Attack Of Acute Pancreatitis Research Articles

Study of laparoscopic cholecystectomy in gallstones induced pancreatitis

Background: Many general surgeons still harbor a notion that laparoscopic cholecystectomy in patients with acute gallstone induced pancreatitis has a higher morbidity. The timing of cholecystectomy in these patients is a matter of debate. Aim of the study was to assess the degree of difficulty, the timing of laparoscopic cholecystectomy (LC), and the complications of surgery in patients of gall stone pancreatitis subjected to laparoscopic cholecystectomy.Methods: 69 patients were diagnosed with gall stone induced pancreatitis over a period of 12 months and 46 underwent laparoscopic cholecystectomy. After an acute attack of pancreatitis the procedure was performed on index admission or was delayed for an interval of 3 to 4 weeks, thereby dividing the study sample into two on the basis of timing of surgery. The severity of pancreatitis was graded according to the Revised Atlanta criteria.Results: All the patients who underwent laparoscopic cholecystectomy had either mild or moderate severity of pancreatitis. Comparing the two groups with regard to timing of cholecystectomy, no statistically significant difference was noted in operating time, difficulty in surgery, conversion rate to open procedure or post-operative stay.Conclusions: Laparoscopic cholecystectomy in patients with gallstone induced pancreatitis does not attribute any additional risk and does not have increased morbidity nor is there any increase risk of conversion.

Diabetes Mellitus is Associated With Mortality in Acute Pancreatitis.

Predicting severe pancreatitis is important for early aggressive management of patients with acute pancreatitis (AP). Despite the established role of diabetes mellitus (DM) in the risk of AP, the impact of DM on the clinical outcome in AP has not been fully elucidated. The objective of this study was to assess the risk of mortality and severity in AP among patients with type-2 DM. Patients diagnosed with first attacks of AP were enrolled from January 2013 to June 2015. A total of 201 patients (63.2% male, mean age, 59.4 y) with AP were included. Etiologies included gallstones (51.2%), alcohol (37.3%), hypertriglyceridemia (2%), and idiopathic causes (9.5%). There were 54 AP patients (26.9%) with type-2 DM. Severity indices in AP, such as Atlanta Classification (severe), Ranson score, and Bedside Index of Severity in Acute Pancreatitis, were higher in subjects with DM than those without DM. Prevalence of intensive care unit admission and mortality were higher in AP patients with DM compared with those without DM. The association between DM and increased risk of mortality in AP remained statistically significant even after adjustments for confounding factors and Atlanta Classification (odds ratio, 7.76, 95% confidence interval, 1.26-47.63, P=0.027). Type-2 DM was associated with severity and increased mortality in patients with AP. Our findings provide evidence of the potential role of DM in the pathogenesis and management of severe AP.

Therapeutic Options of Management of Pseudo Cyst of the Pancreas

The pancreatic pseudocyst is a common problem encountered in surgical practice. It usually followed an attack of acute pancreatitis or chronic pancreatitis or trauma. So early diagnosis and treatment is crucial to avoid complications such as infection, bleeding, rupture. The course of the disease cannot be predicted, some Resolved spontaneously, others enlarged and reached considerable sizes causing Pressure symptoms on nearby structures which need surgical intervention.

Role of computed tomography in diagnosis, follow-up, and minimally invasive treatment of acute pancreatitis

