Acute Alcoholic Pancreatitis Research Articles

A 5-Year Retrospective Cohort Study: Epidemiology, Etiology, Severity, and Outcomes of Acute Pancreatitis.

The aim of this study was to evaluate the epidemiology, etiology, severity, and outcomes of acute pancreatitis (AP) in the southern Sichuan region of China. All patients with first-attack AP between 2013 and 2018 in the Affiliated Hospital of Southwest Medical University were retrospectively identified. The etiology tendency was analyzed, and the relationship was defined with sex, aging, severity, length of stay, and mortality. Three thousand twenty-eight patients were enrolled for analysis. Acute biliary pancreatitis had the highest incidence rate; the second and third most common causes were hypertriglyceridemic (14.4%) and alcoholic (14.2%), followed by idiopathic (13.6%), mixed etiology (12.9%), and miscellaneous (2.31%). Patients with alcoholic AP were more likely to be middle-aged males, whereas patients with acute biliary pancreatitis were more likely to be elderly females (P < 0.05). The overall mortality in the hospital was 1%, and there was no difference in each etiological groups (P > 0.05). Biliary disease was the predominant etiology of AP in southern Sichuan of China, and hypertriglyceridemia ranked second. The proportion of hypertriglyceridemic AP and mixed etiology AP gradually increased, whereas idiopathic AP decreased. There were different etiology proportion of AP according age, sex, and severity.

Evaluation of 880 patients diagnosed with acute pancreatitis according to the Revised Atlanta Classification: A single-center experience.

OBJECTIVE The Revised Atlanta Classification (RAC) is increasingly used in the evaluation of patients diagnosed with acute pancreatitis (AP). In our study, we aimed to evaluate the etiology, disease severity, and mortality rates of patients diagnosed with AP in our center in the previous 6 years. METHODS Patients diagnosed with AP between 2013 and 2018 were evaluated. AP etiology, demographic data, disease severity, and mortality rates according to the RAC were evaluated. RESULTS A total of 880 patients were included in the study. Five hundred and eighteen (59%) patients were female and 362 (41%) were male. Regarding the etiology, 474 (53.9%) patients had biliary AP (BAP), 71 (8.1%) had hyperlipidemic AP (HAP), and 44 (5%) had alcoholic AP (AAP). According to the RAC, 561 (63.7%) patients were considered to be in the mild AP group (MAP), 268 (30.5%) in the moderately severe AP (MSAP), and 51 (5.8%) in the severe AP (SAP). The mortality rate was 4.8% in the MSAP group and 49% in the SAP group. Mortality was 2.3 times in patients over 65 years old and 3.7 times higher in patients with ischemic heart disease. CONCLUSIONS In our country, BAP is still the main etiology of acute pancreatitis. Over the years, we have seen a decrease in BAP and idiopathic AP cases, while there was an increase in HAP cases due to factors such as lifestyle changes and fatty nutrition. We found that mortality was associated with disease severity, advanced age (> 65 y), hypertension, and ischemic heart disease regardless of the etiology.

Acute pancreatitis in Chile: A multicenter study on epidemiology, etiology and clinical outcome. Retrospective analysis of clinical files

BackgroundEpidemiology of acute pancreatitis (AP) is variable in different geographical regions. ObjectivesTo compare etiology and severity of AP to published data from South America and the rest of world, study impact of demographical factors and treatment on its outcome in Chilean hospitals. MethodsMulticenter observational study. Data of consecutive patients with AP were collected at the moment of discharge from 11 centers and retrospectively analyzed. ResultsData of 962 patients were included in the analysis, 447 men and 515 women. Mean age was 48,2 years. Biliary etiology was significantly more frequent in women (70%) than in men (52%). Conversely, alcohol was responsible for about 17% of AP in men but exceptional in women. Mild AP was seen in 73.4%, moderately severe in 14.1% and severe in 13%. The overall mortality was 2.5% (24 of 962): 0.3%, 3.1% and 15.1% in mild, moderately severe and severe cases, respectively. No difference was found in the mortality and severity of biliary versus alcoholic AP, while hypertriglyceridemia induced AP was more severe, without increased mortality. Severity and mortality increased with age. ERCP was performed in 16% of biliary pancreatitis. Adherence to main guidelines was heterogeneous: more than half of mild AP patients were admitted to critical care units and antibiotics were used in about 25% them. ConclusionThis is the first multicenter study in Chile on AP. When compared to literature, we found similar severity distribution and an acceptably low mortality. Biliary etiology was dominant, but alcohol was also important in men.

