Etiological Factor In Acute Pancreatitis Research Articles

Нейтрофільні позаклітинні пастки при гострому панкреатиті

The review focuses on the role of neutrophilic extracellular traps (NETs) in the pathogenesis of acute pancreatitis. It is shown that NETs can activate trypsin, cause inflammation and pancreatic tissue damage, and clog the excretory ducts. NETs are involved in the formation of gallstones, which are one of the leading etiological factors of acute pancreatitis. NETs also surround necrotic tissue in patients with severe acute pancreatitis and contribute to further systemic inflammatory response syndrome. The mechanisms of NETs formation in acute pancreatitis, in particular, the importance of damageassociated molecular patterns, neutrophil microparticles, and platelets in these processes are considered.

A clinical study on epidemiology and etiological factors of acute pancreatitis-hospital based study in South India

Background: Acute pancreatitis is an important cause of acute abdomen with high morbidity and mortality. This study aimed to evaluate the epidemiology and etiological factors of acute pancreatitis in a tertiary care hospital in South India.Methods: This retrospective study was carried among 70 patients. Data was collected and analysis done based on age, gender, etiology and severity of acute pancreatitis.Results: Males were found more commonly affected than females in the ratio (M:F) of 5:1. Mean age of the study group was 37.2 years and maximum incidence was seen in the age group of 31 to 40 years. Overall alcohol was the most common etiological factor followed by idiopathic cause and gall stone disease.Conclusions: Males were more commonly affected than females with acute pancreatitis. Alcohol and gall stones were the leading cause of acute pancreatitis in males and females respectively. Alcohol was the most common cause in this geographical location.

STRUCTURAL ANALYSIS OF CLINICAL AND LABORATORY AND INSTRUMENTAL DIAGNOSIS AND TREATMENT OF ACUTE PANCREATITIS

Summary. The purpose of the study: to analyze the causes of development, terms of hospitalization, the frequency of severe type, complications and overall mortality in acute pancreatitis according to the clinic data.
 Materials and methods: the results of treatment of 622 patients with acute pancreatitis were analyzed. Among them there were 336 women (54.1 %) and 286 men (45.9 %). The mean age of patients was (48.2 ± 2.2) years. The diagnosis of acute pancreatitis was made according to the recommendations (Atlanta, 2012). All patients with acute pancreatitis underwent ultrasound examination of the abdominal cavity and computed tomography, enhanced by intravenous contrast.
 Results and discussion: Etiological factors of acute pancreatitis were: biliary factor in 270 (43.4 %) patients, alcohol — in 155 (24.9 %), acute pancreatitis on the background of triglyceridemia — in 135 patients (21.7 %), 21 (3.4 %) patients had postoperative pancreatitis, medication — in 8 (1.3 %) patients and without a clear etiology — in 33 (5.3 %) patients. The terms of hospitalization of patients are as follows: after 24–48 hours from the onset of the disease — 215 (34.6 %) cases, after 6–24 hours after the onset of the disease — 204 (32.8 %) cases, after 48 hours and later from the time of the disease — 129 (20.7 %) cases and 74 (11.9 %) cases of hospitalization up to 6 hours from the onset of the disease. Severe acute pancreatitis developed in 147 (23.6 %) patients and was accompanied by the development of organ failure lasting > 48 hours. 594 (95.4 %) patients with acute pancreatitis received only conservative infusion therapy. 28 (4.5 %) patients required surgical treatment. The overall mortality in patients with acute pancreatitis was 9 (1.4 %) cases.
 Conclusions: Hyperdiagnosis of acute pancreatitis is a common problem in modern surgery. Formulation of the diagnosis according to the unified diagnostic criteria considerably facilitated diagnosis. The dominant factors of acute pancreatitis are biliary (43.4 %) and alcoholic factors (24.9 %). Most often (34.6 %) patients were admitted to the department on the second day after the onset of the disease. Remains high level of severe acute pancreatitis, which amounted to 23.6 % of cases. 594 (95.4 %) patients with acute pancreatitis received infusion therapy. 28 (4.5 %) patients underwent surgical treatment. The total mortality in acute pancreatitis according to our clinic was 9 (1.4 %) cases, the majority of them (7 patients) died in the early period of acute pancreatitis.

Insufficient etiological workup of COVID-19-associated acute pancreatitis: A systematic review.

BACKGROUNDSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, mostly causing respiratory symptoms, is also known to affect the gastrointestinal tract. Several case reports hypothesize that SARS-CoV-2 could be an etiological factor in acute pancreatitis (AP).AIMTo assess all the available evidence in the literature relating to coronavirus disease 2019 (COVID-19) and AP.METHODSWe performed a systematic review of the available literature on the topic. The systematic search was conducted on 15 May 2020 on MEDLINE, EMBASE, CENTRAL, Web of Science and Scopus with a search key using the terms “amylase,” “lipase,” “pancr*,” “COVID-19” and synonyms. Due to the low quality and poor comparability of the studies, a meta-analysis was not performed.RESULTSSix case reports and two retrospective cohorts were included, containing data on eleven COVID-19 patients with AP. Five patients had AP according to the Atlanta classification. Other publications did not provide sufficient information on the diagnostic criteria. Most cases were considered SARS-CoV-2-induced, while several established etiological factors were not investigated. We were able to identify other possible causes in most of them.CONCLUSIONWe strongly highlight the need for adherence to the guidelines during a diagnostic and etiological workup, which could alter therapy.

Recurrent acute pancreatitis induced by 5-ASA and azathioprine in ulcerative colitis

Drug-induced acute pancreatitis (DIAP) is an often-neglected entity where the disorder is the consequence of the toxic effects of various agents applied to treat potentially life-threatening conditions, such as inflammatory bowel disease. Here, we present the case of a male patient with ulcerative colitis with a history of two episodes of recurrent acute pancreatitis. After excluding other potential causes, we suspected DIAP since the patient received 5-aminosalycilate (5-ASA) prior to the first episode and, one year later, azathioprine (AZA) prior to the second episode. The causative effect of AZA was confirmed by performing a re-challenge with a reduced dose. While both episodes of DIAP had a mild disease course, they were associated with acute relapse of ulcerative colitis. Last seen, the patient was asymptomatic. With this case, we would like to highlight the importance and diagnostic difficulties of DIAP in the background of recurrent cases when common etiological factors of acute pancreatitis are excluded.

Нelicobacter pylori as etiological factor of acute pancreatitis and marker of its purulent-septic complications development

Objective. Studying of role of Нelicobacter pylori as etiological factor of acute pancreatitis and marker of development of its purulent-septic complications.
 Маterials and methods. Screening investigation was performed in all 124 patients, suffering acute pancreatitis and admitted to hospital; then a screening investigation of Нelicobacter pylori in feces and the blood serological investigation was conducted. In 39 (31.5%) patients bacteriological investigation of biological material for revealing of Нelicobacter pylori was conducted. The patients were distributed into two groups: the main - 66 patients with severe and with a middle severity course of acute pancreatitis and a control one - 58 patients with light course of acute pancreatitis.
 Results. Positive results of fecal express-test were obtained in 105 (84.7%) patients. In accordance to the blood serological investigations results in 24 h from the admittance to hospital moment in a control group a positive result was obtained in 8 (13.8%) patients, and in the main - in 23 (34.8%); while in 7 days - in 9 (15.5%) and 42 (63.6%) patients, accordingly. Аntibiotics, which are applied for therapy in purulent-septic complications of acute pancreatitis, guarantee the efficacy of eradication of Нelicobacter pylori in 94.9% patients.
 Conclusion. The enhancement of quantity of the blood positive serological investigations by 28.8% (р < 0.001) in patients of the main group in 7 days from the admittance to the hospital date trusts, that Нelicobacter pylori constitutes not the only one etiological factor in acute pancreatitis, but a possible marker of development of its purulent-septic complications as well.

Do the etiological factors of acute pancreatitis affect the course of the disease?

To investigate the accuracy of resistin, leptin and adiponectin levels in predicting persistent organ failure in patients with acute pancreatitis (AP).Data from 90 consecutive patients admitted to our hospital for AP were retrospectively collected from an ongoing prospective cohort study. The levels of adiponectin, leptin and resistin were measured and compared between patients with and without persistent organ failure. The accuracy of the adipokines in predicting persistent organ failure were compared with the patients' Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, and were separately investigated in overweight and non-overweight groups.Persistent organ failure occurred in 26.7% of the patients. The levels of resistin were significantly increased in AP patients with persistent organ failure, in both the overweight and the non-overweight subgroups. Resistin and APACHE-II score predicted persistent organ failure with comparable areas under the curve (AUC) of 0.72 and 0.75, respectively (p = 0.66). Resistin demonstrated similar accuracy with the APACHE-II score in predicting persistent organ failure in the overweight (0.69 vs. 0.66, p = 0.82) and non-overweight (0.76 vs. 0.87, p = 0.39) subgroups. There was no correlation between adiponectin and persistent organ failure, but a weak correlation between leptin and persistent organ failure was demonstrated.Resistin and leptin levels, rather than adiponectin, correlate with persistent organ failure in patients with AP.