Background Acute pancreatitis is an inflammatory disease of the pancreas with variable involvement of other regional tissues or remote organ systems. It has a mild, self-limiting course in 80% of patients who recover without complications. The remaining patients have a severe disease with local and systemic complications, and this disease carries a mortality risk of 10–24%. Objective To examine the role of computed tomography (CT) in diagnosis, follow-up, and guided therapy in acute pancreatitis. Patients and methods The study was performed on 100 patients with acute pancreatitis from January 2014 to October 2016. There were 80 males and 20 females. Inclusion criteria Previously known acute pancreatitis attacks, clinically suspected acute pancreatitis, laboratory results suggesting acute pancreatitis, and patients with trauma with suspected pancreatic injury sequelae were the inclusion criteria. All patients were subjected to history taking; laboratory assessment, including serum amylase, lipase, creatinine levels, complete blood count, lipid profile (mainly triglyceride), and blood glucose; as well as CT scan to assess the pancreatic parenchyma, peripancreatic region, extrapancreatic ascites, pleural effusion, lung bases, and intestinal loops. Results The study included 100 patients whose age ranged from 9 to 83 years old, with a mean of 41.89 years. Overall, 80 (80%) patient were males and 20 (20%) patient were females. The CT showed sensitivity of 99.1% and specificity of 100% with positive predictive value of 100% and negative predictive value of 97% in the diagnosis of acute pancreatitis. Conclusion Acute pancreatitis can be severe and life-threatening. Imaging is central in the identification of complications, and radiological scoring systems can predict prognosis. With the current move toward minimally invasive treatment, the role of image-guided therapy is increasing and the need for surgical intervention is decreasing. CT is playing a golden role in diagnosis, follow-up, and guided therapy of acute pancreatitis.

Isoliquiritigenin Ameliorates Acute Pancreatitis in Mice via Inhibition of Oxidative Stress and Modulation of the Nrf2/HO-1 Pathway.

Oxidative stress plays a crucial role in the pathogenesis of acute pancreatitis (AP). Isoliquiritigenin (ISL) is a flavonoid monomer with confirmed antioxidant activity. However, the specific effects of ISL on AP have not been determined. In this study, we aimed to investigate the protective effect of ISL on AP using two mouse models. In the caerulein-induced mild acute pancreatitis (MAP) model, dynamic changes in oxidative stress injury of the pancreatic tissue were observed after AP onset. We found that ISL administration reduced serum amylase and lipase levels and alleviated the histopathological manifestations of pancreatic tissue in a dose-dependent manner. Meanwhile, ISL decreased the oxidative stress injury and increased the protein expression of the Nrf2/HO-1 pathway. In addition, after administering a Nrf2 inhibitor (ML385) or HO-1 inhibitor (zinc protoporphyrin) to block the Nrf2/HO-1 pathway, we failed to observe the protective effects of ISL on AP in mice. Furthermore, we found that ISL mitigated the severity of pancreatic tissue injury and pancreatitis-associated lung injury in a severe acute pancreatitis model induced by L-arginine. Taken together, our data for the first time confirmed the protective effects of ISL on AP in mice via inhibition of oxidative stress and modulation of the Nrf2/HO-1 pathway.

Acute pancreatitis in children: A single center experience over ten years.

Sağ E, Kaya G, Bahat-Özdoğan E, Karahan SC, İmamoğlu M, Sarıhan H, Çakır M. Acute pancreatitis in children: A single center experience over ten years. Turk J Pediatr 2018; 60: 153-158. Acute pancreatitis (AP) is an inflammatory disease characterized by sudden onset abdominal pain together with elevation of pancreatic enzymes and radiographic changes. Increased incidence of AP in children have been reported in recent reports. In this study; we aimed to analyze the demographic characteristics, etiology, outcome and incidence of AP among hospitalized children in our center. Medical records of the children with AP since January 2005 were analyzed from hospital files (N=63). Major etiologies were systemic diseases (14.3%), trauma (11.1%), cholelithiasis (9.5%); 54% (N=34) of the patients had mild AP, while 28.6% (N=18) had moderately severe AP and 17.4% (N=11) had severe AP. Organ dysfunction was found in 11 patients (17.4%) at initial examination. During the follow-up period (68.1±24.3 months), 10 patients (15.9%) experienced 24 recurring AP (RAP) attacks. Male gender, presence of local pancreatic or systemic complications at initial attack, metabolic and hereditary diseases were associated with the increased risk of RAP (p < 0.05 for all). The mortality rate associated with AP was 4.84%. There was an increase in the incidence of AP since 2010 (9.57 in 2009-2010 vs. 39.17/10,000 patients in 2015-2016 years; p=0.0002; OR: 4.1) among the hospitalized patients. Our results indicate that AP is a mild disease in children and the incidence is increasing among hospitalized children. Male gender, presence of local pancreatic or systemic complications at initial attack, metabolic diseases and hereditary diseases were associated with the increased risk of RAP.

