13], P < 0.00001), disappearance of abdominal distension (SMD = -2.02, 95% CI [-2.59, -1.44], P < 0.00001), and disappearance of peritoneal irritation (SMD = -2.20, 95%CI [-3.95, -0.46], P < 0.00001) was shorter than in the control group. The levels in the experimental group of TNFα (SMD = -2.01, 95% CI [-2.71, -1.32], P < 0.00001), CRP (SMD = -2.50, 95% CI [-3.20, -1.79], P < 0.00001), IL-6 (SMD = -2.67, 95% CI [-3.48, -1.85], P < 0.00001), IL-8 (SMD = -2.92, 95% CI [-4.02, -1.83], P < 0.00001), serum amylase concentration (SMD = -2.83, 95% CI [-4.07, -1.60], P < 0.00001), and urine amylase concentration (SMD = -2.34, 95% CI [-3.81, -0.88], P < 0.00001) were lower compared with control group. There was no statistically significant difference in the incidence of adverse reactions between the experimental and control groups. The combination of octreotide and ulinastatin can improve the intestinal mucosal barrier function, reduce inflammatory response, and decrease amylase levels in patients with acute pancreatitis, without increasing the incidence of adverse reactions. It has significant therapeutic effects and can be promoted as a treatment option for acute pancreatitis in China.

Exam 1: Recurrent Acute Pancreatitis: Many Faces (/Facets) of a Challenging Disease

2025-06-20

| Gastroenterology

scRNA-Seq and Bulk-Seq Identify Novel Markers Associated With Calcium Regulation and Immunomodulation in Acute Pancreatitis

2025-06-20

Zefang Sun , Rui Zhou , Caihong Ning +4 more | PubMed

Background: The exact pathogenesis of acute pancreatitis (AP) remains unclear. A ceRNA profile based on single-cell RNA-seq (scRNA-seq) and bulk RNA-seq analysis will deepen our understanding of the mechanisms in … Background: The exact pathogenesis of acute pancreatitis (AP) remains unclear. A ceRNA profile based on single-cell RNA-seq (scRNA-seq) and bulk RNA-seq analysis will deepen our understanding of the mechanisms in AP and identify new potential biomarkers. Materials and Methods: The differentially expressed lncRNA (DElncRNA) and mRNA (DEmRNA) were identified using bulk RNA-seq data. The interactions across miRNA and lncRNA/mRNA were integrated to construct a ceRNA network. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses were performed to analyze the function and pathways. Meanwhile, scRNA-seq analysis was used to evaluate the expression of genes. In addition, immune cell infiltration was also evaluated and the correlation analysis was used to assess the relationship between candidate lncRNAs and immune-related genes. Results: A ceRNA network that contains 6 DElncRNAs, 38 miRNAs, and 215 DEmRNAs was constructed. A total of 5 candidate mRNAs and 5 candidate lncRNAs were identified. Pathway analysis suggested the candidate genes are associated with calcium-related regulation. scRNA-seq analysis indicated that 5 candidate mRNAs ( Afdn, Pik3r1, Ap1s1, Cryab , and Sel1l ) may be involved in the pathogenesis of AP by influencing calcium signaling. Immune infiltration analysis found that mice with AP are highly infiltrated with M1 macrophage, monocyte, and CD4+ memory T cells. In quantitative real-time PCR (qRT-PCR) validation, all candidate mRNAs and most candidate lncRNAs displayed consistent expression trends. Conclusions: The comprehensive analysis of the ceRNA network identified novel genes may regulate calcium-related pathways and participate in the immunomodulation in AP. Trial registration: Not applicable.

Successful Management of a Pancreatic Abscess in a Dog with Juvenile Diabetes Mellitus Through Ultrasound-Guided Drainage and Medical Therapy

2025-06-20

Alexandra Daravigka , Stefanos Ninis , Panagiotis Bourdekas +5 more | Veterinary Sciences

A five-month-old female mixed-breed dog presented with a two-week history of polyuria, polydipsia, and vomiting. Clinical examination revealed poor body condition, growth retardation, pale oral mucous membranes, weak pulse, and … A five-month-old female mixed-breed dog presented with a two-week history of polyuria, polydipsia, and vomiting. Clinical examination revealed poor body condition, growth retardation, pale oral mucous membranes, weak pulse, and prolonged capillary refill time. Laboratory findings included neutrophilic leukocytosis with a regenerative left shift, fasting hyperglycemia, elevated fructosamine, glycated hemoglobin, and β-hydroxybutyrate concentrations, while the acid–base balance remained normal. Canine-specific pancreatic lipase and trypsin-like immunoreactivity concentrations ruled out an underlying pancreatitis or exocrine pancreatic insufficiency, respectively. Urinalysis showed glycosuria and ketonuria. Supportive care included antibiotics and regular insulin administration. Abdominal ultrasonography identified a pancreatic cavity with a thick wall and mixed echogenic fluid. Ultrasound-guided drainage was performed without complications. Cytology confirmed a pancreatic abscess with pyogranulomatous inflammation, though the culture results were negative. The dog was discharged with intermediate-acting lente insulin. Follow-up ultrasonographic evaluations at 7, 14, and 21 days and 5 months post-drainage showed no recurrence. The diabetes remained well-controlled one year post-discharge. This case report describes the successful management of a dog with juvenile diabetes mellitus complicated by a pancreatic abscess, highlighting the effectiveness of percutaneous ultrasound-guided drainage combined with medical therapy.

