Acute Alcoholic Pancreatitis Research Articles

S10 The Impact of the COVID-19 Pandemic on Number of Admissions for Acute Alcoholic Pancreatitis

S10 The Impact of the COVID-19 Pandemic on Number of Admissions for Acute Alcoholic Pancreatitis

S9 Does Access to Alcohol Matter? Association of Alcohol Outlet Access With Hospitalization for Acute Pancreatitis

Introduction: Alcohol is among the leading causes of acute pancreatitis. We aimed to evaluate the association of admissions for alcoholic pancreatitis and access to alcohol based upon residence within a zip code and county. Methods: Admissions for acute alcoholic pancreatitis were reviewed from 2015 to 2021 within our hospital network. Our analysis included only Pennsylvania residents, as it is an alcoholic beverage control state in which spirits are only sold in state owned stores. Data was collected regarding demographics, including zip code and county of residence. Results: A total of 415 admissions amongst 216 patients were included from 15 counties and 107 zip codes within Pennsylvania. Liquor stores per counties included range from 1 to 74; admissions per counties included range from 1 to 219 (Table 1). Liquor stores per zip codes included range from 0 to 4; admissions per zip codes included range from 1 to 8. In a univariable linear regression model, there is a strong correlation between admissions per county and stores per county, with R^2 = 0.96. This was redemonstrated in a chi-squared analysis with P < 0.05. The liquor stores per zip code did not have a strong correlation to admissions per zip code in a linear regression model. Conclusion: Our data suggests a significant relationship between the number of liquor stores within a county and patients admitted for acute alcoholic pancreatitis from that county. We suspect that increased access to alcohol may influence the rates of admission. It may be prudent for counties with more liquor stores to also have more resources for patients with alcohol use disorders, as these may prevent hospitalizations, and ultimately complications of acute alcoholic pancreatitis.Table 1.: Number of admissions per county for alcohol induced acute pancreatitis within our healthcare network in relation to number of liquor stores within those counties

S65 Incidence, Burden and Predictors of One-Year Readmission for Alcohol Acute Pancreatitis

S65 Incidence, Burden and Predictors of One-Year Readmission for Alcohol Acute Pancreatitis

Alcoholic pancreatitis

Alcohol misuse is a common cause of pancreatitis, both acute and chronic. Alcoholic pancreatitis can present a significant diagnostic challenge for GPs, and a high index of suspicion must be maintained to avoid delayed or missed diagnoses. Management is multi-faceted and an enduring relationship between patient and GP ensures the best patient outcomes. This article will discuss both acute and chronic alcoholic pancreatitis, the diagnosis of alcohol-induced pancreatitis in its different forms and how to create a management plan that addresses symptom control as well as improving long term patient outcomes.

Alcohol Reduction to Reduce Relapse in Acute Alcoholic Pancreatitis-Missed Opportunities.

AimResuming drinking is a main contributant to recurrence in alcoholic pancreatitis. We assessed current clinical practice in the Netherlands regarding alcohol in managing patients with a first episode of acute alcoholic pancreatitis.MethodsA survey was distributed to 35 hospitals affiliated with the Dutch Pancreatitis Study Group. We evaluated current support based on various components of brief interventions, the participation of psychosocial healthcare providers, the cooperation with the primary care physicians and the presence of a protocol and its implementation.ResultsThe response rate was 100% (n = 35). Psychoeducation is the most frequently performed intervention in current support treatment (97% of hospitals). In 17% of hospitals, healthcare providers with a psychosocial background routinely participate in current support treatment; 37% of hospitals create an individual treatment plan in which goals regarding alcohol cessation are specified and only 46% of hospitals provide the primary care physician with specific discharge information; 31% of hospitals indicate that the treatment is uniformly performed within their division of Gastroenterology. Protocols are available in 3% of the hospitals surveyed. Opportunities to involve the patient’s social network were not given sufficient priority.ConclusionAmong Dutch hospitals, there is no routine management strategy with regard to enhancing treatment for heavy alcohol use in alcoholic pancreatitis patients. There is a need to test a validated support program in randomized studies. Meanwhile, possible opportunities for effecting change are often missed.