EVALUATION OF ACUTE PANCREATITIS BY GLASGOW PROGNOSTIC SCORE

Objective To study the clinical course and to assess the severity of acute pancreatitis and its management based on Glasgow prognostic score.Material and methods It is a prospective study conducted on 50 consecutive cases of acute pancreatitis admitted to the hospital attached to Khaja Banda Nawaz Institute of Medical Sciences Kalaburgi.Results There were 40 male and 10 female M F 4 1 patients. The peak incidence was in the fourth decade with a median age of 41 years. The commonest etiology was alcohol abuse 70. It was followed by gallstones 20 and hypertriglyceridemia 4. Remaining cases were idiopathic 4 and hypocalcaemia 2. Glasgow scoring helped to categorize the patients into mild and severe cases which led to early diagnosis management and reduction in mortality.Conclusion The incidence of acute pancreatitis is found to be frequent in younger age.. Glasgow Scoring system helps to identify patients who are more likely to have a severe attack of acute pancreatitis requiring urgent treatment. Severe cases should be managed in well equipped ICU. Timely intervention by endoscopist and surgeon are crucial to reduce morbidity and mortality.nbsp

Management of Acute Pancreatitis in the Pediatric Population

Although the incidence of acute pancreatitis (AP) in children is increasing, management recommendations rely on adult published guidelines. Pediatric-specific recommendations are needed. The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas committee performed a MEDLINE review using several preselected key terms relating to management considerations in adult and pediatric AP. The literature was summarized, quality of evidence reviewed, and statements of recommendations developed. The authorship met to discuss the evidence, statements, and voted on recommendations. A consensus of at least 75% was required to approve a recommendation. The diagnosis of pediatric AP should follow the published INternational Study Group of Pediatric Pancreatitis: In Search for a CuRE definitions (by meeting at least 2 out of 3 criteria: (1) abdominal pain compatible with AP, (2) serum amylase and/or lipase values ≥3 times upper limits of normal, (3) imaging findings consistent with AP). Adequate fluid resuscitation with crystalloid appears key especially within the first 24 hours. Analgesia may include opioid medications when opioid-sparing measures are inadequate. Pulmonary, cardiovascular, and renal status should be closely monitored particularly within the first 48 hours. Enteral nutrition should be started as early as tolerated, whether through oral, gastric, or jejunal route. Little evidence supports the use of prophylactic antibiotics, antioxidants, probiotics, and protease inhibitors. Esophago-gastro-duodenoscopy, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasonography have limited roles in diagnosis and management. Children should be carefully followed for development of early or late complications and recurrent attacks of AP. This clinical report represents the first English-language recommendations for the management of pediatric AP. Future aims should include prospective multicenter pediatric studies to further validate these recommendations and optimize care for children with AP.

Association between acute pancreatitis and small intestinal bacterial overgrowth assessed by hydrogen breath test.

AIMTo elucidate the effects of small intestinal bacterial overgrowth (SIBO) on the severity and complications of acute pancreatitis (AP).METHODSIn total, 208 patients with AP as defined by the revised Atlanta classification were admitted to Xuanwu Hospital of Capital Medical University from 2013 to 2016. All patients were admitted within 72 h of AP onset. The hydrogen breath test was performed 7 d after AP onset to detect hydrogen production and evaluate the development of SIBO. The incidence of SIBO was analyzed in patients with AP of three different severity grades. The association between SIBO and complications of AP was also assessed.RESULTSOf the 27 patients with severe AP (SAP), seven (25.92%) developed SIBO. Of the 86 patients with moderately severe AP (MSAP), 22 (25.58%) developed SIBO. Of the 95 patients with mild AP (MAP), eight (8.42%) developed SIBO. There were significant differences in the rates of SIBO among patients with AP of different severities. Additionally, more severe AP was associated with higher rates of SIBO positivity (P < 0.05). SIBO in patients with AP mainly occurred within 72 h of the onset of AP. The incidence of organ failure was significantly higher in patients with SIBO than in those without (P < 0.05).CONCLUSIONSIBO occurs more frequently in patients with MSAP or SAP than in those with MAP, usually ≤ 72 h after AP onset. Additionally, SIBO is associated with organ failure.

Atrial natriuretic peptide reduces inflammation and enhances apoptosis in rat acute pancreatitis.