Increase in the incidence of alcoholic pancreatitis and alcoholic liver disease in Iceland: impact of per capita alcohol consumption

Objective: To analyze the incidence of acute alcoholic pancreatitis and of severe alcoholic liver disease (ALD) and its association with per capita alcohol consumption with identification of both alcoholic cirrhosis (AC) and severe alcoholic hepatitis (AH), in a population-based setting.Methods: A search was undertaken in diagnoses database for diagnostic codes in order to find patients hospitalized with incident acute alcoholic pancreatitis (AP) and alcoholic liver disease in Iceland in 2001–2015. Diagnoses were verified in all patients who were retrospectively reviewed. Those with ALD had either AC or AH. Alcohol sales during the study period were obtained from Statistics Iceland.Results: Overall, 273 patients with acute AP, mean age at diagnosis 50 (14) years, 74% males and 159 patients with ALD, mean age 57 (11) years, 73% males, were identified. Mean per capita alcohol consumption was 6.95 (0.4) liters and increased by 21% over the study period. The annual incidence of AP increased from 4.2 per 100.000 to 9.5 and ALD from 1.6 to 6.1 per 100.000. Trend analysis showed a significant annual increase of 7% (RR 1.07, 95%CI 1.04–1.10) for AP and an annual increase of 10.5% (RR 1.10, 95%CI 1.06–1.15) for ALD. The increase was only significant in males.Conclusions: Increase per capita alcohol consumption over a 15 year study period was associated with an increase in the incidence of severe alcoholic liver disease and alcohol-related acute pancreatitis in males but not in females.

Incidence of non biliary non alcoholic acute pancreatitis in a tertiary hospital

Background: Acute pancreatitis is an important cause of hospital admission with acute abdomen. It is responsible for significant morbidity and also mortality in patients.&#x0D; Objective: To determine the incidence of non-biliary nonalcoholic acute pancreatitis (Non A non B) and also to compare the incidence with alcoholic and biliary pancreatitis in the department of surgery of Chittagong Medical College Hospital, Bangladesh as well as with the developed countries&#x0D; Methods: This prospective study was carried on 75 patients of both sex having acute abdominal pain characteristic of acute pancreatitis and serum amylase &gt;3 times normal, admitted in General Surgery wards in CMCH and supported by biochemical test during June 2008 to May 2010.&#x0D; Results: The mean (±SD) age was 36.1±15.4 years and 32.7±14.3 years in male and female group respectively (p&gt;0.05) and maximum number was found in the age group of 20-30 years in both groups. Choledocolithiasis were 2(33.3%) and 7(21.9%) in male and female respectively evaluated by USG. Sludge in GB 1(16. 7%) in male and 7(21.9%) in female. Biliary ascariasis 3(50.0%) and 16(50.0%) in male and female respectively. Alcoholic was found 4(16.0%), Biliary 2(8.0%) and Non Alcoholic non Biliary 19(78.0%) in male patients. Biliary 32 (64.0%) and Non Alcoholic non Biliary 18(36.0%) in female patients. The difference was statistically significant (p&lt;0.05). It was observed that the total patients were 75 among them Alcoholic was 4(5.3%), Biliary was 34(45.3%) and Non Alcoholic non Biliary was 37(49.3%) of study patients.&#x0D; Conclusion: Non-A non-B acute pancreatitis accounts for about a half - of all cases of acute pancreatitis and is significantly less frequent among female patients. Biliary pancreatitis was higher in female subjects. Bilio pancreatic ascariasis is 50.0% in both male and female subjects.&#x0D; Journal of Surgical Sciences (2017) Vol. 21 (2): 85-88

