First Episode Of Acute Pancreatitis Research Articles

Imbalance in the vWF – ADAMTS13 axis exists early in acute pancreatitis and predicts persistent organ failure and pancreatic necrosis-a prospective study

BackgroundThe pathophysiology of Acute Pancreatitis (AP) may be complicated by endothelial activation. von Willebrand Factor (vWF)- ADAMTS13 axis is a marker of endothelial activation. The study aimed to investigate the axis in AP, comparing it in patients with and without persistent organ failure (OF), with and without pancreatic necrosis, and correlating it with the standard severity scores (CRP, APACHE II, BISAP, SOFA, and qSOFA) MethodsvWF-Antigen (vWF:Ag), vWF-Collagen-Binding-Assay (vWF:CBA), and ADAMTS13 activity (ADAMTS13:act) levels were measured within 5 days of symptom onset in consecutive patients (n = 98), who were admitted with a first episode of AP (Dec 2021–May 2023). ResultsOf the 98 patients admitted with AP, 78(79.6 %) had no or transient OF; 20(20.4 %) had persistent OF. Age was comparable (43.73 ± 15.36 vs 38.65 ± 13.69) [mean ± SD](years), and males were predominant in both groups (70.5 % vs 80 %). Patientswith persistent OF had higher vWF:CBA(%)[323(279–486.5) vs 199.5(159.1–295.75)] and lower ADAMTS13:act(%)[35.4(23.8–56.85) vs 56.35(44.1–71.9)][median (25th – 75th percentile)](P = 0.001) than those with no or transient OF. Patients with pancreatic necrosis (n = 19) had lower ADAMTS13:act(%)[42.79 ± 18.69] than those without pancreatic necrosis (n = 18) [62.49 ± 22.64] (P < 0.01). ADAMTS13:act had a negative correlation(r = −0.2), whereas vWF:Ag and vWF:CBA had a positive correlation (r = 0.2) with the standard severity scores (P < 0.05). ADAMTS13:act could predict pancreatic necrosis [AUROC-0.737, P < 0.05] and persistent OF [AUROC–0.746, P < 0.001], while vWF:CBA could predict persistent OF [AUROC– 0.73, P < 0.001]. ConclusionvWF-ADAMTS13 axis helps to predict severe disease and is associated with poor outcomes in acute pancreatitis.

The Role of Pancreatitis Risk Genes in Endocrine Insufficiency Development After Acute Pancreatitis in Children

Acute pancreatitis (AP) is increasingly recognized as a risk factor for diabetes mellitus (DM). We aimed to study the association of pancreatitis genes with pancreatic endocrine insufficiency (pre-DM and DM) development post AP in children. This was an observational cohort study that enrolled subjects ≤21 years with their first episode of AP and followed them for 12 months for the development of pancreatic endocrine insufficiency. Pancreatitis risk genes (CASR, CEL, CFTR, CLDN2, CPA1, CTRC, PRSS1, SBDS, SPINK1, and UBR1) were sequenced. A genetic risk score was derived from all genes with univariable p<0.15 RESULTS: A total 120 subjects with AP were genotyped. Sixty-three subjects (52.5%) had at least 1 reportable variant identified. For modeling the development of pancreatic endocrine insufficiency at one year, 6 were excluded (2 with DM at baseline, 3 with total pancreatectomy, and 1 death).. From this group of 114, 95 remained normoglycemic and 19 (17%) developed endocrine insufficiency (4 DM, 15 pre-DM). Severe AP (58% vs 20%; p=0.001) and at least one gene affected (79% vs 47%, p=0.01) were enriched among the endocrine insufficient group. Those with versus without endocrine insufficiency were similar in age, sex, race, ethnicity, body mass index, and AP recurrence. A model for pre-DM/DM development included AP severity (OR=5.17 [1.66, 16.15], p=0.005) and genetic risk score (OR=4.89 [1.83, 13.08], p=0.002) and had an AUC of 0.74. In this cohort of children with AP, pancreatitis risk genes and AP disease severity were associated with pre-DM or DM development post AP.

