Common Cause Of Acute Pancreatitis Research Articles

A study on OGD Scopy Findings in Acute Pancreatitis

Background: The aim of the study was to list different mucosal lesions in the established acute form of pancreatitis in the upper part gastrointestinal tract in endoscopy. Methods: We performed a prospective study in patients over 18 years of age with acute pancreatitis. Abdominal pain with sudden onset or serum amylase and/or lipase > 2 times upper limit of normal. characteristic of acute pancreatitis in Abdominal computed tomography (CT) or typical findings of acute pancreatitis in Ultrasound scan. Patients who are unfit or not willing to undergo endoscopy or who have a peptic ulcer disease detected during endoscopy, peptic ulcer disease in the last 3 months is excluded. Results: In this study, the most common age group for acute pancreatitis was 30-60 years. In this study, alcohol is the most common cause of acute pancreatitis, accounting for 90% of the study. Abdominal pain is the most common symptom. CT scan is most (100%) confirmatory in the diagnostic study of acute pancreatitis. This study involved 30 patients with acute pancreatitis. In OGD, 24(80%) patients had a positive finding in the upper gastrointestinal tract, in that 16 patients(53.33%) significant Gastritis found. An enlarged pancreas is the only CT finding in most cases. Conclusions: Esophagitis and duodenal and gastric ulcer are common endoscopic findings in acute pancreatitis. They do not correlate with the severity of pancreatitis.

Prediction of severe hypertriglyceridemia-associated acute pancreatitis using a nomogram based on CT findings and blood biomarkers.

Hypertriglyceridemia is a common cause of acute pancreatitis (AP). Fatty liver, a manifestation of metabolic syndrome, is related to the severity of AP. The present study aimed to construct an accurate predictive model for severe AP (SAP) by combining the fatty liver infiltration on a computerized tomography (CT) scan with a series of blood biomarkers in patients with hypertriglyceridemia-associated AP (HTG-AP). A total of 213 patients diagnosed with HTG-AP were included in the present retrospective study. Clinical information and imageological findings were retrospectively analyzed. The model was constructed from independent risk factors using univariate analysis, the least absolute shrinkage and selection operator method. Subsequently, the data from the training group of 111 patients with HTG-AP was analyzed using logistic regression analysis. The efficacy of the model was verified using an external validation group of 102 patients through the receiver operating characteristic curve (ROC). Independent predictors, including serum calcium, C-reactive protein, lactate dehydrogenase and liver-to-spleen CT attenuation ratio (L/S ratio), were incorporated into the nomogram model for SAP in HTG-AP. The model achieved a sensitivity of 91.3% and a specificity of 88.6% in the training group. Compared with the Ranson model, the established nomogram model exhibited a better discriminative ability in the training group [area under the curve (AUC): 0.957] and external validation group (AUC: 0.930), as well as better calibration and clinical benefits. The present study demonstrates that the constructed nomogram based on CT findings and blood biomarkers is useful for the accurate prediction of SAP in HTG-AP.

Acute Pancreatitis Secondary to Cocaine Intoxication: A Case Series.

Gallstones, alcohol use, hypertriglyceridemia, and hypercalcemia have been considered the most common causes of acute pancreatitis; however, about 20% of the cases remain idiopathic since no definite cause can be established. It has been noticed that there is a small number of patients who have presented to the hospital with a diagnosis of acute pancreatitis who have concurrently been using cocaine yet have no recent alcohol use and no gallstones. The purpose of this series of case reports is to review the evidence behind the association between cocaine and pancreatitis. In most of the cases, the etiology of acute pancreatitis is usually straightforward.However, when faced with a patient who has acute pancreatitis but lacks the common causes such as alcoholism, gallstones, normal triglyceride levels, and no evidence of malignancy, it seems reasonable to consider drugs as a potential cause for pancreatitis.