Serum lipase amylase ratio in predicting the etiology of acute pancreatitis

Background: Acute pancreatitis remains a major cause of significant morbidity and mortality. Alcoholism and biliary tract stone disease are the main causes in up to 80% of cases. The diagnosis of acute pancreatitis is based on the correlation of clinical, biochemical, and radiological criteria. Serum lipase and amylase have been used to diagnose acute pancreatitis with values greater than three times the upper limit of normal being diagnostic. Objective: The aim is to study the value of serum lipase: amylase ratio in predicting the etiology of acute pancreatitis. Materials and Methods: This prospective study was conducted in a tertiary care hospital in North-East India during a 2-year period. The serum lipase/amylase ratio has been evaluated in 52 patients (31 acute alcoholic pancreatitis, 19 acute gallstone pancreatitis, 2 idiopathic). Results: Analysis of data showed that patients with acute alcoholic pancreatitis had higher serum lipase levels (2722.5 ± 285.7, mean ± standard deviation) compared to acute gallstone pancreatitis (1565.21 ± 198.2). On the other hand, acute gallstone pancreatitis patients had higher serum amylase (862.3 ± 105.5) compared to acute alcoholic pancreatitis patients (683.03 ± 618.31). Determination of lipase: amylase ratio showed that out of 31 patients of acute alcoholic pancreatitis 22 patients (71%) had lipase: amylase ratio ≥3. Out of 19 patients of acute gallstone pancreatitis, 17 patients (89.5%) had lipase: amylase ratio Conclusion: Serum lipase: amylase ratio fixed at 3.0 can assist in differentiating acute biliary pancreatitis from acute alcoholic pancreatitis. The lipase: amylase ratio ≥3 is observed in alcoholic acute pancreatitis while biliary pancreatitis has ratio

Worldwide Variations in Demographics, Management, and Outcomes of Acute Pancreatitis

Few studies have compared regional differences in acute pancreatitis. We analyzed data from an international registry of patients with acute pancreatitis to evaluate geographic variations in patient characteristics, management, and outcomes. We collected data from the APPRENTICE registry of patients with acute pancreatitis, which obtains information from patients in Europe (6 centers), India (3 centers), Latin America (5 centers), and North America (8 centers) using standardized questionnaires. Our final analysis included 1612 patients with acute pancreatitis (median age, 49 years; 53% male, 62% white) enrolled from August 2015 through January2018. Biliary (45%) and alcoholic acute pancreatitis (21%) were the most common etiologies. Based on the revised Atlanta classification, 65% of patients developed mild disease, 23% moderate, and 12% severe. The mean age of patients in Europe (58 years) was older than mean age for all 4 regions (46 years) and a higher proportion of patients in Europe had comorbid conditions (73% vs 50% overall). The predominant etiology of acute pancreatitis in Latin America was biliary (78%), whereas alcohol-associated pancreatitis accounted for the highest proportion of acute pancreatitis cases in India (45%). Pain was managed with opioid analgesics in 93% of patients in North America versus 27% of patients in the other 3 regions. Cholecystectomies were performed at the time of hospital admission for most patients in Latin America (60% vs 15% overall). A higher proportion of European patients with severe acute pancreatitis died during the original hospital stay (44%) compared with the other 3 regions (15%). We found significant variation in demographics, etiologies, management practices, and outcomes of acute pancreatitis worldwide. ClinicalTrials.gov number: NCT03075618.

18 Characteristics and 30-Day Outcomes of Acute Pancreatitis Admissions According to Etiology: A Nationwide Analysis

INTRODUCTION: Acute pancreatitis (AP) is a frequent cause of hospitalization in the United States. The major etiologies of AP are alcohol, choledocholithiasis, and drug-induced. We aim to describe demographic, clinical, and admission characteristics of AP hospitalizations according to etiology. In addition, we compared in-hospital and 30 day mortality and readmission outcomes among the three major AP subtypes. METHODS: We performed a retrospective analysis of the 2016 National Readmission Database. Hospital admissions of adults (&gt;18 years of age) with the primary or secondary discharge diagnosis of AP. Specific ICD-10 codes were used to classify AP into biliary pancreatitis (K851), alcoholic pancreatitis (K852), and drug-induced pancreatitis (K853). Patients with nonspecific AP codes were classified as biliary pancreatitis if they had a concomitant diagnosis of cholelithiasis and as alcoholic AP if they had a diagnosis of alcohol abuse. Non-specific AP admissions were excluded. Characteristics and 30-day outcomes of the three groups were compared using the X-square test for categorical variables and the one-way analysis of variance (ANOVA) for continuous variables. RESULTS: A total of 81,382 admissions met the inclusion criteria: 32,459 had biliary AP, 46,438 alcoholic AP, and 2,485 drug-induced AP. Patients with alcoholic AP were more likely to be male (69.1%) and younger (mean age 46.6) compared to the other groups. Patients with biliary AP were more likely to develop cholangitis (1.8%) compared to the other groups (≤0.2%). HIV was more associated with drug-induced pancreatitis (1.4%) compared to the other groups (≤0.4%). Mean length of stay was longest (5.9 days) and mean costs were highest ($15,367) in biliary AP. These were lowest in drug induced AP (4.2 days and $9413, respectively). In-hospital mortality (0.9%) and 30-day mortality (1.3%) was highest in biliary AP compared to the other groups. Thirty day- readmissions were highest in alcoholic AP (14.3%) compared to drug induced AP (11.5%) and biliary AP (10.1%). CONCLUSION: In this large, nationally representative patient sample, drug induced AP had the lowest length of stay and costs, while alcoholic AP had the highest 30-day readmission rates (14.3%). Biliary pancreatitis was associated with the highest in-hospital and 30-day mortality. Knowledge of these findings may allow us to design and target future studies to mitigate the high readmission rates in alcoholic pancreatitis, and the complications and mortality in biliary pancreatitis.