Inhibition of nicotinamide phosphoribosyltransferase protects against acute pancreatitis via modulating macrophage polarization and its related metabolites

Background & objectivesAcute pancreatitis is a common inflammatory disorder of the exocrine pancreas with no specific therapy. Intracellular nicotinamide phosphoribosyltransferase (NAMPT), the rate-limiting enzyme in nicotinamide adenine dinucleotide (NAD) salvage pathway, is involved in many inflammatory disorders. In this study, we investigated the role of NAMPT in experimental acute pancreatitis. MethodsAcute pancreatitis was induced in mice using three disparate models: (1) caerulein hyperstimulation, (2) ethanol plus palmitoleic acid, and (3) retrograde biliopancreatic ductal infusion of sodium taurocholate. The NAMPT inhibitor FK866 and NAMPT downstream product nicotinamide mononucleotide (NMN) was administered. Serum and pancreas were collected and analyzed biochemically and histologically. Bone marrow derived macrophages were isolated, cultured with cytokines or pancreatic acini, then analyzed by quantitative PCR and non-targeted metabolomics. ResultsThe levels of pancreatic NAMPT and NAD were down-regulated upon acute pancreatitis. NAMPT inhibitor FK866 suppressed M1 macrophage polarization while NMN boosted it. In co-culture of macrophages with acinar cells, inhibition of NAMPT prevented M1-like macrophage differentiation induced by injured pancreatic acini. The injured pancreatic acinar milieu induced a unique metabolic signature linked to macrophage polarization, and inhibition of NAMPT reversed these metabolites changes. Furthermore, NMN supplementation aggravated caerulein hyperstimulation pancreatitis and alcoholic pancreatitis, and inhibition of NAMPT protected against caerulein hyperstimulation, alcoholic and biliary acute pancreatitis and reducing pancreatic macrophage infiltration in vivo. ConclusionsNAMPT inhibition protects against acute pancreatitis via preventing M1 macrophage polarization and restoring the metabolites related to macrophage polarization and that NAMPT could be a promising therapeutic target for acute pancreatitis.

The Epidemiology of Annular Pancreas in the United States: A Population-based Study.

Annular pancreas is a rare congenital condition where the second part of the duodenum is encircled by pancreatic tissue. There is a scarcity of data on its natural history therefore, we aimed to evaluate the epidemiology of annular pancreas and identify underlying associations using a large database. A multi-institutional database (Explorys) was surveyed. A cohort of patients with a Systematized Nomenclature of Medicine-Clinical Terms diagnosis of "MRI, CT, EUS and/or ERCP" between April 2015 and April 2020 was identified. Subsequently a cohort of patients with history of "annular pancreas" was identified. There were a total of 40,075,980 individuals in the database with 6,162,600 (15.38%) who had an magnetic resonance imaging, computed tomography, endoscopic retrograde cholangiopancreatography, and/or endoscopic ultrasound. There were 210 (3.4/100,000) had a diagnosis of annular pancreas. When compared with the control group, patients with annular pancreas were more likely to have a history of alcohol use, smoking, acute pancreatitis, chronic pancreatitis, gastritis, duodenitis, jaundice, and gastrointestinal outlet obstruction. This is the largest study evaluating the epidemiology of annular pancreas. We found the estimated prevalence rate of annular pancreas to be 3.4/100,000 in those who had abdominal imaging. Annular pancreas was more likely to be diagnosed in patients with symptoms pertaining to acute or chronic pancreatitis, biliary, and gastric outlet obstruction.

Thirty-Day Readmission Among Patients with Alcoholic Acute Pancreatitis.