Therapeutic plasma exchange decreases serum triglyceride level rapidly and reduces early recurrence rate but no advantages in improving outcomes for patients with hyperlipidemic acute pancreatitis: a retrospective propensity score matching analysis based on twenty year’s experience

BackgroundHyperlipidaemic acute pancreatitis (HLAP) has become the most common cause of acute pancreatitis (AP) not due to gallstones or alcohol (Mosztbacher et al, Pancreatology 20:608-616, 2020; Yin et al, Pancreas 46:504-509, 2017). Therapeutic plasma exchange (TPE) has been reported to be effective in reducing serum TG levels which is important in management of HLAP (World J Clin Cases 9:5794-803, 2021). However, studies on TPE are mostly focusing on cases reports, TPE remains poorly evaluated till date and need to be compared with conservative therapy with a well-designed study.MethodsA retrospectively cohort study on HLAP patients between January 2003 and July 2023 was conducted. Factors correlated with efficacy of TPE were included in a propensity model to balance the confounding factors and minimize selection bias. Patients with and without TPE were matched 1:2 based on the propensity score to generate the compared groups. Lipid profiles were detected on admission and consecutive 7 days. The triglyceride (TG) level decline rates, percentage of patients to reach the target TG levels, early recurrence rate, local complications and mortality were compared between groups.ResultsA total of 504 HLAP patients were identified. Since TPE was scarcely performed on patients with TG < 11.3 mmol/L, 152 patients with TG level 5.65 to 11.3 mmol/L were excluded while 352 with TG ≧11.3 mmol/L were enrolled. After excluding 25 cases with incomplete data or pregnancy, 327 patients, of whom 109 treated without TPE while 218 treated with TPE, were included in data analysis. One-to-two propensity-score matching generated 78 pairs, 194 patients with well-balanced baseline characteristics. Of 194 patients enrolled after matching done, 78 were treated without while 116 with TPE. In the matched cohort (n = 194), patients treated with TPE had a higher TG decline rate in 48 h than those without TPE (70.00% vs 54.00%, P = 0.001); the early recurrence rates were 8.96% vs 1.83%, p = 0.055. If only SAP patients were analyzed, the early recurrence rates were 14.81% vs 0.00% (p = 0.026) respectively. For patients with CT severity index (CTSI) rechecked within 14 days, early CTSI improment rate were 40.90% vs 31.91%. Local complications checked 6 months after discharge were 44.12% vs 38.30%. Mortality was 1.28% vs 1.72%. No differences were found in early stage CTSI improment rate (P = .589), local complications (P = .451) or motality between two groups.ConclusionsTPE reduces TG levels more quickly in 48 h compared with those with conservative treatment, but no difference in the consecutive days. TPE tends to reduce the early recurrence rate comparing with conventional therapy, but TPE has no advantages in improving CTSI in early stage, and no improvement for outcomes including local complications and mortalty.

A retrospective study of pregnant patients with acute pancreatitis.

Acute pancreatitis is a rare disease in pregnant patients. Although it may have serious maternal and fetal consequences, morbidity and mortality rates have decreased recently due to appropriate and rapid treatment with earlier diagnosis. The aim of this study was to evaluate pregnant patients diagnosed with acute pancreatitis. The study included pregnant patients diagnosed with acute pancreatitis who were admitted to Adana City Training and Research Hospital in Adana, Turkey, between January 2014 and January 2022. Patients' files were screened. Patients' demographics, acute pancreatitis etiology, severity, complications, and applied treatment, as well as maternal and fetal outcomes were evaluated. The study included 65 pregnant patients with acute pancreatitis. The mean age was 26.6±5 (19-41) years. Acute pancreatitis was observed in the third trimester. The most common cause of acute pancreatitis was gallstones, and its severity was often mild. Only two patients required endoscopic retrograde cholangiopancreatography, and the remaining patients were treated medically. Maternal and infant death developed in a patient with necrotizing acute pancreatitis secondary to hyperlipidemia. The most common etiology of acute pancreatitis in pregnancy was gallstones. Acute pancreatitis occurred in the third trimester. Most of the patients had mild acute pancreatitis. Maternal and fetal complications were rare. We think that the reasons for the low mortality rate were mild disease severity and biliary etiology, and most patients were in the third trimester, as well as early diagnosis and no delay in the intervention.