1259 From Pancreatitis to Takotsubo: A Rare Complication of Acute Pancreatitis

INTRODUCTION: Takotsubo cardiomyopathy or stress cardiomyopathy (TCM) is a transient reversible form of cardiomyopathy. It is characterized by reduced ejection fraction and signs of myocardial ischemia and often precipitated by acute emotional or physical stressors. We present a rare case of TCM in a postmenopausal woman triggered by acute alcoholic pancreatitis. CASE DESCRIPTION/METHODS: A 57-year-old female with a history of alcohol abuse and diabetes mellitus presented to the emergency department with a two-day history of severe diffuse abdominal pain with radiation to the back. Associated symptoms included nausea and vomiting. Vital signs were within normal limits. Physical examination was significant for a mildly tender abdomen. Laboratory findings revealed leukocytosis of 14.6 and lipase of 882. All other chemistry and complete blood count labs were within normal limits. CT abdomen without contrast revealed peripancreatic fat stranding suggestive of acute pancreatitis. The patient was admitted for IV fluid resuscitation and pain management. On day 2 of admission, the patient became dyspneic and desaturated to 82% on room air. Stat chest x-ray showed flash pulmonary edema. Bedside ultrasound revealed a dilated IVC. Troponin (0.97) and BNP (1627) levels were elevated, concerning for acute heart failure exacerbation. EKG revealed no acute ischemic changes. The patient was aggressively diuresised with significant improvement in respiratory status. Transthoracic echocardiography (TTE) revealed a left ventricular ejection fraction (LVEF) of 40% with basal segment hyperkinesis but apical akinesis consistent with stress-induced cardiomyopathy. Follow up coronary angiography revealed normal coronary vessels. The patient was started on guideline-based heart failure therapy and was discharged to home in stable condition. A repeat TTE obtained 4 months later revealed unchanged LVEF and persistent apical akinesis in the setting of persistent alcohol use. Guideline directed therapy was continued and the patient was counseled on alcohol cessation. DISCUSSION: Acute pancreatitis induced TCM is rare. Our case further confirms the heterogenicity of TCM, including non-classical stressors such as alcohol abuse which may delay myocardial recovery.