Alcoholic acute pancreatitis (AAP) comprises the second most common cause of acute pancreatitis in the USA, and there is lack of data regarding 30-day specific readmission causes and predictors. We aim to identify 30-day readmission rate, causes, and predictors of readmission. Retrospective analysis of the 2016 National Readmission Database of adult patients readmitted within 30days after an index admission for AAP. Totally, 76,609 AAP patients were discharged from the hospital in 2016. The 30-day readmission rate was 12%. The main cause of readmission was another episode of AAP. Readmission was not associated with higher mortality (1.3% vs. 1.2%; P = 0.21) or prolonged length of stay (5.2 vs. 5.0days; P = 0.06). The total health care economic burden was $354 million in charges and $90 million in costs. Independent predictors of readmission were having Medicaid insurance, a Charlson comorbidity index score ≥ 3, use of total parenteral nutrition, opioid abuse disorder, prior pancreatic cyst, chronic alcoholic pancreatitis, and other chronic pancreatitis. Obesity was associated with lower odds of readmission. Readmission rate for AAP is high and its primary cause are recurrent episodes of AAP. Alcohol and substance abuse pose a high burden on our health care system. Public health strategies should be targeted to provide alcohol abuse disorder rehabilitation and cessation resources to alleviate the burden on readmission, the health care system and to improve patient outcomes.

Resectable periampullary tumor in patients with previous pancreatitis. What type of surgical procedure to choose?

To evaluate the early outcomes of radical surgical treatment of patients with resectable periampullary tumors and previous acute pancreatitis (AP). A retrospective analysis included 9 patients. AP was diagnosed in all patients at different times of preoperative period (post-manipulative AP in 7 cases, alcoholic AP in 2 cases). Pancreaticoduodenectomy was performed in 5 patients, total pancreatectomy (TP) - in 4 patients. Severe postoperative complications occurred in 3 patients after pancreaticoduodenectomy. There were no complications after TP. All complications after pancreaticoduodenectomy were associated with a pancreatic stump that required urgent surgical interventions. Three patients died from surgical complications. All postoperative deaths were observed after pancreaticoduodenectomy. TP may be a safer surgical option compared to pancreaticoduodenectomy in patients with resectable periampiullary tumors and preoperative AP.

Purtscher's-like retinopathy as a rare complication of acute alcoholic pancreatitis.

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA M. Wieczorek M, Caban M, Fabisiak A, Małecka-Panas E. Purtscher’s-like retinopathy as a rare complication of acute alcoholic pancreatitis. Gastroenterology Review/Przegląd Gastroenterologiczny. 2021;16(2):170-173. doi:10.5114/pg.2021.106669. APA M. Wieczorek, M., Caban, M., Fabisiak, A., & Małecka-Panas, E. (2021). Purtscher’s-like retinopathy as a rare complication of acute alcoholic pancreatitis. Gastroenterology Review/Przegląd Gastroenterologiczny, 16(2), 170-173. https://doi.org/10.5114/pg.2021.106669 Chicago M. Wieczorek, Michalina, Miłosz Caban, Adam Fabisiak, and Ewa Małecka-Panas. 2021. "Purtscher’s-like retinopathy as a rare complication of acute alcoholic pancreatitis". Gastroenterology Review/Przegląd Gastroenterologiczny 16 (2): 170-173. doi:10.5114/pg.2021.106669. Harvard M. Wieczorek, M., Caban, M., Fabisiak, A., and Małecka-Panas, E. (2021). Purtscher’s-like retinopathy as a rare complication of acute alcoholic pancreatitis. Gastroenterology Review/Przegląd Gastroenterologiczny, 16(2), pp.170-173. https://doi.org/10.5114/pg.2021.106669 MLA M. Wieczorek, Michalina et al. "Purtscher’s-like retinopathy as a rare complication of acute alcoholic pancreatitis." Gastroenterology Review/Przegląd Gastroenterologiczny, vol. 16, no. 2, 2021, pp. 170-173. doi:10.5114/pg.2021.106669. Vancouver M. Wieczorek M, Caban M, Fabisiak A, Małecka-Panas E. Purtscher’s-like retinopathy as a rare complication of acute alcoholic pancreatitis. Gastroenterology Review/Przegląd Gastroenterologiczny. 2021;16(2):170-173. doi:10.5114/pg.2021.106669.