EGS P29 Evaluating Compliance and Identifying Barriers to Timely Cholecystectomy in Gallstone Pancreatitis: A Retrospective Study

Abstract Background Gallstone pancreatitis is a common cause of acute pancreatitis. Timely cholecystectomy within two weeks of admission is recommended by the UK Pancreatitis Guidelines and NCEPOD to prevent recurrent pancreatitis and associated complications. This study aimed to evaluate compliance with these guidelines at a District General Hospital. Methods A retrospective analysis was conducted on all patients (n=92) admitted with acute pancreatitis between July 1st 2022, and January 31st 2023. Patient demographics, diagnostic methods, time to surgery, and relevant laboratory values (median amylase, median CRP) were collected and analysed. Results 35% (n=32) of patients had gallstone pancreatitis. 26 were fit for cholecystectomy. 35% (n=9) were operated on within 2 weeks. Median time to surgery was 7 days and median CRP 133. There were no readmissions within 6 months. The delayed surgery cohort (n=17) had a median time to surgery of &amp;gt;60 days, median CRP 29 and a 59% (n=10) readmission rate . 1 patient had three readmissions. Reasons for delay were: 2 pancreatic necrosis, 1 pregnancy, 1 pneumonia, 1 delirium, 2 bed pressure, and 10 no clinical reason. 5 patients are still waiting for surgery at the time of analysis &amp;gt;6months. Conclusions Prior to the COVID-19 pandemic, compliance with UK pancreatitis and NCEPOD guideline was excellent (GIRFT) at our institution. Our findings are that most patients with gallstone pancreatitis are not being operated upon within two weeks. Delays result in hospital readmissions increasing resource use. Most delays were organisational rather than clinical. Patients who were ambulated for operative management within 2 weeks rarely were operated upon within this timeframe. Trust initiatives aimed at COVID-19 recovery prioritised early discharge and repurposed emergency ‘hot lists’ to reduce elective waiting lists. Interventions to increase emergency operating capacity are most likely to improve matters.

Hypertriglyceridemia and acute pancreatitis: clinical and basic research—a narrative review

Hypertriglyceridemia (HTG) is the third most common cause of acute pancreatitis (AP), and the incidence of HTG-induced AP (HTG-AP) is rising worldwide as a result of changes in lifestyle and dietary habits. In China, HTG accounts for 10% to 20% of the causes of AP, even becoming the second leading cause of AP. The presentation and diagnosis of HTG-AP is similar to that of AP from other causes, however, the complication rates and severe AP are significantly higher in patients with HTG-AP than in patients with other etiologies. Regarding the management of HTG-AP, the initial management is similar to that of AP from other causes and mainly includes fluid resuscitation, pain control, and nutritional support. In addition to supportive care, it is necessary to take appropriate measures to decrease serum TG levels, in order to alleviate the progression of AP and prevent recurrence. This review aims to summarize existing clinical and basic research evidence of HTG-AP and seeks to highlight the epidemiology, definition, pathogenesis, clinical course, diagnosis, management, prevention of recurrence, and specific clinical scenarios, such as HTG-AP during pregnancy, HTG-AP with diabetic ketoacidosis.

CHARACTERISTICS AND RESULTS OF TREATMENT OF HYPERTRIGLYCERIDEMIA-INDUCED ACUTE PANCREATITIS AT CAN THO UNIVERSITY OF MEDICINE AND PHARMACY HOSPITAL