Acute Pancreatitis due to Cephalexin: A Case Report and Review of Literature

Acute pancreatitis (AP) due to medication represents 0.3% to 1.4% of all cases of acute pancreatitis. Acute pancreatitis due to cephalosporins is rarely reported with only five cases reported in literature thus far. Cephalexin is a Beta lactam antibiotic which is classified as a first-generation cephalosporin. Although GI side effects including nausea, vomiting, transient hepatitis, and pseudomembranous colitis have been reported, acute pancreatitis has never been reported.To our knowledge, this is the first of probable primary Cephalexin-induced acute pancreatitis. A 55 years old female patient with past medical history significant for multiple sclerosis (MS), basal cell carcinoma (BCC), history laparoscopic cholecystectomy due to gallstones had excision of BCC done in dermatology clinic and received a dose of 500 mg Cephalexin for prophylaxis. Three hours later, she presented to emergency department (ED) for sudden onset of upper abdominal pain radiating to back. The pain was associated with severe nausea and poor appetite. She denied history of drinking alcohol, trauma, insect or scorpion bite and previous history of pancreatitis. Her medication list included Fingolimod (Gilenya) and Oxcabazepine both of which she was taking for years without any side effects. Abdominal examination revealed epigastric tenderness, with no rebound or palpable masses. Initial laboratory workup revealed lipase of 889 Units/L (6 times upper normal limit). However, CT abdomen in the ED was negative for peripancreatic fat stranding, fluid collection, and pancreatic focal lesions. Based on abdominal pain and elevated lipase three-time upper normal limit, the patient was diagnosed with acute pancreatitis. She was admitted and started on aggressive intravenous hydration. Further work up showed normal liver enzymes and serum triglyceride of 68 mg/dl. IgG subclasses were normal. Ultrasound showed unremarkable liver, absent gallbladder, and extra hepatic duct measured 10 mm. MRCP was obtained, which showed mild extrahepatic duct dilatation up to 11 mm without any dominant stricture or stone. Cephalexin was discontinued. Four days later her appetite improved and pain resolved and she was discharged home on low fat diet. In the absence of other causes of acute pancreatitis, cephalosporins such as Cephalexin should be considered as a potential etiologic factor of acute pancreatitis in patients who present with abdominal pain and elevated serum lipase levels.Table: Characteristics findings of published case reports of Cephalosporin induced pancreatitis.

Actualités sur la prise en charge de la pancréatite aiguë

Over the past decades, the incidence and the number of hospital admissions for acute pancreatitis have increased in the Western countries. The two most common etiological factors of acute pancreatitis are gallstones (including small gallstones or microlithiasis) and alcohol abuse. Acute pancreatitis is associated with a significant mortality (4–10%) and 25% in case of pancreatic necrosis, especially. Edematous pancreatitis is benign and oral feeding can be restarted once abdominal pain is decreasing and inflammatory markers are improving. Enteral tube feeding should be the primary therapy in patients with predicted severe acute pancreatitis who require nutritional support. Enteral nutrition in acute pancreatitis can be administered via either the nasojejunal or nasogastric route. In case of necrosis, preventive antibiotics are not recommended. The single indication is infected necrosis confirmed by fine needle aspiration. The incidence trends of acute pancreatitis possibly reflect a change in the prevalence of main etiological factors (e.g. gallstones and alcohol consumption) and cofactors such as tobacco, obesity and genetic susceptibility. Priority is to search for associated causes, especially in cases with atypical symptoms. In case of first acute pancreatitis in patients older than 50years, the presence of a tumor (benign or malignant) has to be specifically ruled out, using CT-scan, MRI and endoscopic ultrasound.

Hypercalcemia related pancreatitis

Common etiological factors of acute pancreatitis are alcohol, gallstone disease, drugs, trauma, viral infection and hyperlipidemia. Hypercalcemia as a cause of pancreatitis is very rarely reported. Hypercalcemia is usually the result of hyperparathyroidism (HPT) and the most common cause of HPT is parathyroid adenoma. We present a case of recurrent pancreatitis, which helped in diagnosing an otherwise clinically silent parathyroid adenoma.