Distal pancreatectomy for giant pancreatic pseudocyst with splenic rupture in a patient with chronic pancreatitis

Pancreatic pseudocysts are a frequent complication of chronic pancreatitis. Spontaneous splenic rupture and subcapsular hematoma is a rare and fatal event in a pseudocyst. In the literature, the real incidence of this kind of complication is not clearly defined. We herein present a case of a 31 year-old male with a large pseudocyst associated with splenic rupture. The patient had a history of acute alcoholic pancreatitis three months ago in another hospital centre. He presented at our emergency department with abdominal pain and poor general condition (hemodynamic instability). After resuscitation, an abdominal CT scan was performed, which showed a giant pseudocyst (16x17x24cm, APxLxCC) causing a splenic rupture contained by the spleen capsule. After multidisciplinary committee, we proposed a minimally invasive surgical approach. Previously, we proposed drainage by percutaneous approach of the pseudocyst. The procedure were performed without incidences. After drainage, we performed a minimally robot-assisted distal pancreatectomy with splenectomy using Da Vinci Xi system. Five trocars were used, the operative time was 321min, we used Echelon black cartridge-mechanical staple for pancreatic transection. A grade B pancreatic fistula occured in the immediate postoperative period, adequately drained and treated with somatostatin analogues. We removed the drain at the outpatient consultation three weeks after surgery. The anatomo-pathology reported a peripancreatic pseudocyst with extensive acute and subacute bleeding and inflammatory changes. Keywords: Angiographic drainage, pseudocyst, spleen rupture, robot-assisted surgery. Figure legend: △: main pancreatic duct (pancreatic tail); →:splenic capsular dissection; ✱: spleen; ✱: pseudocyst

Mutual Effect of &lt;i&gt;NAT2&lt;/i&gt; rs1799930 (590G&gt;A) Polymorphism and Alcohol Abuse on Risk of Acute Pancreatitis

Aim. Estimation of the contribution of rs1799930 (590G&gt;A) polymorphism of gene NAT2 to the development of acute alcoholic pancreatitis.Materials and methods. DNA samples were obtained from 547 unrelated patients with acute alcoholic pancreatitis and 573 unrelated individuals without gastrointestinal diseases. A survey selected individuals with the alcohol consumption of &gt;200 g/week pure ethanol two times a week or more during 10 or more years. Genotyping was performed with PCR using TaqMan allelic discrimination assays.Results. No association was observed between the NAT2 allelic rs1799930 (590G&gt;A) polymorphism, risk of acute alcoholic pancreatitis, duration and rate of alcohol consumption. The 590G&gt;A variant of rs1799930 in gene NAT2 correlated with an increased risk of acute alcoholic pancreatitis (odds ratio 2.16; 95% confidence interval 1.13–4.12) under alcohol consumption &gt;200 g/week pure ethanol.Conclusion. The rs1799930 G/A polymorphism of gene NAT2 increases the risk of acute pancreatitis under alcohol consumption &gt;200 g/week pure ethanol.

STUDY OF SERUM LIPASE TO AMYLASE RATIO IN DIFFERENTIATING BETWEEN ACUTE ALCOHOLIC AND NON-ALCOHOLIC PANCREATITIS

Acute pancreatitis (AP) is a common condition involving the pancreas. The estimated incidence is about 3% of cases presenting with pain in abdomen.(4) Gall stones and alcoholism together account for 80% of acute pancreatitis.(5) Although the overall mortality rate for acute pancreatitis is 2-10% and this is primarily related to the 10-30% of patients with severe disease characterized by pancreatic and peripancreatic necrosis.(6) Diagnosis remains clinical and can be supported by 1.5 - 2 fold increase above the upper limit of normal of serum amylase and lipase.(10) Amylase and lipase levels are known to be the most important factors in determining acute pancreatitis. It is well known that these levels are usually elevated in acute pancreatitis, without regard to whether it is of biliary type or alcoholic type. Furthermore whether or not these levels can be used to discern between the two types, has been also a matter of concern. It has been reported that the lipase/amylase ratio could be a new index distinguishing two types of pancreatitis, with the critical value being 2. This report had been followed by some debate between supporters and opponents. Currently CECT is the imaging modality of choice where areas of hypo perfusion correlate with necrosis. (11) It can’t differentiate between alcoholic and non-alcoholic AP. Identification of two groups could help formulating treatment protocol for either group. The aim of the present study is to establish the utility of the ratio of the serum lipase and serum amylase, a new index distinguishing acute episode of alcoholic from non alcoholic pancreatitis.