Background: After alcohol and gallstones, hypertriglyceridemia is the third most common cause of acute pancreatitis (AP). Hypertriglyceridemia is triglyceridemia concentration &gt;150mg/dl (1.7mmol/l). Severe hypertriglyceridemia &gt;1000mg/dl (11.3 mmol/l) is considered the cause of AP. Objectives: To compare some clinical and subclinical features and results of treatment of AP with two levels of hypertriglyceridemia &lt;11.3mmol/l and &gt;I1.3mmol/l at the Department of General Internal Medicine in Can Tho University of Medicine and Pharmacy Hospital. Materials and methods: This was a cross-sectional descriptive study of 33 patients who were admitted to the hospital with hypertriglyceridemia-induced AP. Results: Clinical symptoms and some laboratory tests did not differ between the two groups. Statistically significant differences occurred in the 2 groups as blood CRP value with p=0.009, low sodium levels 134.22±4.73mmol/l and high BMI levels 26.63±5.15kg/m2 in the group with TG ≥ 11.3 mmol/l. The rate of amylase increased 3 times in the high-TG group was 85.2%. Both groups had elevated glucose and LDH levels respectively, with 10.56±5.13 mmol/l and 310.64±206.01U/L. Ultrasound diagnosis of acute pancreatitis reached 100%, CTSI and BISAP index were high in the group with TG ≥11.3mmol/l. The days of using insulin and staying in the hospital were significantly different, with p=0.004 and p=0.014. Conclusions: Comparing the 2 groups of acute pancreatitis with blood TG &lt;11.3mmol/l and ≥11.3mmol/l, there was no difference in clinical symptoms. Mean values of sodium, BMI and blood CRP (p=0.009) were different between the two groups of acute pancreatitis. Treatment results in days of using insulin and staying in the hospital had statistically significant differences between the 2 groups.

The Predictive Value of Urinary Trypsinogen-2 Dipstick for Early Diagnosis of Acute Pancreatitis in Intensive Care

Abstract Background Acute pancreatitis is a sudden inflammation in the pancreas, with potential and variable involvement of adjacent organs or other organ systems. Aim of the Work to evaluate the rule of urinary trypsinogen-2 using dipstick test in the diagnosis of acute pancreatitis. Patients and Methods This cross-sectional study was carried out in surgical intensive care unit, Ain Shams University hospitals, during a period of 6 months. Forty five patients were included in our study, thirty patients were diagnosed as acute pancreatitis and fifteen patients weren’t diagnosed as acute pancreatitis through cross sectional study. All patients were subjected to full history taking, full clinical examination, laboratory investigations including serum levels of renal function tests, CBC, total and direct bilirubin, liver enzymes, alkaline phosphatase, INR, amylase and lipase. Urinary trypsinogen-2 dipstick test was done. Also, radiological examinations were done using ultrasonography of abdomen and pelvis, computed tomography of the abdomen. Results The most common cause of acute pancreatitis was gall stone obstructive pancreatitis (70%) and we found that serum amylase and lipase were elevated in (83.3% and 86.7% respectively) in acute pancreatitis patients. While the sensitivity of urinary trypsinogen-2 dipstick test was 93.3% in acute pancreatitis patients. The specificity of serum amylase, serum lipase was 73.3% for both of them, while the specificity of urinary trypsinogen-2 was 100% in diagnosis of acute pancreatitis. Conclusion In-conclusion urinary trypsinogen-2 dipstick test is a promising low cost, bed side and easy test to be done in the diagnosis of acute pancreatitis.

Acute pancreatitis after cesarean section

The prevalence of acute pancreatitis in pregnancy is low; similarly to the non-pregnant population, the outcome varies from mild to fatal forms. Occurrence of the disease in pregnancy is mostly in the third trimester or the postpartum period. The most common cause of acute pancreatitis is cholelithiasis but hypertriglyceridemia, fatty diet, obesity and alcohol consumption are further predisposing factors. A 27-year-old twin-pregnant woman developed acute severe pain 2 days after a cesarean section. Labor tests showed elevated amylase (1080 U/L) and lipase (2670 U/L) serum levels. For the purpose of pain relief, we inserted an epidural catheter and indicated an abdominal computer tomography examination. The abdominal imaging did not show morphological disorder of the pancreas or cholangial obstruction. We performed conservative therapy, early per os feeding, pain relief and fluid resuscitation. On the postpartum 7. day, the serum pancreas enzyme levels decreased to normal and the patient - with her babies - was discharged home. Though acute pancreatitis is a rare event in pregnancy, we should consider it in cases with acute, typical or non-typical pain. It is challenging to differentiate the disease from the acute syndromes of pregnancy. Orv Hetil. 2023; 164(31): 1231-1234.