1372 A Rare Case of Purtscher's Retinopathy in the Setting of Acute Alcoholic Pancreatitis

INTRODUCTION: Purtscher's retinopathy (PUR) is a rare condition first described in 1910. Occlusive microvasculopathy is characterized by sudden visual loss with multiple areas of retinal whitening in the posterior pole. Associated with acute pancreatitis, connective tissue disorders, renal failure, childbirth, bone marrow transplantation. Proteases like trypsin activate the complement system cascade causing coagulation and leukoembolization of the retinal precapillary arterioles. The emboli lodge in the arterioles producing the clinical appearance of PUR with impaired visual acuity and visual field loss. We present a case of a young female with repeat acute pancreatitis who developed sudden visual changes seconday to PUR. CASE DESCRIPTION/METHODS: 28 yo F with PMH of Etoh abuse, gastritis, Mallory-Weiss tear and prior admissions for pancreatitis presented to ED with emesis and abdominal pain for one day. Exam revealed a diffusely tender abdomen. Labs included lipase (939 U/L) (aspartate aminotransferase = 351 U/L, alanine aminotransferase = 179 U/L, alkaline phosphatase = 133 U/L) and hyperbilirubinemia (1.8 mg/dL). Abdominal U/S showed peripancreatic edema correlating acute pancreatitis along with hepatomegaly and steatosis. On day 1 of admission pt complained of visual disturbances upon awakening. Acute visual changes included blurriness, flashes and floaters which completely resolved by the evening. Bedside ophthalmologic exam revealed multiple cotton wool spots bilaterally. Ophthalmology evaluation revealed macular edema and neurosensory detachment of the macula bilaterally secondary to PUR. Visual field testing showed loss of central field bilaterally with preserved peripheral vision. Acuity was 20/200 bilaterally and received intraocular steroid injections with weekly follow up. Exam at 8 weeks demonstrated improvement to visual acuity to 20/40 bilaterally. DISCUSSION: Purtscher Flecken are variable, polyglonal regions of retinal whitening with a clear zone and are pathognomonic. The treatment for the ocular complications of PuR have not been proven and prognosis depends on the areas of the retina that are affected. Isolated case reports have shown rapid improvement in vision with high dose IV steroids. Steroids help preserve the neuronal membrane and suppress granulocyte aggregation caused by complement activation. Patient's complaining of changes in vision following an episode of acute pancreatitis should undergo eye examination in order to rule out Purtscher-like retinopathy.

1318 Pancreaticopleural Fistula in a Patient With Recurrent Alcoholic Pancreatitis: Combined Endoscopic and Medical Management

INTRODUCTION: Pancreaticopleural fistula (PPF) is a rare complication of pancreatitis, resulting from disruption of the pancreatic duct. This injury may be secondary to acute/chronic pancreatitis, trauma, or surgery. Here we describe a patient with a PPF, and our workup and treatment for this rare condition. CASE DESCRIPTION/METHODS: A 61-year-old male with COPD, alcohol misuse, and history of recurrent acute alcoholic pancreatitis complicated by pseudocysts was admitted with one month of worsening shortness of breath from a large left pleural effusion, which reaccumulated within four days after a 1.6 L thoracentesis. On examination he had mild abdominal tenderness in the RUQ and epigastrium. Labs were notable for serum amylase 1105 U/L, lipase &gt;1000 U/L, and WBC 10.8. He underwent another thoracentesis, removing 1.5 L of fluid which was an exudate with amylase greater than 2000 U/L. CT of the chest and abdomen showed a subdiaphragmatic LUQ fluid collection with communication to the pancreatic body and duct. A chest tube was then placed to prevent fluid re-accumulation. MRCP confirmed a PPF from the proximal pancreatic body duct to the left pleura. He was started on octreotide. ERCP confirmed a fistula originating from the distal pancreatic duct but attempts to pass a wire into the dorsal pancreatic duct were unsuccessful, and a ventral pancreatic sphincterotomy was performed. His chest tube was removed after one day, and he was discharged to continue octreotide at home. Unfortunately, he returned the following day with complaints of dyspnea. Pancrelipase was then added in an attempt to minimize pancreatic exocrine secretions. On follow-up 1 and 2 months later, the pleural fluid is much smaller, and the patient's dyspnea has resolved. DISCUSSION: Here we present a novel management of PPF without pancreatic duct stent placement and instead with pancreatic sphincterotomy to divert pancreatic secretions away from the fistula tract and medical therapy (octreotide and pancrelipase) to reduce the pancreatic secretion. The diagnosis was reached through a combination of clinical history, lab studies (particularly, the elevated amylase in the pleural fluid), and CT and MR imaging. This was further confirmed with ERCP, which is useful especially if a stent can be placed to divert secretions away from fistula tract. Ultimately, this diagnosis requires a high index of suspicion, particularly in patients who present with recurrent effusions in the setting of pancreatitis.