Gegen Qinlian decoction prevents post-ERCP pancreatitis by regulating NLRP3 inflammasome-mediated pyroptosis

2025-06-20

Yong Cui , Jinxin Li , Minzhi Cai +3 more | Frontiers in Pharmacology

Objective Post-ERCP pancreatitis (PEP) is a type of acute pancreatitis (AP) and the most common complication after ERCP. NLRP3 inflammasome-dependent pyroptosis is a key factor in the pathogenesis of acute … Objective Post-ERCP pancreatitis (PEP) is a type of acute pancreatitis (AP) and the most common complication after ERCP. NLRP3 inflammasome-dependent pyroptosis is a key factor in the pathogenesis of acute pancreatitis. Gegen Qinglian decoction (GQD) is a traditional Chinese medicine formula that has the effects of clearing heat and detoxifying, and is now widely used in pancreatic diseases. We have clinically found that GQD can effectively prevent PEP. To explore its potential preventive mechanism, we conducted rat experiments. Methods Before modeling, GQD, indomethacin suppository, NLRP3 inhibitor, etc. were used for intervention, and the GQD used was qualitatively analyzed by UPLC-QTOF-MS/MS. Then, a PEP model was established by injecting contrast medium into the pancreatic and bile ducts of rats, an in vitro model was made by intervening with sodium taurocholate (STC) in AR42J cells. The severity of pancreatitis and the levels of NLRP3 inflammasome components were subsequently evaluated in vivo and in vitro . Results UPLC analysis of GQD identified 227 known metabolites. The expression of NLRP3, Caspase-1, and GSDMD in PEP model was significantly increased compared to the blank group, indicating the activation of NLRP3 inflammasome mediated cell pyroptosis during PEP occurrence. Prophylactic administration of GQD resulted in a reduction in the expression of NLRP3, Caspase-1, and GSDMD. Additionally, GQD significantly alleviated the pathological inflammation in the pancreas, and reduced levels of amylase and inflammatory cytokines. The GQD group, indomethacin suppository group, NLRP3 inhibitor group, and siRNA gene suppression group showed similar results. Conclusion GQD can effectively prevent PEP, and its primary mechanism may be related to the regulation of NLRP3 inflammasome-mediated pyroptosis. Provide theoretical basis for the use of traditional Chinese medicine in clinical practice to prevent diseases.

Development and validation of an AI-driven radiomics model using non-enhanced CT for automated severity grading in chronic pancreatitis

2025-06-19

Chengwei Chen , Jian Zhou , Shaojia Mo +7 more | European Radiology

Chronic Pancreatitis with Stones: What is the Best Way to Treat?

2025-06-19

B. S. Joseph , Alice Rose , A. Bassam | Archives of Surgery and Clinical Research

Pancreatic duct stones (PDS) are a common complication of chronic pancreatitis (CP). PDS can lead to duct obstruction and cause chronic abdominal pain. Ductal stone clearance, as well as short … Pancreatic duct stones (PDS) are a common complication of chronic pancreatitis (CP). PDS can lead to duct obstruction and cause chronic abdominal pain. Ductal stone clearance, as well as short and long-term pain relief, is the cornerstone of endoscopic or surgical treatment. A step-up approach seems reasonable in pancreatic duct stone clearance. Extracorporeal shock wave lithotripsy (ESWL) combined with standard endoscopic retrograde cholangiopancreatography (ERCP) is as effective as a surgical approach for treating painful CP with less morbidity and medical costs. Therefore, endotherapy is considered a first-line therapy in selected patients. In case of insufficient pancreatic ductal clearance or strictures, advanced endoscopic techniques, per-oral pancreatoscopy (POP) with intraductal lithotripsy and/or endoscopic ultrasound-guided ductal drainage (EUS-PDD), will expand the role of the endoscopic approach. Because these new techniques are challenging, technically complex, and with high adverse events (AEs), they should be reserved for advanced tertiary care centers. Although there is increasing data that early surgical intervention may lead to better pain control and pancreatic duct stone clearance, surgery is reserved for patients failing endotherapy or patients with suspected malignancy.