Dynamic nomogram for predicting infected pancreatic necrosis in female patients of childbearing age with hypertriglyceridemia-induced acute pancreatitis

BackgroundHypertriglyceridemia is a common cause of acute pancreatitis. Pregnant women are at risk of developing hypertriglyceridemia-induced acute pancreatitis (HTG-AP); however, whether pregnancy increases the risk of infected pancreatic necrosis (IPN) is unknown. AimWe aimed to assess the association between pregnancy and IPN. MethodsThis 10-year retrospective cohort study was conducted at Jinling Hospital. Adult female patients of childbearing age with HTG-AP between January 2013 and September 2022 were screened. Logistic regression analyses were performed to assess the risk factors for IPN. Patients admitted within 7 days were assigned to the training and validation sets to develop a dynamic nomogram for IPN prediction. Results489 patients were included, and 144 developed IPN. Logistic regression analyses revealed pregnancy (OR: 2.578 95% CI: 1.474–4.510) as an independent risk factor for IPN. Gestation weeks, ARDS, albumin level, and serum creatinine level were selected as the predictors of the dynamic nomogram for IPN prediction, with good discrimination in the training set (AUC 0.867 95% CI: 0.794–0.940) and validation set (AUC 0.957 95% CI: 0.885–1.000). ConclusionPregnancy increases the risk of IPN in adult patients of childbearing age with HTG-AP, and the dynamic nomogram may help risk stratification for IPN.

Inhibition of TRAF6 improves hyperlipidemic acute pancreatitis by alleviating pyroptosis in vitro and in vivo rat models

ObjectiveHypertriglyceridemia (HTG) is one of the common causes of acute pancreatitis (AP). Hyperlipidemic acute pancreatitis (HTG-AP) is associated with higher mortality owing to its tendency for greater severity and rapid progression. The purpose of this study was to explore the mechanism of involvement of tumor necrosis factor receptor-related factor 6 (TRAF6) in pyroptosis during HTG-AP.MethodsThe HTG environment was simulated with palmitic acid treatment in vitro and a high-fat diet in vivo. Cerulein was used to establish the HTG-AP model, followed by genetic and pharmacological inhibition of TRAF6. Pyroptosis activation, inflammatory reaction, and the interaction between TRAF6 and pyroptosis in HTG-AP were assessed.ResultsHTG was found to aggravate the development of pancreatitis, accompanied by increased pyroptosis and enhanced inflammatory response in HTG-AP models. Mechanistically, TRAF6 downregulation decreased the activation of pyroptosis in cerulein-induced HTG-AP.ConclusionCollectively, inhibition of TRAF6 improved HTG-AP and the associated inflammation by alleviating pyroptosis.

Abstract #1385190: Empagliflozin Induced Acute Pancreatitis

Acute pancreatitis is a rapid onset inflammatory process of the pancreas which may have local and systemic manifestations. The most common causes of acute pancreatitis are gallstones and alcohol use. Other causes include drug-induced. Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a class of oral hypoglycemic agents which is approved by the FDA for treating diabetes and for heart failure. 56-year-old, female patient known to have uncontrolled type 2 diabetes. Presented with a complaint of acute epigastric pain radiating to the back and then become a generalized abdominal pain, moderate in severity, not relieved by analgesic, associated with nausea and vomiting. The patient denied any history of alcohol, smoking use. A review of her medication list included sitagliptin 100 mg, metformin 2g, gliclazide 60 mg and more recently, empagliflozin 10 mg which was started seven weeks prior to symptoms onset. Physical examination was significant for tenderness in epigastric area. Laboratory workup revealed an elevated serum lipase 3851 units/L, serum amylase 3755 units\L abdominal CT scan shows mild fatty atrophy and mild peri-pancreatic fat stranding and free fluid adjacent to the tale and body suggesting evidence of acute pancreatitis. Abdominal ultrasound shows the gall bladder was without stones. The patient was admitted with diagnosis of mild acute pancreatitis and underwent conservative management. Patient condition was improved and discharged on same pre-admission antidiabetic medication with OPD follow-up. 3 weeks later she presented to the emergency department complaining from acute epigastric pain radiating to the back and association of nausea and vomiting. With tenderness in epigastric area laboratory workup revealed an elevated serum lipase and amylase. Abdominal CT scan confirmed acute interstitial pancreatitis. After 3 days of conservative management she was improved and discharged but this time her diabetologist discontinue empagliflozin and she was started on insulin. She was following up with her diabetologist in outpatient clinic and there was no history of recurrence of pancreatitis. Drug induce pancreatitis are rare cause but must be considered. It is therefore important to determine the underlying etiology of acute pancreatitis to prevent occurrence, recurrence, and the complications of pancreatitis. FDA and Health Canada have identified a potential safety issue and possible association between SGLT-2 inhibitors and acute pancreatitis but Further studies are required to investigate this association. This case report emphasized the possible association between SGLT2 inhibitors and acute pancreatitis. Physicians must be aware about this side effect as a possible cause of acute pancreatitis after exclusion of most common etiologies. Also, physician should inform the patient about the side effects of SGLT2 and the symptoms of acute pancreatitis and advised them to stop SGLT-2 inhibitors use in case such symptoms occur. Further studies are required to investigate this association.

