Course Of Acute Biliary Pancreatitis Research Articles

Association of polymorphic loci of the GSS gene with the risk of acute biliary pancreatitis

Aim. To investigate the role of single nucleotide polymorphisms (SNPs) rs13041792, rs1801310, and rs6088660 in the GSS gene and environmental factors in the development of acute biliary pancreatitis (ABP) and its complications.Materials and methods. The material for the study was blood samples obtained from 84 patients with ABP and 573 healthy individuals. Both groups were comparable in terms of gender and age. To diagnose ABP, we used the clinical guidelines recommended by the working group of the Russian Society of Surgeons. DNA was isolated by phenol / chloroform extraction. Multiplex genotyping of SNPs was performed by the iPLEX assay on the MALDITOF MassARRAY-4 genetic analyzer. Statistical data processing was performed using Statistica 10 and SNPStats software.Results. We found that insufficient consumption of fresh vegetables and fruits increased the probability of ABP in carriers of genotypes G/A-A/A at rs1801310 in GSS (р = 0.02). The analysis revealed the association of the T allele at rs6088660 with the odds for developing acute pancreatitis (р = 0.007) and digestive fistulas (р = 0.02). A high probability of death was associated with rs1801310 (G/A genotype, р = 0.002) and rs6088660 (C/T genotype, р = 0.01) in the GSS gene.Conclusion. SNPs rs6088660 and rs1801310 in the GSS gene can be used to predict the course of ABP.

The joint contribution of the GGT1 gene and some haploand phenotypes to the development of acute biliary pancreatitis

He aim of the study was to determine the role of polymorphisms of the GGT1 gene and environmental risk factors in the acute biliary pancreatitis. The material of the study was DNA samples obtained from 84 patients with ABP and 573 healthy individuals. The disease was diagnosed using clinical guidelines (Russian Society of Surgeons). To assess the associations of alleles and genotypes of the gene with the risk of acute pancreatitis, the χ2 test and the odds ratio (OR) with 95% confidence intervals (CI) were used. Statistical analysis was carried out using the Statistica 10.0 program (StatSoft, USA) and the SNPStats program. Results. It was found that the A/A-G/G rs5760489 and A/A rs4820599 GGT1 genotypes have an increased risk of ABP. The H3 A-A-A-A haplotype is associated with a reduced risk of the disease, while the H6 A-G-A-A haplotype, on the contrary, increases the risk of developing the disease. The absence of exposure to alcohol abuse reduces the risk of ABP in carriers of the genotypes A/G-G/G rs5760489, A/G-G/G rs4820599, smoking -A/G-G/G rs4820599 and A/G-G/G rs5760489. The A/G-G/G rs4820599, G/A-A/A rs5751909 and A/G-G/G rs5760489 genotypes have a protective effect with sufficient consumption of fresh vegetables and fruits, the main suppliers of glutathione to the body. The presence of glutathione deficiency leads to the oxidative stress, and phenotypic changes we found: leukocytosis (allele A, rs5760489), peritonitis (allele A, rs5751909). Conclusion. The GGT1 gene can be used to predict the development and clinical course of acute biliary pancreatitis and its complications.

Benign biliary strictures associated with acute biliary pancreatitis.

There are limited data about the benign biliary strictures (BBS) which can develop during the clinical course of acute biliary pancreatitis (ABP) due to compression of the common bile duct (CBD) by edematous and inflamed pancreatic tissue. We aimed to determine the incidence of BBS due to ABP and its clinical course after endoscopic management. The study was retrospectively conducted among patients with ABP who were admitted to a single tertiary reference center during 3years. BBS-ABP was defined as distal narrowing of the CBD with proximal dilatation and delayed drainage of the contrast into the duodenum. Endoscopic treatment was performed by inserting a single 7F or 10F plastic stent which was exchanged every 3months until stricture resolution. Patients were followed for 1year after stricture resolution. Seven hundred and twenty-one patients had ABP during the study period. Among them, 257 (35.6%) patients underwent ERCP and 26 patients (3.6%) had CBD stricture due to ABP. A 7 Fr plastic stent was inserted in 18 patients and 10 Fr in 8 patients. The stricture was completely resolved at 3months in 66.7%, at 6months 23.8% and at 9months (9.5%) of the patients. There was no procedure-related complications other than asymptomatic stent migration in 4 (19%) patients. None of the patients had recurrent biliary stricture during the 1year stent-free follow-up period. BBS-ABP is a frequently seen clinical entity. In most patients, the stricture improves within 3months and temporary endoscopic stenting prevents the patients from the consequences of the obstruction during this period.