Cap-Assisted Direct Endoscopic Necrosectomy for Walled-Off Pancreatic Necrosis: A Case Report

2025-06-19

Mustafa Süveran , Can Boynukara , Betül Piyade +2 more | Cureus

Blood serum from individuals with Alzheimer’s disease alters microglial phagocytosis in vitro

2025-06-19

Barbara Altendorfer , Rodolphe Poupardin , Sophie Lefèvre‐Arbogast +7 more | Neural Regeneration Research

Abstract In Alzheimer’s disease, microglial phagocytosis is engaged in the pathogenesis as it clears abnormal protein accumulations, debris, and apoptotic cells in the early stages of Alzheimer’s disease, but fuels … Abstract In Alzheimer’s disease, microglial phagocytosis is engaged in the pathogenesis as it clears abnormal protein accumulations, debris, and apoptotic cells in the early stages of Alzheimer’s disease, but fuels neuroinflammation and accelerates disease progression in later stages. In vivo parabiosis experiments in aged animals have demonstrated that blood-born factors modulate synaptic plasticity, neurogenesis, and microglial responses. We hypothesize that peripheral factors can modulate microglial function and thereby possibly influence Alzheimer’s disease pathology. The objective of this study is to investigate the effects of Alzheimer’s disease serum on microglial phagocytosis. Here, we use an immortalized human microglial cell line in an in vitro parabiosis assay to investigate the impact of the serum from individuals diagnosed with Alzheimer’s disease ( n = 30) and age-matched controls ( n = 30) (PRODEM study) on microglial phagocytosis. Exposure to Alzheimer’s disease serum increased microglial phagocytic uptake of pH-sensitive fluorescent particles and downregulated expression of the lysosomal master regulator transcription factor EB ( TFEB ) and of ATPase H + transporting lysosomal V1 subunit B2 ( ATP6V1B2 ), a component of the vacuolar ATPase. To identify serum components that may relate to changes in phagocytosis, serum samples of the Three-City Study (3C Study) were used. In the 3C Study, blood samples were collected up to 12 years before the onset of cognitive decline or dementia and their serum metabolome is well-defined. Microglia exposed to the serum of future Alzheimer’s disease patients from the 3C Study displayed an increased phagocytic uptake compared with the serum of matched controls, depending on the presence of the apolipoprotein E ε4 allele in the Alzheimer’s disease patients. Furthermore, microglial phagocytosis correlated inversely with serum levels of the omega-3 fatty acid eicosapentaenoic acid. We confirmed this inverse correlation between eicosapentaenoic acid and phagocytosis in the serum samples of the PRODEM cohort. In addition, in vitro testing of eicosapentaenoic acid on microglial phagocytosis showed a concentration-dependent decrease in phagocytic uptake. In conclusion, following incubation with Alzheimer’s disease blood serum, we observed increased microglial phagocytic uptake and the downregulation of TFEB and ATP6V1B2 , possibly indicating lysosomal dysfunction. Furthermore, microglial phagocytosis was inversely correlated with serum eicosapentaenoic acid levels, suggesting an important role for dietary eicosapentaenoic acid in microglial function.

Hereditäre Pankreatitis

2025-06-19

Francesco Vitali , Ali A. Aghdassi | Deleted Journal

Ernährung bei akuter und chronischer Pankreatitis

2025-06-19

Max Seitzinger | Deleted Journal

Gender-Related Differences in Hospitalization Outcomes of Acute Pancreatitis: A Retrospective Analysis

2025-06-19

Ahmed Ali Aziz , Muhammad Ali Aziz , Nosheen Omar +4 more | Cureus

Background Acute pancreatitis (AP) is a common gastrointestinal condition that frequently necessitates hospitalization. The aim of our study is to investigate whether gender affects the outcomes of adult patients hospitalized … Background Acute pancreatitis (AP) is a common gastrointestinal condition that frequently necessitates hospitalization. The aim of our study is to investigate whether gender affects the outcomes of adult patients hospitalized with AP. Methods Using the Nationwide Inpatient Sample (NIS) database 2020 and the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes, we performed a retrospective study of adult patients admitted with AP. We compared inpatient outcomes of AP between males and females. The primary outcome was all-cause inpatient mortality. Secondary outcomes were length of stay (LOS), total healthcare cost utilization, incidence of acute renal failure (ARF), sepsis, shock, and the need for intensive care unit (ICU) admission. We used STATA Version 16.1 to perform the statistical analyses. Multivariate logistic regression analysis was conducted to assess if gender was an independent predictor for these outcomes and to adjust for any confounders. Results A total of 252,595 adult patients were admitted for AP in 2020. The mean age was 50.89 years, and 139,180 (55.1 %) of the patients were males. Female patients had a higher prevalence of chronic kidney disease (9.26% vs 8.47%, P < 0.01), congestive heart failure (6.48% vs 5.69%, P < 0.01), and obesity (23.37% vs 17.39%, P < 0.01). Male patients had a higher prevalence of diabetes mellitus type 2 (27.32% vs 24.68%, P < 0.01), diabetes mellitus type 1 (1.32% vs 1.25%, P = 0.5), liver cirrhosis (1.81% vs 1.75%, P = 0.61), and smoking/tobacco use (39.38% vs 29.28%, P < 0.01). Females had significantly lower likelihood of in-hospital mortality (aOR: 0.64, 95% CI: 0.51-0.82, P < 0.01), ARF (aOR 0.72, 95% CI: 0.68-0.76, P < 0.01), sepsis (aOR: 0.68, 95% CI: 0.63-0.75, P < 0.01), and shock (aOR: 0.74, 95% CI: 0.62-0.89, P < 0.01) than males. There was no statistically significant difference between LOS, total hospitalization charges, and ICU admission between the two genders. Conclusions We found that females had significantly improved clinical outcomes, including lower mortality, ARF, sepsis, and shock, as compared to males. There was no statistical difference between the two genders in LOS, total hospitalization charges, and ICU admission. Further prospective studies are needed to accurately understand these differences to guide clinical practice.