GC-MS based metabolomics strategy to distinguish three types of acute pancreatitis

Acute pancreatitis (AP) is a progressive systemic inflammatory response with high morbidity and high mortality, which is mainly caused by alcohol, bulimia, gallstones and hyperlipidemia. The early diagnosis of different types of AP and further explore potential pathophysiological mechanism of each type of AP is beneficial for optimized treatment strategies and better patient's care. In this study, a metabolomics approach based on gas chromatography-mass spectrometry (GC-MS), and random forests algorithm was established to distinguish biliary acute pancreatitis (BAP), Hyperlipidemia acute pancreatitis (HLAP), and alcoholic acute pancreatitis (AAP), from healthy controls. The classification accuracies for BAP, HLAP, and AAP patients compared with healthy control, were 0.886, 0.906 and 0.857, respectively, by using 5-fold cross-validation method. And some special metabolites for each type of AP were discovered, such as l-Lactic acid, (R)-3-Hydroxybutyric acid, Phosphoric acid, Glycine, Erythronic acid, l-Phenylalanine, d-Galactose, l-Tyrosine, Arachidonic acid, Glycerol 1-hexadecanoate. Furthermore, associations between these metabolites with the metabolism of amino acids, fatty acids were identified. Our studies have illuminated the biomarkers and physiological mechanism of disease in a clinical setting, which suggested that metabolomics is a valuable tool for identifying the molecular mechanisms that are involved in the etiology of BAP, AAP, HLAP and thus novel therapeutic targets.

Long-term Outcome and Causes of Death for Working-age Patients Hospitalized Due to Acute Pancreatitis With a Median Follow-up of 10 Years.

To examine long-term survival and causes of death among working-age patients with acute pancreatitis (AP) compared with the normal population. Few studies have investigated long-term survival after AP and recurrent AP compared with the normal population; moreover, results from those studies are difficult to compare, due to suboptimal control populations and wide variations in follow-up times. This retrospective, registry-based study included 1644 patients with AP, aged 18 to 64 years, admitted to Oulu University Hospital in 1995 to 2012. Patient data were compared with data from 8220 age- and sex-matched controls that resided in the hospital district area. Alcohol was the main etiologic factor causing 71.4% of the cases. During the median follow-up time of 9.5 years, mortality was 24.2% in the study group and 6.3% in the control group (P < 0.001). Alcohol-related factors caused 39.4% of deaths and alcohol AP was the main single cause of death (16.3%) in the study group. Of all fatal AP cases, 42.9% were related to recurrence. Survival was similar among patients with nonalcohol AP and controls. The long-term mortality among patients admitted to the hospital due to (mainly alcohol induced) AP was 4 times higher than that in the age- and sex-matched control population. The significant difference in the causes of death between patients with alcohol AP and controls could be explained by alcohol-related diseases. Occurrences of AP without an alcohol etiology had a minimal impact on survival.

Does Etiology of Pancreatitis Matter? Differences in Outcomes Among Patients With Post-Endoscopic Retrograde Cholangiopancreatography, Acute Biliary, and Alcoholic Pancreatitis.

We compared outcomes of acute alcoholic pancreatitis (AAP), acute biliary pancreatitis (ABP), and post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). This was a retrospective cohort study conducted at a tertiary care center between June 2007 and June 2012. A total of 300 (68%) patients were diagnosed with AAP, 88 (20%) with ABP, and 55 (12%) with PEP. Longer length of hospital stay (LOHS) was more common in ABP (23%) as compared with AAP (10%) and PEP (7%, P = 0.025). Pseudocyst (P = 0.048), organ failure (OF) (P = 0.01), need for interventions (P ≤ 0.001), and mortality (P = 0.002) occurred more in ABP as compared with other groups. Systemic inflammatory response syndrome was associated with LOHS of more than 10 days (P = 0.01) and multi-OF (P = 0.05). Chronic pancreatitis was associated more with pseudocyst (P < 0.001) and mortality (P = 0.03). Serum urea nitrogen of greater than 25 g/dL predicted LOHS of more than 10 days (P = 0.02), OF (P < 0.001), multi-OF (P < 0.001), and persistent OF (P < 0.001). Acute biliary pancreatitis is a more severe disease compared with PEP and AAP. Chronic pancreatitis, systemic inflammatory response syndrome, and high serum urea nitrogen are important predictors of morbidity.