Prognostic Significance of the Red Cell Distribution Width/Albumin Ratio in the Prediction of the Severity of Acute Biliary Pancreatitis: A Preliminary Report.

ObjectiveAcute pancreatitis (AP) is a common inflammatory disease that should be considered in the etiology of patients presenting to the emergency department with abdominal pain. AP manifests with a clinical picture that can lead to organ failure and even death; therefore, early diagnosis and treatment are essential. In this study, we aimed to evaluate the red cell distribution width (RDW)/albumin ratio (RAR), which, we consider, can be used to determine the clinical course of acute biliary pancreatitis (ABP).Material and methodThe study included 166 patients with ABP. The patient's demographic information, blood values at the time of the first presentation to the emergency department, and radiological results were recorded by screening them retrospectively. Using the Atlanta criteria, the cases were classified into mild, moderately severe, and severe AP groups (MAP, MSAP, and SAP, respectively) and compared.ResultsOf the patients, 121 (72.9%) patients had MAP, 40 (24.1%) had MSAP, and five (3%) had SAP. There was no statistically significant difference between the three groups regarding gender and age. The SAP group had significantly higher median values for the length of hospital stay [19 (4-31) days], white blood cell (WBC) count [20.4 x109/L (9.1-23.3 x109/L)], and creatinine (Cre) [1.4 mg/dL (0.7-3.4 mg/dL)] (p<0.001, p=0.003, and p=0.014, respectively). The RDW and albumin values of all the groups were within normal ranges. RAR was higher in the SAP group but did not statistically significantly different between the groups. In the receiver operating characteristic (ROC) analysis of RAR, the area under the curve (AUC) value was determined as 0.75, sensitivity as 80%, specificity as 70.2%, and positive likelihood ratio as 2.1 (p=0.05).ConclusionIt is considered that RAR may be a helpful method in determining the course of ABP attacks, but there is a need for studies with a larger series, including all pancreatitis cases.

Лікування та профілактика печінкової дисфункції при гострому панкреатиті біліарної етіології у хворих на цукровий діабет