Incretin system and glucagon secretion in patients with chronic pancreatitis

2025-06-19

Gea Ciccarelli , Gianfranco Di Giuseppe , Giulia Gliozzo +7 more | European Journal of Clinical Investigation

Abstract Background Diabetes of the exocrine pancreas (DEP) is an underdiagnosed form of diabetes, prevalently caused by acute and chronic pancreatitis (CP). The contribution of incretin system dysfunction and the … Abstract Background Diabetes of the exocrine pancreas (DEP) is an underdiagnosed form of diabetes, prevalently caused by acute and chronic pancreatitis (CP). The contribution of incretin system dysfunction and the role of glucagon levels in the pathogenesis of DEP remain unclear. The aim of our study is to assess the secretion of glucagon like peptide‐1 (GLP‐1), glucose‐dependent insulinotropic peptide (GIP) and glucagon, along with the incretin effect, in individuals with and without CP. By comparing these parameters within the same glucose tolerance class, we seek to elucidate specific hormonal alterations that characterize DEP. Methods To pursue this aim, we conducted a cross‐sectional study on 32 patients with chronic pancreatitis (wCP) and 60 patients without chronic pancreatitis (w/oCP), who were administered an oral glucose tolerance test, a hyperglycemic clamp and a mixed meal test with measurement of glucose, insulin, C‐peptide, GLP‐1, GIP and glucagon. Results The comparison between individuals wCP and w/oCP showed worse beta‐cell function and lower incretin effect for the former, but incretin and glucagon levels were similar. Diabetes prevalence was higher in the group wCP than in the group w/oCP (56% vs. 33%). Thus, to evaluate the differences determined by CP, we found it necessary to stratify individuals according to glucose tolerance class. After stratification, we found that both groups had similar beta‐cell function, incretin effect and incretin and glucagon secretion. Conclusions Therefore, incretin and glucagon levels and the incretin effect varied according to glucose tolerance, not the presence or absence of CP. Similar defects in incretin secretion and effects are responsible for diabetes development in individuals wCP and w/oCP.

Obstruktive chronische Pankreatitis

2025-06-19

Jakob Vielhauer , Liva Rudroff , Bernhard W. Renz | Deleted Journal

Erratum for “Association of Diet with Treatment Response in Dogs With Chronic Enteropathy: A Retrospective Multicenter Study”

2025-06-18

| Journal of Veterinary Internal Medicine

Comparison of Immediate Oral Feeding vs Conventional Oral Feeding in Patients with Mild to Moderately Severe Acute Pancreatitis: A Randomized Controlled Trial from a Tertiary Care Center in North India

2025-06-18

Anurag Dahra , Vidiyala Sai Sandeep , Pritam Singh +3 more | Euroasian Journal of Hepato-Gastroenterology

Incidence and Outcome of HTG-AP at a Tertiary Care Center in Eastern India: A Retrospective Analysis

2025-06-18

Preetam Nath , Suprabhat Giri , Bipadabhanjan Mallick +7 more | Euroasian Journal of Hepato-Gastroenterology

Is there any Association of Distal Biliary Strictures with Acute Pancreatitis?

2025-06-18

Zaigham Abbas , S Nazir , Darayus P Gazder +5 more | Euroasian Journal of Hepato-Gastroenterology

Contrast-enhanced CT-based prediction models for early intervention efficacy and in-hospital mortality risk in acute necrotizing pancreatitis with persistent organ failure

2025-06-18

Minchun Bu , Yun Zhang , Faxi Chen +7 more | European Radiology

Right Renal Halo Sign in Dogs with Presumed Acute Pancreatitis on Radiographs: A Pilot Study

2025-06-18

Elodie E. Huguet , Clifford R. Berry , Michael Schaer +3 more | Journal of the American Animal Hospital Association

ABSTRACT Radiographic signs of acute pancreatitis in dogs include widening of the pyloroduodenal angle and a cranial abdominal mass effect/decreased serosal detail. In some dogs with acute pancreatitis, it has … ABSTRACT Radiographic signs of acute pancreatitis in dogs include widening of the pyloroduodenal angle and a cranial abdominal mass effect/decreased serosal detail. In some dogs with acute pancreatitis, it has been anecdotally noted that the right renal silhouette could be well visualized on the ventrodorsal abdominal radiograph. The purpose of this study was to see whether increased right renal conspicuity (i.e., renal “halo” sign) is associated with pancreatitis, other causes of a right cranial abdominal mass effect, decreased abdominal serosal detail as with the presence of peritoneal effusion, or perhaps representing a normal variation. The medical records of 100 dogs were retrospectively collected and divided into four groups, including control dogs (n = 30), right-sided hepatic mass effect (n = 16), peritoneal effusion (n = 15), and acute pancreatitis (n = 39). Ventrodorsal radiographs from each case were randomized for evaluation by a radiologist blinded to the final diagnosis. A right renal halo sign was identified in 13/39 (33%) of dogs with acute pancreatitis, 2/16 (12.5%) dogs with a right cranial abdominal mass effect, and 1/30 (3%) control dog. This study supports that the renal halo signs on ventrodorsal radiographs is most prevalent in dogs with acute pancreatitis and may help support a clinical diagnosis of this medical disorder.