Comparative study of the outcome between alcohol and gallstone pancreatitis in a high‐volume tertiary care center

Background and AimThe two most common etiologies of acute pancreatitis (AP) are alcohol and gallstone. Whether etiology contributes to the outcome in patients with AP is an unresolved issue, more so in the severe form of the disease. The aim is to study the effects of the etiological factors of alcohol and gallstone on the disease course and the role of etiology in the subgroup of severe AP.MethodsConsecutive patients of AP with alcohol or gallstone etiology were included. Various severity parameters and various outcome measures, such as need for organ support, intensive care, surgical or radiological intervention, hospital stay, and mortality, were evaluated between the two groups.ResultsOf the 759 patients, alcoholic pancreatitis was seen in 368 (48.5%), while gallstone disease was observed in 246 (32.4%). Gallstone pancreatitis occurred in older age (P < 0.0001), had a higher female predilection (P < 0.001), and a higher body mass index (P = 0.002) compared to alcohol pancreatitis. Both groups were similar in terms of development of various organ failures and various severity assessment scores. Alcoholic AP had higher rates of necrosis (P = 0.05) and the need for percutaneous catheter drainage (P = 0.02). Outcome measures such as length of hospital stay, need for intensive care, organ support, surgical intervention, or mortality were similar between the two groups. Subset analysis of severe AP (303 patients) showed no difference between the two etiologies with regard to outcome.ConclusionThe outcome of AP was independent of the etiology of the disease, alcohol or gallstone, and more so in the severe form of the disease. The number of local complications tends to be slightly higher in the alcoholic group.

Mechanisms of damage of acinar pancreatic cells in acute alcohol pancreatitis

The review analyzes the current data on the main mechanisms of toxic effects of alcohol and its metabolites on pancreatic acinar cells in acute pancreatitis. It is shown that the mechanisms of cellular damage are multicomponent and closely linked by the regulatory factors of the molecular level. At the early stage of the disease, they lead to the following structural and functional changes in acinar cells that promote the premature intracellular trypsinogen activation and autoaggression: sustained rise of cytosolic Ca2+ and excess of mitochondrial matrix Ca2+; destabilization due to lysosomes and zymogen granules; debective autophagy; mitochondrial depolarization; decreased ATP production and necrosis.

Development of pancreato-pleural fistula in recurrent acute alcoholic pancreatitis

Development of pancreato-pleural fistula in recurrent acute alcoholic pancreatitis

Prevalence, morbidity and mortality of hypertriglyceridemic acute pancreatitis in the General Hospital of Playa del Carmen, México. Analysis of five years

Introduction: Hypertriglyceridemia (HTG) is the underlying cause of pancreatitis in 7% of the general population and is the third cause after gallstones and alcohol. HTG may be associated with acute pancreatitis as an epiphenomenon or as a precipitant thereof. Generally, more than 75% of pancreatitis induced by hypertriglyceridemia is due to secondary causes and although these are not sufficient to elevate triglycerides to cause pancreatitis, a preexisting defect is required to obtain a TG&gt;1000 mg/dL to induce acute pancreatitis. Material and Method: To identify the prevalence morbidity and mortality of acute pancreatitis due to hypertriglyceridemia, a retrospective and cross-sectional observational clinical study was performed for a period of five years. Results: During the study period, 100 cases of acute pancreatitis of various etiologies were collected, 29 (29%) of which corresponded to acute pancreatitis of hypertriglyceridemic origin; history of risk: type 1 Diabetes mellitus one case (3.4%); Type 2 Diabetes mellitus 27 cases (24%); history of alcoholism nine cases (31%); positive smoking 4 cases (13.8%); hypertriglyceridemia 27 cases (94%); obesity 17 cases (59%); lipemic serum 19 cases (65.5%), and In-hospital stays average six days. Mortality in one case. Discussion: In the Mexican national survey of ENASUT 2012, it was found by age group that hypercholesterolemia is highest in the age groups of 50-69 years of age. (Table 1) The frequency of hyperlipidemia in patients with pancreatitis ranges from 12 to 38%, and of hypertriglyceridemia, between 4 and 53%; what is important is to define whether its presence is primary or causal, or secondary or consequence of other clinical conditions such as Diabetes mellitus, alcohol abuse, pregnancy or use of medications. The triglycerides were obtained on routine laboratory tests in our hospital and their values were steadily elevated and the hipertrigliceridemic acute pancreatitis is the principal cause instead the alcoholic acute pancreatitis. Keywords: Pancreatitis acute;Hypertriglyceridemic; Prevalence; Morbidity; Mortality