Acute Pancreatitis in the Guangdong Province, China

Background/Aims: Many studies have recently been published on acute pancreatitis; however, few large-sample studies have been focused on the risk factors for deaths in severe acute pancreatitis. To address this issue, the present study was intended to assess etiology, severity, and mortality of acute pancreatitis in the Guangdong Province (Guangdong), China, and to analyze the risk factors responsible for deaths in severe acute pancreatitis in this large series of patients. Methods: Four tertiary medical centers located in Guangdong were involved in this retrospective study. Data of 2,342 patients with acute pancreatitis admitted to these centers from December 1990 through December 2005 were collected in a standardized form and analyzed. Results: Of the 2,342 patients (1,130 men and 1,212 women, mean age 51±18, range 4–98 years), 1,778 (76.0%) had mild pancreatitis, and 564 (24.0%) had the severe form. Biliary tract disease (47.5%) was the predominant etiology, the overall mortality rate was 5.0%, and the fatality rate in patients with severe acute pancreatitis was 20.0%. Among the deceased patients in the severe acute pancreatitis group, logistic regression analysis of variables showed that the independent risk factor for mortality was shock, while a biliary origin was a protective factor against a poor prognosis. Conclusions: In this case series, the results suggest that biliary tract disease was the main etiologic factor of acute pancreatitis in Guangdong. The majority of deaths in severe acute pancreatitis occurred within the first 14 days of admission; the only independent risk factor for mortality was systematic complication of shock.

Recurrent Acute and Chronic Pancreatitis in Two Brothers With Familial Chylomicronemia Syndrome

The chylomicronemia syndrome is well recognized as a rare etiologic factor of acute pancreatitis; however, whether hypertriglyceridemia can cause chronic pancreatitis (CP) remains unclear. We describe the long-time course of 2 brothers with the familial chylomicronemia syndrome caused by identical compound heterozygous mutations in the lipoprotein lipase (LPL) gene with markedly reduced LPL activity. Other etiologic factors were excluded, including mutations in the PRSS1, SPINK1, and CFTR gene. Although both brothers had recurrent acute pancreatitis and the same LPL genotype, CP became evident in only one patient. Progression to CP was associated with a more severe disease course. Thus, the chylomicronemia syndrome may cause CP in the absence of other known causative factors, and similar to alcoholic and hereditary CP, a more severe disease course is associated with disease progression.

JPN Guidelines for the management of acute pancreatitis: treatment of gallstone-induced acute pancreatitis

Gallstones, along with alcohol, are one of the primary etiological factors of acute pancreatitis, and knowledge of the etiology as well as the diagnosis and management of gallstones, is crucial for managing acute pancreatitis. Because of this, evidence regarding the management of gallstone-induced pancreatitis in Japan was collected, and recommendation levels were established by comparing current clinical practices with optimal clinical practices. The JPN Guidelines for managing gallstone-induced acute pancreatitis recommend two procedures: (1) an urgent endoscopic procedure should be performed in patients in whom biliary duct obstruction is suspected and in patients complicated by cholangitis (Recommendation A); and (2) after the attack of gallstone pancreatitis has subsided, a laparoscopic cholecystectomy should be performed during the same hospital stay (Recommendation B).

Stimulatory effects of bilirubin on amylase release from isolated rat pancreatic acini.

Considered to be an etiologic factor of acute pancreatitis, hypersecretion of pancreatic juice and digestive enzymes is often associated with hyperbilirubinemia. We explored the intracellular mechanisms through which bilirubin affects pancreatic exocrine secretory function by examining the effect of bilirubin on isolated rat pancreatic acini. Bilirubin stimulated amylase release in a concentration- and time-dependent manner, significantly increasing amylase release at concentrations >5 mg/100 ml and after 15 min of incubation. Coincubation of bilirubin with vasoactive intestinal polypeptide, 8-bromo-cAMP, or A-23187 had a synergistic effect on amylase release, whereas coincubation with CCK-8, carbamylcholine, or 12-O-tetradecanoylphorbol 13-acetate had an additive effect. Bilirubin did not affect acinar cAMP content or Ca(2+) efflux. Intracellular Ca(2+) pool depletion had no influence on bilirubin-evoked amylase release. The protein kinase C (PKC) inhibitors staurosporine and calphostin C partially but significantly inhibited bilirubin-stimulated amylase release, whereas the PKA inhibitor H-89 did not. The tyrosine kinase (TK) inhibitor genistein, phospholipase A(2) (PLA(2)) inhibitor indoxam, and PLC inhibitor U-73122 also inhibited amylase release. Bilirubin significantly translocated PKC activity from the cytosol to the membrane fraction and activated TK in cytosol and membrane fractions. These results indicate that bilirubin stimulates amylase release by activating PKC and TK in rat pancreatic acini and that PLC and PLA(2) partly mediate this process.

Influence of etiology on the course and outcome of acute pancreatitis.