Utility of the modified computed tomography severity index in prognostication of acute pancreatitis in children

2025-06-18

Hsienchang Chiu , Kin Fen Kevin Fung , Chung Hei Leung +6 more | Pediatric Radiology

Correction: Acute pancreatitis experimental models, advantages and disadvantages

2025-06-18

Genaro J Rosales-Muñoz , Verónica Souza-Arroyo , Leticia Bucio +3 more | Journal of Physiology and Biochemistry

Precision nutrition management in hyperlipidemia-associated acute pancreatitis: mechanistic insights and personalized therapeutic approaches

2025-06-18

Jingyuan Ma , Xing Wan , Jifeng Liu +3 more | Frontiers in Nutrition

Hyperlipidemia-associated acute pancreatitis (HLAP), an acute inflammatory disorder triggered by dyslipidemia, has witnessed a rising global incidence with significant health implications. The pathogenesis of HLAP involves complex interactions among lipid … Hyperlipidemia-associated acute pancreatitis (HLAP), an acute inflammatory disorder triggered by dyslipidemia, has witnessed a rising global incidence with significant health implications. The pathogenesis of HLAP involves complex interactions among lipid metabolism dysregulation, inflammatory cascades, and oxidative stress. Conventional therapeutic approaches, while providing partial symptomatic relief, exhibit limitations in addressing individual variability. Precision nutrition management emerges as a novel paradigm integrating multi-omics profiling (genomic, metabolomic) and clinical parameters to develop personalized intervention strategies. This comprehensive review analyzes the pathophysiological mechanisms linking lipid dyshomeostasis to HLAP progression, systematically evaluates the scientific foundation for precision nutrition interventions, and identifies key gaps in current implementation strategies. Furthermore, we examine current research limitations and outline future avenues for enhancing therapeutic efficacy via personalized nutritional interventions.

Effect of antibacterial and probiotic therapy on the restoration of low fecal elastase levels in patients without imaging findings of pancreatic injuries

2025-06-18

Yu. A. Kucheryavyy , Д. Н. Андреев , N. V. Novozhilov | Meditsinskiy sovet = Medical Council

Introduction. The small intestinal bacterial overgrowth (SIBO) with low levels of fecal elastase-1 (FE-1) often mimics the symptoms of of exocrine pancreatic insufficiency (EPI). In this case, enzyme replacement therapy … Introduction. The small intestinal bacterial overgrowth (SIBO) with low levels of fecal elastase-1 (FE-1) often mimics the symptoms of of exocrine pancreatic insufficiency (EPI). In this case, enzyme replacement therapy with pancreatin preparations proves ineffective. Aim. To study the therapeutic efficacy of rifaximin alfa in patients with low FE-1 levels without imaging findings of pancreatic injury. Materials and methods. The study included 35 outpatients with low FE-1 levels (less than 200 μg/g), refractory clinical manifestations specific to lower gastrointestinal tract diseases, and no signs of pancreatic injuries seen on cross sectional imaging. The total duration of treatment was 15 weeks, during which patients received 6 alternating cycles each lasting 14 days: rifaximin alfa and a probiotic. Rifaximin alfa was administered at a dose of 1,200 mg per day split in 3 doses of 400 mg each for 14 days. Probiotic therapy for 14 days included Lacticaseibacillus paracasei DG (L. paracasei DG) due to the fact that patients had both diarrhea and constipation. L. paracasei DG without prebiotic was prescribed to patients with diarrheapredominant irritable bowel syndrome. L. paracasei DG with a prebiotic was recommended to patients with constipationpredominant irritable bowel syndrome at a dose of 1 capsule/sachet once a day for 3 weeks. Results. A statistically significant regression (p < 0.05) of all primary complaints was observed. The median FE-1 levels significantly increased from 76.0 (95% CI: 48.9–113.0) to 290 (95% CI: 260.0–332.3) μg/g (p < 0.0001). Normalization of FE-1 levels was observed in 32 patients (91.4%) (p < 0.0001). Conclusion. SIBO can be one of the dominant causes of low FE-1 levels in patients with intestinal symptoms and no objective signs of pancreatic injuries. Cyclic therapy with rifaximin-alpha and probiotic based on the strain L. paracasei DG allowed to achieve regression of clinical manifestations, improve the quality of life and normalize FE-1 levels after 15-week therapy in most patients.