Мета роботи — оцінка ефективності традиційних та оптимізованих програм комплексного лікування та профілактики клініко-лабораторних проявів печінкової дисфункції при гострому панкреатиті біліарної етіології у хворих на цукровий діабет шляхом спостереження динаміки маркерів цитопатичної гіпоксії, системи еритрону та обміну заліза. Матеріали та методи. Робота побудована на аналізі результатів комплексного лікування 122 хворих на цукровий діабет, у яких виник гострий панкреатит біліарної етіології (ГПБЕ). Лабораторний аналіз здійснювався в межах моніторингу маркерів цитопатичної гіпоксії, системи еритрону та обміну заліза залежно від морфологічної форми гострого панкреатиту та ефективності оптимізованого та традиційного лікування. Результати. Інтерстиційна форма гострого панкреатиту біліарної етіології в умовах цукрового діабету характеризується вірогідними змінами динаміки карбонільних груп, умісту аргініну та аденозиндезамінази на фоні фізіологічних коливань решти досліджуваних маркерів цитопатичної гіпоксії, констатовані ознаки вираженого функціонального залізодефіцитного стану у вигляді мікроцитозу та гіпохромії. Виникнення некрозу паренхіми підшлункової залози різної площини залежно від морфологічної форми гострого панкреатиту біліарної етіології супроводжується вірогідними ознаками абсолютного залізодефіцитного стану різного ступеня інтенсивності та негативною динамікою показників ендотеліальної дисфункції при відокремленій формі. У хворих на поширений некротичний гострий біліарний панкреатит у патологічні зрушення системного метаболізму долучається катаболізм пуринових нуклеотидів — відбувається зростання рівнів ксантину та гіпоксантину. Стадія декомпенсації системних порушень гомеостазу спостерігається у хворих із субтотально-тотальними формами, коли додатково діагностується зростання концентрацій ферментів, що відповідальні за утилізацію продуктів катаболізму пуринових нуклеотидів (ксантиноксидаза, ксантиндегідрогеназа), які здатні до продукції реактивних форм кисню, стимулюючи оксидативний стрес. Висновки. Перебіг ГПБЕ у хворих із цукровим діабетом супроводжується закономірними змінами маркерів синдрому цитопатичної гіпоксії, системи еритрону та обміну заліза, ступінь тяжкості цих порушень має пряму кореляцію з площею морфологічних змін у підшлунковій залозі та динамікою маркерів печінкової недостатності, що дозволяє використовувати їх як прогностичні та диференціально-діагностичні критерії. За допомогою методів протокольної терапії не можна усунути наявні метаболічні порушення, а це вимагає включення до стандартних схем консервативного лікування набрякової форми ГПБЕ системного поліфункціонального метаболічного коректора (препарат Берлітіон®) для системної превентивної корекції гомеостазу та механізмів ескалації проявів печінкової дисфункції, що за наявності деструктивних форм вимагають додаткового застосування групи низькомолекулярних гепаринів (препарат Цибор®) для відновлення гемореологічних та гемокоагуляційних порушень на системному та інтраорганному рівнях

Circulating Cell-free DNA in Patients With Acute Biliary Pancreatitis: Association With Disease Markers and Prolonged Hospitalization Time-A Prospective Cohort Study.

To evaluate cfDNA as an indicator of pancreatitis severity. Acute pancreatitis severity scores have limited proficiency, and are complex and challenging to use clinically. Elevation of circulating cfDNA concentration has been shown to be associated with hospital length of stay (LOS) and mortality. In a prospective study, cfDNA concentration was measured by a simple fluorometric test, at admission and for 2 consecutive days, in patients with acute biliary pancreatitis (ABP). Ranson and APACHE II scores were used as measures of pancreatitis severity. Hospital LOS and mortality were used as outcome measures. Seventy-eight patients were included. Patients with severe disease according to Ranson's Criteria (n = 24) had elevated median admission cfDNA compared to patients with mild disease (n = 54, 2252ng/ml vs 1228 ng/ml, P < 0.05 ). Admission cfDNA levels correlated with Ranson and APACHE II scores and markers of bile duct obstruction. LOS did not differ between patients with mild and severe disease according to Ranson and APACHE II scores. Patients with cfDNA at 24 hours concentrations above the cutoff value of healthy patients (>850 ng/ml) had a significantly longer LOS compared to those with normal cfDNA levels ( P < 0.001 ). cfDNA, measured by a rapid simple assay, proved a valuable early marker of severity in ABP with clear advantages for prediction of LOS over Ranson and APACHE II. Measurement of cfDNA has the potential to be an effective practical approach to predict the course of ABP and should be further evaluated in larger trials.