We previously reported that atrial natriuretic peptide (ANP) reduces serum amylase and intrapancreatic trypsinogen activation in the onset of acute pancreatitis whereas secretin increases them. In the present work, we sought to establish the effect of ANP and secretin on the inflammatory response and cell death in experimental acute pancreatitis. The expression and activity of key inflammatory mediators and apoptosis were evaluated in the presence or absence of the atrial peptide, secretin or both in cerulein-induced acute pancreatitis in rats. Also, ultrastructural changes in pancreatic acinar cells were assessed by transmission electron microscopy. ANP significantly reduced NF-κB activation and TNF-α intrapancreatic levels. Furthermore, it decreased inducible nitric oxide synthase and cyclooxygenase 2 expression and activity while it diminished myeloperoxidase activity. ANP also stimulated apoptosis as shown by caspase-3 expression and activation as well as TUNEL assay. These findings correlated well with the ultrastructural changes observed in the exocrine pancreas. Although secretin reduced various inflammatory markers, it also diminished caspase-3 activation and the overall response was the aggravation of the disease as reflected by the ultrastructural alterations of pancreatic acinar cells. In the presence of ANP, various effects evoked by secretin were antagonized. Present findings show that ANP significantly attenuated the severity of acute pancreatitis in the rat by inducing apoptosis and reducing the inflammatory response and further suggest that ANP may have eventual therapeutic implications in the disease and/or in medical interventions at risk of its developing like endoscopic retrograde cholangiopancreatography.

Clinical significance of B7-H3, an expression membrane type of myeloid-derived suppressor cell in patients with acute pancreatitis

Objective To explore the clinical significance of B7 family homology factor-3 (B7-H3), an expression membrane type of myeloid-derived suppressor cell (MDSC), in patients with acute pancreatitis (AP). Methods A total of 63 patients with AP initially treated in the Emergency Department at the First Affiliated Hospital of Soochow University from January, 2014 to December, 2015 were selected.Of them, 25 suffered from mild AP (MAP), 20 had moderate AP (MSAP) and 18 had severe AP (SAP). Another 20 healthy subjects with matching age and gender served as the control group. All patients with AP conformed to the diagnostic criteria of Guidelines or Diagnosis and Treatment of Acute Pancreatitis set in 2013 in China. Patients with other underlying diseases that might influence the clinical outcomes were excluded, including those with tumors, autoimmune diseases, viral infections, trauma and other disorders. A flowcytometer was used to detect the expression rate of MDSC in peripheral venous blood and the expression of B7-H3 on MDSC membrane. The continuous monitoring was carried out for 24 h, 48 h and 72 h in patients with AP. Results Compared with healthy subjects, the MDSC cells in patient groups 24 hours after AP onset increased notably(P<0.01)especially the highest increase in the SAP group, followed by the MSAP group and the lowest in the MAP group. There were significant differences in pairwise comparisons(P<0.05). From successive observation of each group, there was no significant difference in MDSC between the MAP group and the MSAP group 24 hours, 48 hours and 72 hours after AP onset. However, MDSC reached its peak 48 hours after AP onset, but it declined 72 hours after AP onset in the SAP group(P<0.05). B7-H3 expressed significantly 24 hours after AP onset, but there was no expression of B7-H3 in the healthy group. Meanwhile, B7-H3 was expressed most highly in the SAP group, followed by the MSAP group and lowest in the MAP group. There were significant differences in expression of B7-H3 found in pairwise comparisons(P<0.05). The successive observation showed that there was no significant difference in B7-H3 expression between the MAP group and the MSAP group 24 hours, 48 hours and 72 hours after AP onset. However, there was a trend of increase in B7-H3 expression as time prolonged found among 24 hours, 48 hours and 72 hours after AP onset in the SAP group (P<0.05). Conclusions The expressions of MDSC and B7-H3 were high in AP, and there were significant differences in both expressions among MAP, MSAP and SAP groups. These phenomena offer clues in further understanding about the immunological disorders during AP giving better guidelines for clinical practice. Key words: Acute pancreatitis; Myeloid-derived suppressor cell; B7 family homology factor-3