A mini review on role of macro- and micronutrients in managing intrapancreatic fat deposition

2025-06-18

Juyeon Ko , Sung‐Ryong Ko , Lam Anh +1 more | Y HOC TP HO CHI MINH

The increasing prevalence of obesity has drawn attention to intra-pancreatic fat deposition (IPFD), a condition associated with metabolic disorders such as type 2 diabetes, chronic pancreatitis, and pancreatic cancer. Although … The increasing prevalence of obesity has drawn attention to intra-pancreatic fat deposition (IPFD), a condition associated with metabolic disorders such as type 2 diabetes, chronic pancreatitis, and pancreatic cancer. Although initially linked to general obesity, IPFD is now recognized in non-obese individuals, with its prevalence often underestimated due to the absence in International Classification of Diseases. Chemical shift-encoded magnetic resonance imaging (MRI) has become the preferred method for non-invasive quantification of IPFD, providing insights into its role in metabolic dysfunctions, including insulin resistance and lipotoxicity. This rapid review explored the pathophysiology of IPFD, focusing on fatty infiltration and replacement mechanisms, and discussed how dietary factors can influence their progression and management. Recent studies on macronutrient and micronutrient intake in relation to IPFD, particularly those using chemical shift-encoded MRI, were reviewed to identify dietary contributors and their metabolic impacts. Among macronutrients, excessive monosaccharide intake linked to worse outcomes, while resistant starch and monounsaturated fats showed protective effects. Micronutrients like manganese, selenium, iodine, and vitamins B3, B6, B12, and folate demonstrated significant metabolic benefits. Further research is needed to identify other dietary contributors and develop effective targeted nutritional interventions to reduce the burden of IPFD.

Mortality and Readmission Rates in Patients with Chronic Pancreatitis and Morbid Obesity or Prior Bariatric Surgery: A National Readmission Database Analysis

2025-06-18

Yasmin O. Ali , Zachary Leslie , Khalid Ahmed +4 more | Digestive Diseases and Sciences

Nutrition and the pancreas

2025-06-18

Nicolò de Pretis , Federico Caldart , Salvatore Crucillà +7 more | European Journal of Gastroenterology & Hepatology

The pancreas is a compound organ specialized in digestion and absorption of nutrients and in glucose homeostasis. Indeed, the exocrine component produces digestive enzymes and bicarbonates involved in the duodenal … The pancreas is a compound organ specialized in digestion and absorption of nutrients and in glucose homeostasis. Indeed, the exocrine component produces digestive enzymes and bicarbonates involved in the duodenal and jejunal digestion, whereas endocrine cells, mainly located in the islets of Langerhans, produce glucose-regulating hormones. These two different pancreatic functions are strictly and directly regulated by mechanisms that are still not completely understood. Not only pancreatic secretions but also the interaction between exocrine and endocrine pancreatic function have relevance on nutritional status, and there is increasing evidence that nutritional status impacts the prognosis of both inflammatory and pancreatic neoplastic diseases of the pancreas. Signs of malnutrition need to be investigated and identified in patients with pancreatic diseases to optimize the medical management and, potentially, to improve the clinical outcome. Considering the central role of the pancreas in the nutrition state, in this review, we aimed to report the current knowledge on pancreatic exocrine and endocrine functions and their relationship with diet, and the modifications and the impact on prognosis of the inflammatory and neoplastic diseases of the pancreas.

The first pediatric study investigating the utility of a noninvasive urine‐based test for acute pancreatitis diagnosis

2025-06-17

Tamar Orgad , Isra Abu‐Rahma , David Rekhtman +6 more | Journal of Pediatric Gastroenterology and Nutrition

Abstract Objectives Pediatric acute pancreatitis (AP) is a growing clinical concern with a wide spectrum of severity, from mild episodes to life‐threatening conditions. Traditional diagnostic methods primarily rely on serum … Abstract Objectives Pediatric acute pancreatitis (AP) is a growing clinical concern with a wide spectrum of severity, from mild episodes to life‐threatening conditions. Traditional diagnostic methods primarily rely on serum amylase and lipase measurements, which are invasive and can be challenging in children. This study is the first to evaluate the diagnostic accuracy of the urine trypsinogen‐2 dipstick test (UTDT) as a noninvasive test for diagnosing pediatric AP. Methods This prospective study included 28 pediatric patients (31 episodes) presenting with acute abdominal pain at a tertiary medical center from November 2022 to October 2024. AP was diagnosed based on the International Study Group of Pediatric Pancreatitis: In Search for a Cure (INSPPIRE) criteria. Urine samples were collected either within the first 24 hours (h) or later during hospitalization. UTDT sensitivity and specificity were calculated and compared to serum amylase and lipase levels. Results Of the 31 episodes, 19 (61%) were confirmed as AP, and 12 (39%) were attributed to other causes. The UTDT had an overall sensitivity of 68% and specificity of 100%. Sensitivity increased to 87% when urine samples were collected within 24 h of admission. In non‐AP cases, UTDT consistently produced negative results, with the high specificity supporting its reliability in distinguishing AP from other conditions. Conclusions The UTDT demonstrates promise as a rapid, noninvasive diagnostic tool for pediatric AP, particularly when used early in the disease course. Its high specificity and ease of use suggest that it may serve as an alternative to invasive blood tests once validated through larger‐scale studies. Further research is needed to confirm these findings and establish the role of UTDT in clinical practice.