Outcomes and timing of endoscopic retrograde cholangiopancreatography for acute biliary pancreatitis

BackgroundIndication of endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis (ABP) is challenging. AimsIn this retrospective study, we analyzed real-world data to understand the ERCP practice in ABP in Hungarian centers. MethodsClinical data on ABP patients (2013–2015) were extracted from our large multicentric database. Outcomes, quality indicators and the role of early timing of ERCP (<24 h from admission) were analyzed. ResultsThere were 356 patients with ABP. ERCP was performed in 267 (75%). Performance indicators of ERCP proved to be suboptimal with a biliary cannulation rate of 84%. Successful vs unsuccessful cannulation of naïve papilla resulted in lower rates of local [22.9% vs 40.9%, (P = 0.012)] and systemic [4.9% vs 13.6%, (P = 0.042)] complications. Successful vs unsuccessful clearance resulted in lower rates of local complications [22.5% vs 40.8%, (P = 0.008)]. Successful cannulation and drainage correlated with less severe course of ABP [3.6% vs 15.9%, (P = 0.001) and 4.1% vs 12.2%, (P = 0.033)] respectively. A tendency of an increased rate of local complications was observed if ERCP was performed later [<24 h: 21.1% (35/166); between 24–48 h: 23.4% (11/47); >48h: 37.2% (16/43) (P = 0.088)]. ConclusionOptimization of ERCP indication in ABP patients is critical as suboptimal ERCP practices in ABP without definitive stone detection are associated with poorer clinical outcomes.

Peculiarities of the clinical course of acute biliary pancreatitis

Peculiarities of the clinical course of acute biliary pancreatitis

Serum Leptin and Ghrelin Levels in Patients in the Early Stages of Acute Biliary Pancreatitis and Different Degrees of Severity

Acute pancreatitis (AP) is a potentially fatal disease. In animal experiments leptin and ghrelin were shown to modulate the course of AP. The aim of the study was to estimate the relationship between the severity of acute biliary pancreatitis (ABP) and serum levels of leptin and ghrelin in nonobese patients in the first seven days of the hospitalization. The study included nine patients with mild ABP (MABP), eleven patients with severe ABP (SABP) and twenty healthy controls, appropriately matched age, sex and weight. Serum concentrations of leptin and ghrelin were measured in patients on the first, third, fifth, and seventh days of hospitalization using leptin and ghrelin RadioImmunoAssay (RIA) kits. At admission and throughout the study the mean serum leptin concentration in SABP patients was higher than in the controls but without statistical significance. Serum ghrelin concentrations on admission were significantly lower in patients with ABP than in the controls. We observed steadily increasing serum ghrelin levels in both groups of the patients during the course of ABP. The results of our study do not support the role of leptin as a marker of the severity of ABP. On the other hand, rising serum ghrelin levels during the course of ABP may be a marker of recovery and an indicator of the healing process.

Surgical complications following pancreatic resections

s / Pancreatology 12 (2012) 502–597 518 Aims: We studied the relationship between the severity of acute biliary pancreatitis (ABP) and serum levels of leptin and ghrelin in nonobese patients in the first seven days of the hospitalization. Patients and methods: The study included nine patients with mild ABP (MABP), eleven patients with severe ABP (SABP) and twenty healthy controls, appropriately matched age, sex and weight. Serum concentrations of leptin and ghrelin were measured in patients on the first, third, fifth, and seventh days of hospitalization using leptin and ghrelin RadioImmunoAssay (RIA) kits. Results: At admission and throughout the study themean serum leptin concentration in SABP patients was higher than in the controls but without statistical significance. Serum ghrelin concentrations on admission were significantly lower in patients with ABP than in the controls. We observed steadily increasing serum ghrelin levels in both groups of the patients during the course of ABP. Conclusion: The results of our study do not support the role of leptin as a marker of the severity of ABP. On the other hand, rising serum ghrelin levels during the course of ABP may be a marker of recovery and an indicator of the healing process.