Retroperitoneoscopic Pancreatic Necrosectomy: Taming the Relentless March of the Great Marauder

AbstractWe hereby report a case of a 35-year-old male who presented to us with infected pancreatic necrosis, 4 weeks after an episode of acute alcoholic pancreatitis. Imaging investigations showed a predominantly left-sided pancreatic and peripancreatic infected collection. This case was managed successfully in a single sitting by retroperitoneoscopic intervention.

English

BACKGROUND Clinically, the course of all causes of acute pancreatitis is similar; however, inpatients with severe biliary pancreatitis, we can prevent complications with the help of ERCP. Serum L / A ratio of &gt; 2 could help diagnose alcohol as the causative agent1 . Hence, our study aims at assessing the validity in Government Medical College, Thiruvananthapuram, after assessing the specificity and sensitivity of amylase and lipase in alcoholic and non-alcoholic patients separately and lipase amylase ratio as an indicator to distinguish acute alcoholic from non-alcoholic pancreatitis. We also wanted to study the prevalence of pancreatitis in age group of 20 - 40. METHODS This is a diagnostic test evaluation conducted among 92 inpatients of Department of General Surgery selected through consecutive sampling. After randomly selecting patients admitted with a provisional diagnosis of acute pancreatitis, the first investigator administered the consent form, if accepted, examined the patient, evaluated the laboratory parameters. Then these patients were prospectively followed and evaluated. Data are then analysed using Excel spread sheet version 2019 and SPSS software and sensitivity, specificity, prevalence and diagnostic accuracy were determined. RESULTS Among 92 patients, 80 (87 %), 55 (58.8%) and 25 (27.2%) were found to have pancreatitis, alcoholic and non-alcoholic causes respectively. 35 (38 %) patients were in the age group of 31 – 35 years. It was found that lipase has 94.55 % &amp; 91.6 % sensitivity and specificity in alcoholic and 84 % &amp; 91.6 % sensitivity and specificity in non-alcoholic pancreatitis patients, respectively, and amylase has 69 % &amp; 91.67 % sensitivity and specificity in alcoholic and 72 % &amp; 91.67 % sensitivity and specificity in non-alcoholic pancreatitis respectively. CONCLUSIONS Serum amylase and lipase are inevitable investigations with good sensitivity and specificity in the diagnosis of acute pancreatitis. Lipase amylase ratio &gt;2 is diagnostic of alcoholic pancreatitis. KEYWORDS Acute Pancreatitis, Acute Alcoholic Pancreatitis, Acute Non-Alcoholic Pancreatitis, Specificity of Lipase and Amylase, Lipase Amylase Ratio

Risk of Acute Alcohol Pancreatitis is not Increased in Patients with Previous Biliary Pancreatitis in a 10-year Follow-up

Risk of Acute Alcohol Pancreatitis is not Increased in Patients with Previous Biliary Pancreatitis in a 10-year Follow-up

Spontaneous rupture of the pancreatic pseudocyst into the duodenum with massive upper gastrointestinal bleeding: case report and literature review

Pancreatic pseudocyst is one of the common complications of both acute and chronic pancreatitis. While most pseudocysts resolve spontaneously with conservative treatment, larger pseudocysts are more likely to cause complications, such as, spontaneous rupture into the gastrointestinal tract and are usually associated with life-threatening bleeding, which is life threatening complication. Endoscopic or surgical drainage may be necessary for uncomplicated persistent large cysts. We present a case of 32 year old Indian male, admitted to our department, who was a known case of alcoholic acute pancreatitis treated conservatively and developed massive upper GI bleeding and shock. CT angiography and upper GI endoscopy failed so he was taken to theatre several time due to bleeding, recurrent bleeding and a major bile leak. Unfortunately, he was expired. Current study highlights this serious rare life-threatening complication.