Serum Lipase Amylase Ratio in Predicting Aetiology, Severity and Outcome of Acute Pancreatitis in a Tertiary Care Hospital

Background: Acute pancreatitis is a relatively common disease with variable prevalence in different countries. Different modalities are available for predicting aetiology, severity and outcome of acute pancreatitis with different sensitivity and specificity. Moreover, some are not widely available, some are very expensive. A single, cheap, widely available marker with high sensitivity and specificity is yet to be identified. The present study intends to find out the utility of serum lipase amylase ratio in predicting the aetiology, severity and outcome of acute pancreatitis.Methods: This prospective, observational study was done at the Department of Gastrointestinal Hepatobiliary &amp; Pancreatic Disorders (GHPD), BIRDEM General Hospital, Dhaka, during the period of July 2014 to March 2016. A total of 71 patients with acute pancreatitis were included. Complete blood count, serum amylase, serum lipase, serum calcium, liver function test, renal function test, fasting lipid profile, ultrasonography of whole abdomen, CT scan of upper abdomen and arterial blood gas (ABG) were done in all patients. Statistical analysis was done with SPSS version 16.Results: Among 71 patients, 23(32.4%) were due to biliary cause, 15(21.1%) were due to hypertriglyceridaemia, 4(5.6%) were due to alcohol and 22(31%) were due to unknown causes. 45 (63.4%) patients had mild attack, 10(14.1%) patients had moderate attack and 16(22.5%) patients had severe attack of acute pancreatitis. Out of 71 patients, 17(23.9%) developed complication whereas 54(76.1%) developed no complication. Serum lipase amylase ratio in patients with biliary pancreatitis was 1.40±0.39 and in patients with non-biliary pancreatitis was 2.39±0.84(p &lt;0.001). Again, serum lipase amylase ratio in patients with acute alcoholic pancreatitis was 2.89±0.79 and in patients with non-alcoholic acute pancreatitis was 1.95±0.81 (p=0.002). Serum lipase amylase ratio in patients with acute pancreatitis due to hypertriglyceridaemia was 2.75±0.68 and in patients with acute pancreatitis due to other than hypertriglyceridaemia was 1.62±.65(p&lt; 0.001). This study showed that serum lipase amylase ratio was &lt;2.0 in acute biliary pancreatitis and this ratio was &gt;2.5 in acute alcoholic pancreatitis and in acute pancreatitis due to hypertriglyceridaemia. Serum lipase amylase ratio in patients with mild acute pancreatitis was 1.95±0.89; in patients with moderately severe acute pancreatitis the ratio was 2.37±0.92 and in patients with severe acute pancreatitis, the ratio was 2.22±0.70. The difference of lipase amylase ratio among these groups of patients was not statistically significant (p=0.273). Mean lipase amylase ratio among the patients without complication of acute pancreatitis was 2.03±0.92 whereas this ratio among the patients with complication was 2.17±0.68. This difference of lipase amylase ratio was not statistically significant (p=0.557).Conclusion: Role of serum lipase amylase ratio in predicting the aetiology and severity of acute pancreatitis has been addressed in several recent studies. This study was another attempt to achieve this goal. Predicting the aetiology of acute pancreatitis by such a cheap tool will guide further diagnostic work up and management strategy will avoid unnecessary investigations.Bangladesh Crit Care J September 2017; 5(2): 88-92