A STUDY OF CLINICAL PROFILE OF ACUTE PANCREATITIS PATIENTS WITH EMPHASIS ON MODIFIED CT SEVERITY INDEX AND SERUM PROCALCITONIN AS MARKERS FOR ASSESING SEVERITY

Aim: To study the clinical prole of acute pancreatitis patients and MCTSI as an index for predicting severity, I.C.U admissions and mortality of acute pancreatitis cases and also to compare it with serum procalcitonin in predicting severity. This study was conducted Material and Methods: in the Department of Medicine and Gastroenterology, Gauhati Medical College and Hospital for a period of one year. A total 98 acute pancreatitis were included and their clinical prole was studied. MCTSI score was calculated for all the patients and used to predict severity, I.C.U admissions and mortality. MCTSI was also compared with serum procalcitonin in assessing severity. Male preponderance was noted in the study. The Results: peak incidence of disease was noted in the 3rd decade of life. Pain abdomen was found to be the most prominent clinical feature. Alcohol consumption was found to be the most common etiological factor. It was observed that mild, moderate and severe acute pancreatitis according to ATLANTA CLASSIFICATION correlated well with MCTSI scoring system. All the 19 severe acute pancreatitis cases had an MTCSI score in the severe range (p value of 0.0001 - statistically signicant). The mortality rate was signicantly higher in severe acute pancreatitis i.e. 57.89% as compared to mild and moderate acute pancreatitis (p value of 0.0001). The I.C.U admission rate in mild acute pancreatitis was 4.17% as compared to 100 % in severe acute pancreatitis (p value 0.0001). Statistically signicant difference was observed in serum procalcitonin levels (mean ±SD ng/dl) of mild, moderate and severe acute pancreatitis cases as per MCTSI scoring system (p value of 0.0001). Among the 98 cases, Conclusion: male to female ratio was 2.05:1. The most common cause of acute pancreatitis was ethanol abuse. The most prominent symptom was pain in the abdomen followed by vomiting. MCTSI fared well in predicting severity, mortality and I.C.U admissions in acute pancreatitis cases. The relationship of MCTSI score with serum procalcitonin in predicting severity was found to be signicant

Diabetic Ketoacidosis Related to Hypertriglyceridemia-Induced Pancreatitis: A Case Report.

Both diabetic ketoacidosis and acute pancreatitis can result in critical illness. Although not the most common cause of acute pancreatitis, hypertriglyceridemia can account for up to 10% of cases. One source of hypertriglyceridemia is unrecognized diabetes and resultant hyperglycemia. Identifying the underlying cause of acute pancreatitis can guide the most appropriate therapy to resolve this critical illness. This case report addresses the use of insulin infusions to treat hypertriglyceridemia-induced pancreatitis in the setting of concomitant diabetic ketoacidosis.