Assessment of the course of acute pancreatitis in the light of aetiology: a systematic review and meta-analysis

The main causes of acute pancreatitis (AP) are biliary disease, alcohol consumption, hypertriglyceridaemia (HTG) and endoscopic retrograde cholangiopancreatography (ERCP). The aim of this meta-analysis was to evaluate the effects of these aetiological factors on the severity and outcome of AP. Pubmed and Embase were searched between 01/01/2012 and 31/05/2020. Included articles involved adult alcoholic, biliary, HTG- or post-ERCP AP (PAP) patients. Primary outcome was severity, secondary outcomes were organ failures, intensive care unit admission, recurrence rate, pancreatic necrosis, mortality, length of hospital stay, pseudocyst, fluid collection and systematic inflammatory response syndrome. Data were analysed from 127 eligible studies. The risk for non-mild (moderately severe and severe) condition was the highest in HTG-induced AP (HTG-AP) followed by alcoholic AP (AAP), biliary AP (BAP) and PAP. Recurrence rate was significantly lower among BAP vs. HTG-AP or AAP patients (OR = 2.69 and 2.98, 95% CI 1.55–4.65 and 2.22–4.01, respectively). Mortality rate was significantly greater in HTG-AP vs. AAP or BAP (OR = 1.72 and 1.50, 95% CI 1.04–2.84 and 0.96–2.35, respectively), pancreatic necrosis occurred more frequently in AAP than BAP patients (OR = 1.58, 95% CI 1.08–2.30). Overall, there is a potential association between aetiology and the development and course of AP. HTG-AP is associated with the highest number of complications. Furthermore, AAP is likely to be more severe than BAP or PAP. Greater emphasis should be placed on determining aetiology on admission.

S0036 Examining Healthcare Utilization Trends for Acute Pancreatitis in a Large Health System

INTRODUCTION: Acute pancreatitis (AP) is the third most common cause of gastrointestinal (GI)-related hospitalizations in the US and the fourth leading GI illness associated with all-cause 30-day readmissions. Readmissions are associated with increased healthcare utilization as well as mortality from AP at one year. To minimize risk for readmissions, guidelines recommend smoking/alcohol cessation counseling and same-admission cholecystectomy for alcoholic and gallstone AP, respectively. We examined healthcare utilization trends for AP using encounters as a proxy within a large health system. METHODS: ICD-10 codes for AP were used to identify patients who presented to emergency departments (ED) within the MedStar Health system between March 2015 and June 2019. 4,043 patient encounters were eligible for retrospective chart review; these included ED visits and inpatient admissions. Manual review yielded 2,542 charts with extractable clinical information, 1,903 of which had AP as defined by Revised Atlanta Classification (RAC). Variables such as demographics, ever-history of AP, and recent AP within the past 30 days requiring an ED visit were collected. Statistical analysis was performed using GraphPad PRISM. RESULTS: Of 1,903 patients who satisfied RAC for AP, 184 (9.67%) had represented within 30 days following discharge from index presentation. Of those who returned, 22.3% had gallstone pancreatitis and 27.7% had alcoholic pancreatitis as their diagnosis on index hospitalization. 39.7% of those with gallstone pancreatitis had a same-admission cholecystectomy. Those with ever-history of AP were more likely to return following discharge (OR 1.51, P = 0.0136); this effect was more pronounced in patients who had presented immediately prior to index encounter (OR 3.62, P < 0.001). Those who had a previous encounter within the past 30 days had a statistically significant longer length of stay. There was no statistically significant difference in need for ICU level of care between those who were admitted within past 30 days and those who were not. CONCLUSION: Patients with prior encounters for AP are at increased risk for returning to an acute care site and thus increased healthcare utilization. These re-encounters tend to be associated with longer length of stays. Following guidelines and identifying subpopulations most at risk for readmissions would allow for targeted interventions to decrease healthcare utilization.

S3335 Atypical Presentation of Acute Alcoholic Pancreatitis

S3335 Atypical Presentation of Acute Alcoholic Pancreatitis