Acute Pancreatitis Secondary to the Use of Anabolic Steroids

Background: The use of performance-enhancing drugs has increased dramatically in the last decade with high prevalence reported among the young athlete population. Many of these drugs contain anabolic steroids and may carry potential significant side effects and health risks. We report a case of anabolic steroid-induced acute pancreatitis that recurred after the re-administration of the same drug by the patient, confirming the causative relationship. Case Presentation: A 24 year-old White male presented with severe epigastric pain. His past medical history was significant for two hospitalizations during the last year with acute pancreatitis (AP). On the first episode, the patient labs were significant for elevated serum lipase >3000 units/L. He underwent extensive evaluation that ruled out common causes of acute pancreatitis. On the second AP attack, his repeat imaging scans revealed biliary sludge and he underwent elective cholecystectomy. However, two months later the patient presented to our facility with recurrent severe epigastric pain and the CT scan then confirmed mild AP. His physical exam revealed a well-build masculine male with epigastric tenderness to palpation. Known etiologies of AP were again ruled out, as the work up showed absence of alcohol intake by history and serum levels, normal serum triglycerides and normal pancreas anatomy on abdominal CT, normal ducts and unremarkable endoscopic ultrasound exams. Upon further pressing, patient admitted to history of past and current anabolic steroid use for athletic performance enhancement. He began this use 3 years ago and most recently he started using Trenbolone Acetate, a very powerful anabolic steroid. He stopped taking this drug during hospitalizations but restarted it shortly afterwards and increased the doses till he developed symptoms of AP again. The correlation between the timing of steroids administration and the attacks of AP, along with ruling out other causes, confirmed Trenbolone Acetate as the cause of his pancreatitis. His condition resolved with conservative management and withdrawal of drugs. Discussion: Anabolic steroid use is reported as a rare cause of acute pancreatitis. The side effects associated with the use of these increasingly prevalent drugs are difficult to study in clinical trials due to the unethical nature of their consumption. Physicians need to be aware of any serious consequences with their use.

Is There a Weather Seasonal Effect on Acute Pancreatitis Etiology and Outcomes?

Introduction: Approximately 20% of Acute pancreatitis (AP) cases are deemed to be idiopathic. Gallstone disease has been reported to have increased incidence during summer and this could be due to variations in temperature during these months. The aim of this study was to identify the prevalence of different AP etiologies during the weather seasons and to investigate the association between temperature variation, seasonal effect and the onset of acute pancreatitis, its severity and outcomes. Methods: We performed a retrospective cohort study of consecutive patients admitted with a very first episode of acute pancreatitis at a large public hospital in Chicago between 01/2013 and 12/2014. We identified acute pancreatitis diagnosis by ICD9 code and/or lipase ≥ 3 times the normal upper limit. Two physicians reviewed each case to include only first episodes of acute pancreatitis. We excluded patients who were transferred to our center. We included a detailed weather season history and temperature in Celsius degree on the day of admission for each AP case from the publically available website: weather. com. We constructed multivariable logistic regression models. Results: We analyzed 460 patients. Mean age was 48 years (range 17 to 89 years), 54% were males. In Univariate and Multivariate analysis, having an AP episode during winter was found to be protective against Acute Kidney Injury (AKI) (aOR: 0.4, P<0.005, CI 0.2-0.9). After adjusting for admission SIRS, age and gender; Weather seasons were found to impact AP etiology nor be independent risk factors for Persistent Systemic Inflammatory Response Syndrome (SIRS), AKI, ARDS, pancreatic necrosis, mortality, ICU, Length of Stay (LOS), in-hospital infections, BISAP score, nor recurrent AP. In addition, the mean temperature (T) of Chicago (15°C) was compare to lower temperatures as well as higher temperature variations; Higher temperatures than the average Chicago T was found to be protective against Persistent SIRS at 48h (aOR 0.6, P<0.05, CI 0.3-0.9). No other significant impact on these temperatures variations was found. Conclusion: Weather Seasonal effect was not found to impact the etiology of acute pancreatitis. All etiologies were equally distributed among all seasons. However, AKI during winter was found to have a significantly lower incidence and Persistent SIRS had lower incidence during higher or warmer temperatures. This is the largest study to date to examining weather seasonal effect in AP.

The impact of lipoprotein lipase deficiency on health-related quality of life: a detailed, structured, qualitative study