Application of Continuous Renal Replacement Therapy (CRRT) in Patients with Severe Acute Pancreatitis: An Analytical Study

2025-06-17

Yiru Weng , Zhouzhou Dong , Gongjie Ye +4 more | Research Square (Research Square)

<title>Abstract</title> Purpose Exploring the correlation between Continuous Renal Replacement Therapy (CRRT) and the prognostic outcomes of patients with Severe Acute Pancreatitis (SAP); analyzing the impact of CRRT initiation time on … <title>Abstract</title> Purpose Exploring the correlation between Continuous Renal Replacement Therapy (CRRT) and the prognostic outcomes of patients with Severe Acute Pancreatitis (SAP); analyzing the impact of CRRT initiation time on the final prognosis of SAP patients; evaluating factors affecting the therapeutic effect of CRRT in SAP patients without strong indications for CRRT, and developing a multi-factorial predictive model for the efficacy of CRRT in treating SAP. Methods This retrospective cohort study analyzed clinical data from severe acute pancreatitis (SAP) patients admitted to The Affiliated LiHuili Hospital of Ningbo University (2015–2024), collecting baseline characteristics (demographics, disease severity scores), CRRT parameters (initiation timing, laboratory values), and clinical outcomes. Patients were stratified by prognosis and CRRT status, with subgroup analyses performed for CRRT-treated cases. After excluding patients with definitive CRRT indications, we randomly allocated cases to training (80%) and validation (20%) sets. Using logistic regression, we identified CRRT failure predictors, evaluated their predictive value via ROC analysis, and developed/validated a nomogram prediction model. Results Among 563 initially screened SAP patients, 282 were included after exclusions. (1) Prognosis analysis revealed significant differences between improved and poor prognosis groups in age, pancreatitis type, CRRT use, APACHE II and Marshall scores (all P < 0.05). Multivariate analysis identified CRRT as an independent protective factor and Marshall score as a risk factor. Compared to non-CRRT patients, CRRT-treated patients showed significantly shorter hospitalization and vasopressor duration (P < 0.05), with comparable costs. (2) In CRRT-treated patients (with/without strong indications), earlier CRRT initiation (< 36h) correlated with better outcomes (P < 0.05). Multivariate analysis confirmed CRRT initiation time as an independent prognostic factor (optimal cutoff: 36h). (3) Among 114 CRRT-treated patients without strong indications (91 in training set), significant differences existed in pancreatitis type, APACHE II, Marshall score, lactate, calcium, albumin, PT and PCT (P < 0.05). Multivariate analysis identified APACHE II, PCT and lactate as independent risk factors, and calcium/albumin as protective factors for CRRT failure. The combined model showed excellent predictive value (AUC = 0.912, 95%CI:0.841–0.982). The nomogram demonstrated good calibration in both training and test sets. Conclusions CRRT serves as an independent protective factor against poor outcomes (voluntary discharge/death) in SAP patients, while simultaneously reducing hospitalization duration and vasopressor requirements without increasing financial burden. Early application (within 36 hours) demonstrates greater therapeutic benefit. The developed nomogram prediction model, incorporating key prognostic factors, exhibits excellent clinical applicability and provides an objective basis for evaluating treatment timing in patients without strong CRRT indications.

Thymosin alpha 1 alleviates inflammation and prevents infection in patients with severe acute pancreatitis through immune regulation: a systematic review and meta-analysis

2025-06-17

Yong Tian , Jiaqi Yao , Yihan Ma +4 more | Frontiers in Immunology

Background Immune and inflammatory disorders are part of the complex pathophysiological processes that exacerbate severe acute pancreatitis (SAP) and subsequent infection. Thymosin alpha 1 (Tα1) is an important immunomodulatory agent … Background Immune and inflammatory disorders are part of the complex pathophysiological processes that exacerbate severe acute pancreatitis (SAP) and subsequent infection. Thymosin alpha 1 (Tα1) is an important immunomodulatory agent in clinical practice, but there is a lack evidence to prove its effectiveness in improving the condition of SAP patients. In this study, we aimed to evaluate the efficacy in meta-analysis. Methods We systematically searched PubMed, Embase, Web of Science, Cochrane Library and China National Knowledge Infrastructure (CNKI) up to February 1, 2025. Randomized controlled studies comparing the efficacy of Tα1 as intervention measure with non-Tα1 in improving immune regulation for patients with SAP were included. Review Manager 5.3 was used to assess endpoints in the meta-analysis. Results Five randomized controlled trials comprising 706 patients with SAP were included. The results indicated that Tα1 could increase the percentages of CD4 + cells (MD=4.53, 95%CI [3.02, 6.04], P&lt;0.00001) and improve the CD4 + /CD8 + ratio (MD=0.42, 95%CI [0.26, 0.58], P&lt;0.00001) in SAP patients. There was no statistically significant decrease in CD8 + cells. For inflammation, lower-dose Tα1 could significantly reduce C-reactive protein (CRP) levels (mg/L) (MD=-30.12, 95%CI [-35.75, -24.49], P&lt;0.00001), while higher-dose Tα1 showed no statistically significant difference (MD=-3.83, 95%CI [-12.14, 4.49], P=0.37). In terms of infection, the immunomodulatory therapy of Tα1 obviously reduced the overall incidence of extrapancreatic infections in SAP patients (RR=0.56, 95%CI [0.40, 0.78], P=0.0005), especially for blood (RR=0.60, 95%CI [0.38, 0.94], P=0.03) and abdominal (RR=0.38, 95%CI [0.19, 0.78], P&lt;0.0001), while the reduction in lung infections was not statistically significant. Regarding hospital stay (days), Tα1 did not significantly reduce the time spent (MD=-4.22, 95%CI [-11.53, 3.10], P=0.26). However, Tα1 reduced the APACHE II score (MD=-1.52, 95%CI [-2.22, -0.83], P&lt;0.0001). Conclusion Tα1 can regulate the balance of immune cells and alleviate immune suppression in SAP patients, including increasing CD4 + T cells and CD4 + /CD8 + ratios. Tα1 may exert anti-inflammatory and extrapancreatic infection-preventive effects on SAP patients and improve their condition or prognosis. More researches are needed to validate the results. Systematic review registration https://www.crd.york.ac.uk/prospero , identifier CRD42024570517.