It has been supposed that there are differences with regard to clinical course and outcome due to the underlying etiological factor in acute pancreatitis. Therefore, the objective of this study was to analyze the severity of the disease, serum enzymes, indicators of necrosis, systemic complications, and mortality in acute pancreatitis with regard to the etiology. One hundred ninety patients with acute pancreatitis (127 male, 63 female) were studied prospectively and subdivided into three etiological groups: (i) alcohol, (ii) gallstones, and (iii) other causes and idiopathic acute pancreatitis. Severity scores (Ranson and Bank) and findings by contrast-enhanced computed tomography were similar in all three groups. Analysis of serum enzymes [lipase, aspartate aminotransferase (ASAT)] and indicators of necrosis (C-reactive protein, alpha 1-antitrypsin, alpha 2-macroglobulin, and lactate dehydrogenase) showed only for ASAT within 24 h significantly higher levels in biliary acute pancreatitis in comparison with the other groups. There were no differences in the rate of infected pancreatic necrosis and mortality in alcohol-related acute pancreatitis (31 and 5.3%), biliary acute pancreatitis (38 and 10%) and acute pancreatitis due to other etiological factors (43 and 5.5%). In conclusion, this study clearly showed that once the pathogenetic mechanisms have initiated the disease, the course and outcome of acute pancreatitis are not influenced by the underlying etiological factor.

Clinical Significance of Ultrasonography, Computed Tomography, and Biochemical Tests in the Rapid Diagnosis of Gallstone-Related Pancreatitis

Real-time ultrasonography (US), computed tomography (CT), and biochemical tests were prospectively performed to detect gallstones in 88 consecutive patients immediately after the onset of an attack of acute pancreatitis. The sensitivity of biochemical tests was 84.6% when the patients had three or more positives of five parameters [including serum bilirubin, alkaline phosphatase (AP), gamma-glutamyl transpeptidase (GGT), alanine transaminase (ALT), and alanine transaminase-aspartate transaminase (ALT-AST) ratio]. The sensitivity, specificity, and accuracy were 71.8, 98.0, and 86.4% for US, and 52.9%, 100%, and 79.5% for CT. The sensitivity, specificity, and accuracy were improved to 82.1, 100, and 93.2% by the combination of US and CT, and 94.9, 100, and 97.7% by the combination of US and biochemical tests. Adding CT to the combination of US and biochemical tests resulted in only a slight improvement in sensitivity and accuracy. In conclusion, a combination of US and biochemical tests can provide the best noninvasive method in rapidly detecting gallstones as an etiological factor in acute pancreatitis. Computed tomography is not cost-effective. A positive result of biochemical tests despite a negative finding in US calls for an intensive search for gallstones by further investigation with endoscopic retrograde cholangiography or repeated US examinations.

Carboxylic Ester Hydrolase

By use of an enzyme-linked immunosorbent assay we established serum reference values of carboxylic ester hydrolase, a pancreatic secretory lipolytic enzyme, and explored to see if a raised serum level is indicative of acute pancreatitis. Postoperative elevation of carboxylic ester hydrolase was observed in seven out of ten patients who underwent pancreatic surgery. Serum levels of carboxylic ester hydrolase and amylase were determined in 129 patients admitted due to abdominal emergency conditions. Amylase was elevated in 27 patients, and in 20 of these raised carboxylic ester hydrolase levels affirmed the diagnosis acute pancreatitis. In five out of the seven patients with elevated amylase alone no etiologic factor of acute pancreatitis was found. Another 11 patients had raised carboxylic ester hydrolase levels without concomitant elevation of amylase. In all these patients, a likely cause of pancreatic inflammation was identifiable. Hence, a raised carboxylic ester hydrolase level, even in presence of normal amylase, could be indicative of acute pancreatic inflammation.

Acute Fatt‐ Liver of Pregnanc‐ with H‐perlipidemia, Acute Hemorrhagic Pancreatitis and Disseminated Intravascular Coagulation

AbstractAn autops‐ case of a 32‐ear old nulliparous woman who died of acute fatt‐ liver of pregnanc‐ (AFLP) associated with h‐perlipidemia, acute hemorrhagic pancreatitis and disseminated intravascular coagulation (DIC) is reported. Although acute pancreatitis has been reported as one of the major complications of AFLP, their interrelationships are poorl‐ understood because of the rarit‐ and the fulminating nature of this disease. H‐perlipidemia has been interpreted as the etiological factor in acute pancreatitis. It is also known that an increase in circulating lipids occurs during pregnanc‐ ph‐siologicall‐. AFLP presents itself onl‐ in the last trimester of pregnanc‐. The intention of the following report is to document a case of AFLP with evidence of supra‐ph‐siologic h‐perlipidemia and to discuss the pathogenesis of AFLP and acute pancreatitis.