BackgroundLipoprotein lipase deficiency (LPLD) is an autosomal recessive inherited disorder caused by loss-of-function mutations in genes involved in the lipoprotein lipase pathway. It is characterised by chylomicronaemia, severe hypertriglyceridaemia and an increased risk of recurrent pancreatitis that often requires hospitalisation. This research aimed to improve our understanding of the debilitating impact that LPLD has on the daily lives of patients and their families.MethodsThe research comprised a 2-h interview with the patient and, where possible, a 1-h interview with a family member; a 1-week pre- and post-interview task (written and/or video diary); and a 30–45-min follow-up telephone interview. Feelings and thoughts at each stage of the disease journey were captured on a 0–10 rating scale, while the impact of disease on overall health status was measured via the EuroQoL 5 domains, 3 levels (EQ-5D-3L) questionnaire (descriptive and visual analogue scale).ResultsOf four patients identified, three (two female, one male) were recruited to participate in the study; the male patient did not complete the pre-interview task or consent to a family member interview. Demographics and medical history differed among patients in terms of age at symptom onset, their journey to LPLD diagnosis, treatments, the number of attacks of pancreatitis and lengths of hospitalisations. Health-related quality of life, assessed by the EQ-5D-3L, was poor during acute attacks of pancreatitis but was minimally impacted by their condition at interview. Patients described feeling apprehensive, frightened, anxious, depressed or frustrated during and after hospitalisations; spouses of the two female patients also reported being worried or afraid. LPLD affected many aspects of daily living, including diet; socialising and building relationships; state of mind (fear of another attack of pancreatitis or lack of disease control); college and working life (through absenteeism and consequent financial implications); and being reliant on family and friends for support.ConclusionsThe interviews of the three patients with LPLD highlighted several concerns and emphasised the need for improved education, support, dietary advice and appropriate disease management. Additional support services would ease the fear and uncertainty surrounding attacks of pancreatitis, and would allow for improved treatment during hospitalisations.

Diagnosing acute pancreatitis—Clinical and radiological characterisation of patients without threefold increase of serum lipase

ObjectivesDiagnosing acute pancreatitis (AP) may be challenging in patients with acute abdominal pain but missing threefold increased serum lipase levels (Lip−). This studyaims both to characterize these patients using clinical, radiological and mortality data, and to assess the group of patients who need contrast-enhanced computed tomography (CECT). MethodsIn this retrospective, IRB approved study 234 consecutive patients with AP were investigated. Inclusion criteria were single (SAP) and recurrent attacks (RAP) of AP and CECT ≥72h after onset of symptoms. Severity of AP was assessed by C-reactive protein at 48h after hospital admission and using 3 CT-based scores (CTSI, mCTSI, EPIC) by 2 observers. Mortality rates from pancreatic and non-pancreatic causes were noted with regard to lipase increase. Results were compared with paired t-test and Wilcoxon signed-rank test. Results64/234 (27%) patients belonged to Lip− group and 170/234 (73%) patients were allocated to Lip+ group. Significantly more male patients (78% in Lip− vs. 63% in Lip+, p<0.05) with RAP (63% in Lip− vs. 21% in Lip+, p<0.001) were observed in the Lip− group. EPIC was significantly lower in Lip− group compared to Lip+ group (3(IQR 2–5) vs. 2(IQR 1–3), p<0.001). Mortality from pancreatic and non-pancreatic causes was comparable in Lip− and Lip+ group (pancreatic causes: 9% vs. 6%, p=0.60; nonpancreatic causes: 8% vs. 5%, p=0.58). Conclusions27% of all patients with AP presented without threefold increase of lipase levels. Thus, they would be underdiagnosed without confirming CECT, which revealed significantly lower counts of pleural effusions and ascites. Male patients with RAP were found significantly more often among the Lip− group. Hence, they would benefit the most from CECT for diagnosing AP.

Association of use of selective serotonin reuptake inhibitors with risk of acute pancreatitis: a case-control study in Taiwan.

Few studies have reported the association of the use of selective serotonin reuptake inhibitors (SSRIs) with acute pancreatitis. We conducted a population-based case-control study to explore this relationship. In this study, 4631 cases with first attack of acute pancreatitis and 4631 controls without acute pancreatitis were selected using a randomly sampled cohort of one million health insurance enrollees from 2000 to 2013. Both cases and controls were aged 20-84years and were matched with sex, age, comorbidities, and index year of diagnosis of acute pancreatitis. Patients with current use of SSRIs were defined as those whose last tablet of SSRIs was noted ≤7days before the date of diagnosis of acute pancreatitis; patients with late use of SSRIs were defined as those whose last tablet of SSRIs was noted ≥8days before the date of diagnosis; and patients with no use of SSRIs were defined as those who were never prescribed SSRIs. The odds ratio (OR) and 95% confidence interval (CI) for acute pancreatitis associated with the use of SSRIs were assessed using multivariate unconditional logistic regression analysis. After adjusting for covariables, multivariate logistic regression analysis revealed that compared with patients with no use of SSRIs, the adjusted OR of acute pancreatitis for those with current use of SSRIs was 1.7 (95% CI, 1.1-2.5), whereas that for patients with late use of SSRIs was 1.0 (95% CI, 0.9-1.2) without statistical significance. Current use of SSRIs is associated with the diagnosis of acute pancreatitis. Therefore, clinicians should consider the possibility of SSRI-associated acute pancreatitis among patients currently taking SSRIs and those presenting with the diagnosis of acute pancreatitis without a definite cause.