Therapeutic Plasma Exchange in ICU Patients with Acute Hypertriglyceridemia-Induced Pancreatitis Improves Patient Outcomes

Background: Acute severe pancreatitis is associated with high morbidity and mortality. Hypertriglyceridemia is the third most common cause of acute pancreatitis and higher triglyceride levels increase the risk for severe acute pancreatitis. Plasma exchange is an effective treatment method to lower triglycerides. Our study aimed to investigate the efficiency of plasma exchange as a treatment option for acute hypertriglyceridemia-induced pancreatitis (HTGP), the impact on mortality assessed by the SOFA, SAPS II, BISAP Score, Ranson’s, and Glasgow-Imrie Criteria, as well as the overall length of stay in hospital and ICU. Methods: In this retrospective single-center cohort study, triglycerides before and after plasma exchange were compared. SOFA and SAPS II were taken on ICU admission and at discharge. To further characterize the patient cohort, BISAP Score (on admission), Ranson’s Criteria (on admission and after 48 h), and the Glasgow-Imrie Criteria (48 h after admission) were calculated. Results: The study included 11 patients (91% male; median age 45 years). Triglycerides were reduced from 4,266 ± 3,560.6 to 842 ± 575.9 mg/dL during plasmapheresis (p < 0.001). The median ICU length of stay was 3 ± 4.2 days. In-hospital mortality was 0%. The SOFA score was significantly reduced from 4 ± 3.4 points on admission to 2 ± 2.1 points at discharge (p = 0.017). Triglycerides and cholesterol decreased from 3,126 ± 3,665 to 531 ± 273 mg/dL (p = 0.003) and from 438 ± 137.9 to 222 ± 59.5 mg/dL (p = 0.028), respectively. The BISAP Score on admission was 3 ± 0.5 points, Ranson’s Criteria were 3 ± 1.5 points (48 h after admission, cumulative), and Glasgow-Imrie Criteria 3 ± 1.3 points (48 h after admission). Conclusion: Plasmapheresis is an efficient and safe treatment method for ICU patients with acute HTGP and significantly reduces triglycerides. Furthermore, plasmapheresis significantly improves the clinical outcomes of patients with HTGP.

Acute Pancreatitis and Acute Recurrent Pancreatitis in Children: Imaging Findings and Outcomes.

The prevalence of acute pancreatitis and acute recurrent pancreatitis in children has increased over the years, and there are limited data about imaging findings. This study aimed to reveal the imaging findings of acute pancreatitis and acute recurrent pancreatitis in children at a tertiary care hospital. The patients with acute pancreatitis and acute recurrent pancreatitis diagnosed between January 2007 and December 2018 were included. Demographic and clinical features, follow-up period, and interventions were noted. Imaging features were evaluated for pancreatic enlargement, peripancreatic fluid, and biliary ducts for initial examination and pancreas parenchymal necrosis, peripancreatic collection, walled-off necrosis, pseudocyst, parenchymal atrophy, and biliary ductal dilatation for follow-up. The study included 74 patients with a mean age of 9 ± 4.9 years. The most common causes of acute pancreatitis and acute recurrent pancreatitis were biliary tract anomalies (n = 21), biliary ductal stones (n = 9), and cystic fibrosis (n = 8). Findings consistent with acute pancreatitis were determined by ultrasound in 40.5% (n = 30/74), whereas by magnetic resonance imaging in 60% (n = 39/65). Forty-one percent of the patients (n = 16) with positive magnetic resonance imaging findings did not show any findings on ultrasound. Acute recurrent pancreatitis was seen in 32 patients (43.2%). Follow-up imaging was performed in 55 patients (74.3%) between 2 months and 11 years. At follow-up, 8 patients had peripancreatic collections (6 walled-off necrosis and 2 pseudocysts). Recognizing the imaging findings of acute pancreatitis and its complications is crucial. Magnetic resonance imaging should be preferred as a second option following ultrasound, with the advantages of biliary ductal system delineation and better characterization of complications.