Risk factors for chronic and recurrent pancreatitis after first attack of acute pancreatitis

Objective: To study the outcome of acute pancreatitis and risk factors for recurrent and chronic pancreatitis in a population based cohort of patients with first-time acute pancreatitis.Methods: All patients with first-time acute pancreatitis from 2006–2015 in Iceland were retrospectively evaluated. Medical records were scrutinized and relevant data extracted.Results: 1102 cases of first-time acute pancreatitis were identified: mean age 56yr, 46% female, 41% biliary, 21% alcohol, 26% idiopathic, 13% other causes, mean follow-up 4yr. 21% had ≥1 recurrent acute pancreatitis which was independently related to alcoholic (vs. biliary hazard ratio (HR) 2.29, 95% confidence interval (CI) 1.51–3.46), male gender (HR 1.48, 95%CI 1.08–2.04), and smoking (HR 1.62, 95%CI 1.15–2.28). 3.7% developed chronic pancreatitis. Independent predictors were recurrent acute pancreatitis (HR 8.79, 95%CI 3.94–19.62), alcoholic (vs. biliary HR 9.16, 95%CI 2.71–30.9), local complications (HR 4.77, 95%CI 1.93–11.79), and organ-failure (HR 2.86, 95%CI 1.10–7.42).Conclusions: Recurrent acute pancreatitis occurred in one-fifth of patients. Development of chronic pancreatitis was infrequent. Both recurrent acute pancreatitis and chronic pancreatitis were related to alcoholic acute pancreatitis, while recurrent acute pancreatitis was associated with smoking and male gender, and chronic pancreatitis to recurrent acute pancreatitis, organ-failure, and local complications.

Trends in the Use of Endoscopic Retrograde Cholangiopancreatography for the Management of Acute Pancreatitis in the United States

Introduction: Acute Pancreatitis (AP) is one of the most frequent gastrointestinal causes for hospitalization in US. The incidence of AP has increased over time. Endoscopic retrograde cholangiopancreatography (ERCP) has historically provided a means for both diagnosis and treatment of AP. Methods: We performed a retrospective cohort study using the Nationwide Inpatient Sample from 2002-2014. We identified patients with a primary discharge diagnosis of AP who underwent ERCP via ICD-9 codes. We further categorized acute pancreatitis into two categories i.e biliary and alcoholic AP. We analyzed patient and hospital characteristics, length of stay, and in-hospital mortality, and adjusted for weighted sample schema. Results: From 2002 to 2014, the AP discharges increased from 235589 (81.9 discharges per 100,000 persons) to 279145 (87.5 discharges per 100,000 persons). The percentage of discharges with ERCP declined from 10.84% in 2002 to 6.91% in 2014. For Biliary AP, the ERCP declined from 32.71% in 2002 to 24.04% in 2014. For Alcoholic AP, ERCP declined from 1.36% to 0.77%. Patients undergoing ERCP in biliary AP have decreased mortality than without (0.77% Vs 1.37%, P=0.001). In alcoholic AP, patients undergoing ERCP have increased mortality than without (1.24 Vs 0.64% P=0.002). The odds of getting ERCP was more with age above 70, female gender, Asian race, Medicare insurance status, urban teaching and large hospitals. The odds of having complications like shock, altered mental status, Acute Kidney injury, pleural effusion, acute respiratory failure & pseudocyst formation was more with alcoholic AP undergoing ERCP than with biliary AP. Median length of stay and median total hospital charges were more in hospitalizations with ERCP than without in both biliary and alcoholic pancreatitis. Conclusion: Over the last twelve years ERCP use in US hospitalizations with AP is declining because of newer imaging modalities. ERCP use in biliary AP was associated with having odds of decreased mortality, but in alcoholic AP it was associated with increased mortality. The Alcoholic AP patients undergoing ERCP were having more odds of complications as well. The cohort that underwent ERCP had increased total costs and charges. Further prospective studies are needed to elucidate whether increased mortality in alcoholic AP patients undergoing ERCP is because of procedure itself or these patients are sicker to begin with.801_A Figure 1. Complications and Procedures during Acute Pancreatitis Hospitalizations801_B Figure 2. Trends of In-Hospital Mortality, Median Length of Stay and Median Cost of Care in Acute Pancreatitis patients undergoing ERCP.