Early definitive treatment rate as a quality indicator of care in acute gallstone pancreatitis

Early definitive treatment (cholecystectomy or endoscopic sphincterotomy in the same admission or within 2 weeks after discharge) of gallstone disease after a biliary attack of acute pancreatitis is standard of care. This study investigated whether compliance with early definitive treatment for acute gallstone pancreatitis can be used as a care quality indicator for the condition. A retrospective cohort study was conducted using the Hospital Episode Statistics database. All emergency admissions to National Health Service hospitals in England with a first time diagnosis of acute gallstone pancreatitis in the financial years 2008, 2009 and 2010 were examined. Trends in early definitive treatment between hospital trusts were examined and patient morbidity outcomes were determined. During the study interval there were 19 510 patients with an overall rate of early definitive treatment at 34·7 (range 9·4-84·7) per cent. In the 1-year follow-up period, 4661 patients (23·9 per cent) had one or more emergency readmissions for complications related to gallstone pancreatitis. Of these, 2692 (57·8 per cent) were readmissions for acute pancreatitis; 911 (33·8 per cent) were within the first 2 weeks of discharge, with the remaining 1781 (66·2 per cent) occurring after the point at which definitive treatment should have been received. Early definitive treatment resulted in a 39 per cent reduction in readmission risk (adjusted risk ratio (RR) 0·61, 95 per cent c.i. 0·58 to 0·65). The risk was further reduced for acute pancreatitis readmissions to 54 per cent in the early definitive treatment group (adjusted RR 0·46, 0·42 to 0·51). In acute gallstone pancreatitis, compliance with recommended early definitive treatment varied considerably, with associated variation in outcomes. Compliance should be used as a quality indicator to improve care.

SPD-L1 Expression is Associated with Immunosuppression and Infectious Complications in Patients with Acute Pancreatitis.

Acute pancreatitis (AP) with infectious complications has high mortality because of early-stage immunosuppression. The programmed cell death-1 (PD-1)/programmed cell death ligand 1 (PD-L1) pathway is an important host immunosuppression mechanism. Soluble PD-L1 (sPD-L1) expression regulates co-inhibitory signals in malignancies or autoimmune disorders; however, its effects in AP are unknown. Here, we evaluated whether serum sPD-L1 is involved in immune dysfunction and assessed its relationship with infectious complications in early AP. Blood samples were obtained from 56 patients with acute pancreatitis and 21 healthy individuals in this prospective study. Serum sPD-L1 levels within 48h after AP onset were tested by enzyme-linked immunosorbent assays. Relevant immune parameters (human leucocyte antigen-DR, lymphocyte count) and inflammatory markers (C-reactive protein, white blood cell count) were analysed. sPD-L1 was significantly upregulated in patients with early AP, especially those with infectious complications, compared to healthy controls. Significant negative correlations were observed among monocyte HLA-DR expression, lymphocyte count and sPD-L1 levels in AP. Multivariate regression indicated that sPD-L1 was an independent risk factor for infectious complications in AP. The findings suggest that increased sPD-L1 expression appears to be involved in the development of immunosuppression in the early stage of AP and that sPD-L1 might be an early parameter for prediction of infectious complications in patients with AP.

Stent drainage achieved by endoscopic ultrasonography-guided puncture from duodenal bulb to the minor pancreatic duct for the treatment of acute epigastric pain in a patient with pancreas divisum.

Stent drainage achieved by endoscopic ultrasonography-guided puncture from duodenal bulb to the minor pancreatic duct for the treatment of acute epigastric pain in a patient with pancreas divisum.