Acute pancreatitis due to hypertriglyceridemia: Plasmapheresis versus medical treatment

OBJECTIVE: Hypertriglyceridemia (HTG) is the third-most common cause of acute pancreatitis. Plasmapheresis is an extracorporeal treatment method used for treatment. This study aimed to investigate the efficacy of medical treatment and plasmapheresis in patients with acute pancreatitis due to HTG. METHODS: This was a retrospective cross-sectional study. The patients were divided into two groups according to the treatment they received as those who received only medical treatment and those who performed plasmapheresis with medical treatment. According to the treatment received by the patients; clinical, demographic, and laboratory data, Ranson scores, and bedside index of severity in acute pancreatitis (BISAP) scores, decrease in triglyceride levels in 24 h, length of hospital stay, and outcomes were recorded. RESULTS: Forty-seven patients were included in the study. The level of triglyceride decreases at the 24th h was 59.7% ±17.3% in those who received medical treatment and was 70.4% ±15.1% in those who received plasmapheresis (P = 0.032). Receiver operating characteristic curve analysis was performed to predict the need for plasmapheresis treatment, area under the curve (AUC) value of the triglyceride level was the highest (AUC: 0.822, 95% confidence interval: [0.703–0.940]; P < 0.001), the sensitivity and specificity were 83.3% and 72.4%, respectively, and the cut-off value of triglyceride was accepted as 3079.5 mg/dL. CONCLUSION: Plasma triglyceride levels and BISAP score on admission may help physicians to predict the need for plasmapheresis. Plasmapheresis helps to rapidly reduce triglyceride levels in patients with HTG-associated acute pancreatitis.

Research on the clinical treatment of hypertriglyceridemia and acute pancreatitis

Hypertriglyceridemia is the third most common cause of acute pancreatitis in the world [1]. In China, hypertriglyceridemia is gradually rising as the second leading cause of acute pancreatitis [2]. The disease usually occurs in patients with an underlying disorder of lipoprotein metabolisms and secondary conditions such as poorly controlled diabetes mellitus, alcohol abuse, or particular drug use. The clinical manifestations of pancreatitis caused by hypertriglyceridemia are generally similar to acute pancreatitis caused by other causes. However, patients with pancreatitis caused by hypertriglyceridemia may have a longer course of the disease and more complications [3], accompanied by a higher possibility of persistent organ failure. The initial treatment of pancreatitis due to hypertriglyceridemia is similar to that of acute pancreatitis from other causes. It includes aggressive fluid resuscitation, pain control, and nutritional support. In acute pancreatitis, timely recognition of hypertriglyceridemia is crucial in the initial and long-term management of the disease. It is also critical for preventing the recurrence of acute pancreatitis.

Efficacy and adverse effects of insulin versus plasmapheresis in patients with hypertriglyceridemia-3-induced acute pancreatitis: a systematic review and meta-analysis.

Hypertriglyceridemia is a common cause of acute pancreatitis (AP). This literature review compared the effectiveness and adverse events of insulin therapy, with or without heparin, and plasmapheresis, in reducing triglyceride levels in patients with hypertriglyceridemia-induced AP. Systematic reviews, meta-analyses, evidence syntheses, editorials, commentaries, protocols, abstracts, theses and preprints were excluded. Review Manager was used to conduct the meta-analysis. The literature search yielded 2765 articles, but only 5 were included in the systematic review and meta-analysis and the total number of participants in the review was 269. From this study's analysis, insulin ± heparin was more successful in reducing triglyceride levels than plasmapheresis (standardized mean difference -0.37, 95% confidence interval [CI] 0.99 to 0.25; P=0.25). Insulin ± heparin therapy had a lower mortality rate than plasmapheresis (risk ratio [RR] 0.70, 95%CI 0.25-1.95). Hypotension, hypoglycemia, and acute renal failure were less common in the plasmapheresis therapy group than in insulin ± heparin therapy (RR 1.13, 95%CI 0.46-2.81, RR 3.90, 95%CI 0.45-33.78, and RR 0.48, 95%CI 0.02-13.98 for hypotension, hypoglycemia, and acute renal failure, respectively). This study found no significant difference in mortality between insulin ± heparin therapy and plasmapheresis used for the reduction in triglyceride levels. It is notable that no substantial differences were observed in the most common side-effects encountered during these therapies, thus indicating non-inferiority.