Serum leptin and ghrelin levels in patients in the early stages of acute biliary pancreatitis and different degrees of severity

UNLABELLED Acute pancreatitis (AP) is a potentially fatal disease. In animal experiments leptin and ghrelin were shown to modulate the course of AP. The aim of the study was to estimate the relationship between the severity of acute biliary pancreatitis (ABP) and serum levels of leptin and ghrelin in nonobese patients in the first seven days of the hospitalization. MATERIAL AND METHODS The study included nine patients with mild ABP (MABP), eleven patients with severe ABP (SABP) and twenty healthy controls, appropriately matched age, sex and weight. Serum concentrations of leptin and ghrelin were measured in patients on the first, third, fifth, and seventh days of hospitalization using leptin and ghrelin RadioImmunoAssay (RIA) kits. RESULTS At admission and throughout the study the mean serum leptin concentration in SABP patients was higher than in the controls but without statistical significance. Serum ghrelin concentrations on admission were significantly lower in patients with ABP than in the controls. We observed steadily increasing serum ghrelin levels in both groups of the patients during the course of ABP. CONCLUSIONS The results of our study do not support the role of leptin as a marker of the severity of ABP. On the other hand, rising serum ghrelin levels during the course of ABP may be a marker of recovery and an indicator of the healing process.

Early ERCP and biliary sphincterotomy with or without small-caliber pancreatic stent insertion in patients with acute biliary pancreatitis: better overall outcome with adequate pancreatic drainage

Objective. To analyze the efficacy of pancreatic duct (PD) stenting following endoscopic sphincterotomy (EST) compared with EST alone in reducing complication rate and improving overall outcome in acute biliary pancreatitis (ABP). Methods. Between 1 January 2009 and 1 July 2010, 141 nonalcoholic patients with clinical, laboratory and imaging evidence of ABP were enrolled. Emergency endoscopic retrograde cholangiopancreatography (ERCP) was performed within 72 h from the onset of pain. Seventy patients underwent successful ERCP, EST, and stone extraction (control group); 71 patients (PD stent group) had EST, stone extraction and small-caliber (5 Fr, 3-5 cm) pancreatic stent insertion. All patients were hospitalized for medical therapy and jejunal feeding and were followed up. Results. The mean age, Glasgow score, symptom to ERCP time, mean amylase and CRP levels at initial presentation were not significantly different in the PD stent group compared to the control group: 60.6 vs. 64.3, 3.21 vs. 3.27, 34.4 vs. 40.2, 2446.9 vs. 2114.3, 121.1 vs. 152.4, respectively. Complications (admission to intensive care unit, pancreatic necrosis with septicemia, large (>6 cm) pseudocyst formation, need for surgical necrosectomy) were less frequent in the PD stent group resulting in a significantly lower overall complication rate (9.86% vs. 31.43%, p < 0.002). Mortality rates (0% vs. 4.28%) were comparable, reasonably low and without any significant differences. Conclusions. Temporary small-caliber PD stent placement may offer sufficient drainage to reverse the process of ABP. Combined with EST the process results in a significantly less complication rate and better clinical outcome compared with EST alone during the early course of ABP.

TIMING OF THE ENDOSCOPIC SPHINCTEROTOMY (ES) AND OF THE VIDEOLAPAROCHOLECYSTECTOMY (VLC) IN THE ACUTE BILIARY PANCREATITIS

Introduction: There is not uniformity in the literature about the timing of execution of the endoscopic sphincterotomy (ES) and later the videolaparocholecystectomy (VLC) in course of acute biliary pancreatitis (ABP): the aim of the study was to suggest the optimal timing. Patients and Methods: In the period September 1997-November 2004, 67 patients were treated for ABP. Fifteen cases were severe ABP and 52 were mild ABP. In 55 patients an ES was executed within 48-72 hours; in 12 cases the ES was delayed of 10 days. After 8-10 days, 62 patients had a VLC; 5 patients had an open cholecystectomy. Results: The coledochal stone was removed in 32 cases (47.7%); in the last 35 patients (52.3%) the biliary sand or sludge was removed. Immediate results: 1 case (1.5%) of pancreatitis reacutizzation, 6 cases (9.8%) increase of the lypase and amylase, 2 (2.9%) duodenal perforations. The cholecystectomy, laparoscopic and open, did not have relevant complications. Later in time we have registered the develop of 3 postnecrotic pancreatic pseudocysts, treated with surgical therapy. Conclusions: The ES in course of severe and mild ABP has the double goal to clean the principal biliary duct by the stones, and moreover to remove the papillar obstacle because of stenosis, biliary sand or sludge. In our experience, the golden therapeutic timing foresees the ES within 48-72 hours from the beginning of the symptomatology and the VLC within 8-10 days: this time is necessary to establish the absence the progression of the acute pancreatitis.