An Observational Study To Find Impact of Covid19 Infection on Causation and Prognosis of Pancreatitis.

2025-06-17

Neeraja | International Journal For Multidisciplinary Research

Objective: To find impact of covid19 infection on causation and prognosis of pancreatitis Design: Prospective observational study Setting: A large, academic, tertiary medical center Methodology : Clinical and laboratory data … Objective: To find impact of covid19 infection on causation and prognosis of pancreatitis Design: Prospective observational study Setting: A large, academic, tertiary medical center Methodology : Clinical and laboratory data of all consecutive patients with a primary diagnosis of TS during past 6months with history of covid 19 infection was collected .Clinical and radiological grading was taken into consideration for finding severity. Results: out of 30 patient 4 patients had severe covid 19 infection requiring more than 10days of hospitalization but though 1 of those 4 patient developed recurrent pancreatitis but severity score was less(clinical and radiological).14 had mild covid 19 infection with minimal respiratory and more of GI symptoms .Out of these 14 ,10 developed severe acute necrotizing pancreatitis requiring ICU stay and prolonged hospital stay .12 patients had mild covid 19 infection with respiratory symptoms .10 of them had pancreatitis of mild severity ,2 developed severe necrotizing pancreatitis. Interpretation and conclusion: Based on our study we conclude that more than severe covid19infection mild covid 19infection with GI symptoms has a greater impact on the prognosis of patient with pancreatitis. However there is still insufficient evidence showing that covid 19 can cause TS or negatively impact prognosis. Additional major studies are needed to clarify relationship between these two entities

Impact of Prediabetes on In-Hospital Mortality and Clinical Outcomes in Acute Pancreatitis: Insights from a Nationwide Inpatient Sample

2025-06-16

Tahani Dakkak , Nawras Silin , Riaz Mahmood +2 more | Journal of Clinical Medicine

Background/Objectives: Prediabetes is characterized by insulin resistance and systemic inflammation, which may increase susceptibility to acute pancreatitis (AP). However, limited data exist on how prediabetes influences in-hospital outcomes in AP … Background/Objectives: Prediabetes is characterized by insulin resistance and systemic inflammation, which may increase susceptibility to acute pancreatitis (AP). However, limited data exist on how prediabetes influences in-hospital outcomes in AP patients. This study aimed to evaluate the prevalence and clinical outcomes of hospitalized AP patients with prediabetes using the National Inpatient Sample (NIS) database. Methods: We conducted a retrospective cohort study using NIS data from 2016 to 2018, identifying adult patients hospitalized with a primary diagnosis of AP. Patients were stratified based on the presence or absence of prediabetes; those with type 1 or 2 diabetes were excluded. The primary outcome is the association of prediabetes with developing acute pancreatitis and its influence on in-hospital mortality, length of stay, and total hospital cost. Results: Among 193,617 patients hospitalized with AP, 1639 had prediabetes. No statistically significant difference was found in in-hospital mortality, length of stay, or hospitalization costs between patients with or without prediabetes. The in-hospital mortality was 1.22% in prediabetic patients versus 2.01% in non-prediabetic patients (p = 0.0225). The length of stay was shorter in prediabetic patients (4.93 vs. 5.37 days, p = 0.0021), and hospitalization costs were similar (USD55,351.56 vs. USD57,106.83, p = 0.195). Furthermore, prediabetes was not an independent predictor of mortality (OR 0.50, 95% CI 0.31-0.82, p = 0.0063). Significant predictors of mortality included acute kidney injury (OR 12.98, 95% CI 11.96-14.09, p < 0.001) and severe sepsis with shock (OR 5.89, 95% CI 5.27-6.59, p < 0.001). Conclusions: Prediabetes was not associated with an increased in-hospital mortality in AP patients. However, complications such as AKI and septic shock significantly predicted mortality, underscoring the importance of early recognition and management.