PROGNOSIS OF THE CLINICAL COURSE OF ACUTE BILIARY PANCREATITIS

Early prediction of severity of acute biliary pancreatitis (ABP) may have an important value for determination of management tactic and adequate intensive medical care. Applying of the existing prognostic systems not always is sufficient for correct prognosis. There were 227 patients with ABP. The following methods were used for the investigation: clinical, ELISA for the measurement of mediators of inflammatory response, X-ray, ultrasonography, computer tomography, endoscopic retrograde cholangiography, magnetic resonance tomography. Results of statistical analysis shown that for the prediction of severity of clinical course of ABP the several indices should be applied: Age > 60 years Leukocytosis > 12 × 109/L Bilirubin > 50 μM/L Lipase > 800 IU/L ALAT > 1 mM/h·L Alkaline phosphatase > 120 U/L α2-macroglobulin < 1.8 g/L C-reactive protein > 120 mg/L α1-antitrypsin < 2 g/L In cases of four and more positive indices the severe course of ABP is probable. Applying of this system showed the sensitivity 71.4% and specificity 83.3%. Thus, the easy and accessible system for the prediction of severity of ABP was proposed.

Endoskopische Therapie bei akuter und chronischer Pankreatitis

Endoscopic therapy is valuable for both acute and chronic pancreatitis. Early endoscopic papillotomy appears, in the case of a severe course of acute biliary pancreatitis, to be advantageous. Endoscopic drainage can be considered in cases of acute fluid retention and necrosis as well as subacute, non-healing pancreatitis or cyst development. By acute chronic pancreatitis with strictures or bile duct stones, papillotomy, dilation and stent insertion can lead to an improvement in pain symptoms. An improvement in endo- or exocrine function, however, is not expected. Studies on the endoscopic therapy of pancreatitis are still very limited, and recommendations can usually only be made based on retrospective case series.

The impact of timing of endoscopic sphincterotomy (ES) in the course of acute biliary pancreatitis (ABP)

The impact of timing of endoscopic sphincterotomy (ES) in the course of acute biliary pancreatitis (ABP)

Acute pancreatitis in rats: effects of sodium taurocholate, CCK-8, and Sec on pancreatic microcirculation.

With use of in vivo microscopy, pancreatic duct permeability, red blood cell (RBC) velocities, functional capillary density (FCD), and overall changes in capillary blood flow (perfusion index) were estimated after intraductal infusion of sodium taurocholate (0.8 ml, 4%) alone or in combination with systemic administration of cholecystokinin (CCK, 0.3 microg/100 g body wt) or secretin (Sec, 10 microg/100 g body wt). Sodium taurocholate mediated a significant increase in pancreatic duct and capillary permeability within 105 +/- 26 s followed by a transient decrease in RBC velocities and a sustained decrease in FCD, which were paralleled by dramatic flow heterogeneity. Therefore, a significant reduction in overall capillary blood flow was calculated. CCK stimulation aggravated the microcirculatory failure due to a decrease in RBC velocities, which was accompanied by an increase in acinar cellular necrosis. Sec stimulation attenuated microcirculatory failure due to a more moderate reduction of FCD. The enhanced pancreatic duct and capillary permeability, which enables free diffusion of pancreatic digestive enzymes into the parenchyma, is the initiating event in acute biliary pancreatitis, causing microcirculatory failure and tissue damage. The microcirculatory changes are secondary and a propagating factor for the development of acini necrosis. Stimulation with CCK worsened the course of acute biliary pancreatitis.