Impact of Serum Glucose Levels on Outcomes in Acute Pancreatitis: A Retrospective Analysis.

Background and Objectives: The risk of developing glycemic dysregulation up to overt diabetes mellitus (DM) after an episode of acute pancreatitis (AP) is increasingly being analyzed. We aimed to assess the changes in serum glucose levels associated with the first episode of AP, as well as the impact of dysglycemia on outcomes such as the severity of inflammation, the length of hospitalization, mortality, and the persistence of hyperglycemia at follow-up. Materials and Methods: All patients experiencing their first episode of AP, who presented to the Emergency Room (ER) between 1 January 2020 and 31 December 2023, were retrospectively included. On-admission serum glucose and peak serum glucose during hospitalization were the biological markers used to assess glucose metabolism impairment, and they were correlated with outcomes of AP. Results: Our study included 240 patients, 46.67% (112 patients) having a biliary etiology for an AP flare. Patients with COVID-19-associated AP exhibited the highest on-admission and peak serum glucose levels (244.25 mg/dL and 305.5 mg/dL, respectively). A longer hospital stay was noted in patients with peak serum glucose levels of ≥100 mg/dL (9.49 days) compared to normoglycemic patients (6.53 days). Both on-admission and peak glucose levels were associated with elevated CRP levels during hospitalization. A total of 83.78% of patients who received antibiotics exhibited on-admission hyperglycemia, and 72.07% had peak serum glucose levels of ≥100 mg/dL. The presence of hyperglycemia at follow-up was associated with both on-admission and peak serum glucose levels of ≥100 mg/dL, as well as with a longer stay, higher CRP levels, and antibiotic use during index admission. Conclusions: On-admission hyperglycemia predicts a higher inflammatory response in patients at the first episode of AP, while the presence of hyperglycemia during hospitalization is associated with imaging and biological severity and longer hospitalizations, indicating a more severe disease course. Both on-admission and peak in-hospital hyperglycemia were identified as risk factors for sustained hyperglycemia at follow-up.

Recurrent acute pancreatitis in a patient with peanut allergy

Peanut allergy is a common food allergy. Accidental peanut exposure can induce anaphylactic symptoms in allergic individuals. In rare cases, pancreatitis can be induced by food allergies. This report describes a 12-year-old girl with recurrent acute pancreatitis (AP) following a peanut allergy induced 8 years after the first episode. The patient experienced the first episode of AP at 4 years old when she accidentally consumed peanut powder ice cream. AP was recurrently induced 8 years later by an oral food challenge test with a small amount of peanuts, despite decreased specific IgE for peanuts and Arah2. This report is the first to demonstrate that AP, as a peanut-induced symptom, is difficult to tolerate over a long period in a patient with peanut allergy. The possibility of AP induction after accidental ingestion, oral food challenge, or oral immunotherapy for peanuts should be considered in patients with peanut allergy.

High Rate of Islets Autoimmunity in Pediatric Patients with Index Admission of Acute Pancreatitis

Introduction. The underlying pathophysiology of diabetes mellitus after acute pancreatitis is unknown and overall risk of developing diabetes postacute pancreatitis in children is understudied. The objective of our study was to describe the frequency of islet cell autoimmunity and abnormal glucose testing in pediatric patients in the year following their index case of acute pancreatitis. Materials and Methods. Data were obtained from a single-center observational cohort study of patients with their first episode of acute pancreatitis. Islet cell autoantibody titers were measured on stored plasma collected from acute pancreatitis diagnosis, at 3 months and at 12 months postacute pancreatitis attack. Abnormal glucose testing was defined as the presence of prediabetes or diabetes, as defined by American Diabetes Association criteria. Results. Eighty-four patients with acute pancreatitis and islet cell autoantibody data were included, 71 had available glucose measures. Median age at first acute pancreatitis attack was 14 years (IQR 8.7–16.3) and 45/84 (54%) were females. Twenty-four patients (29%) were positive for at least one of four islet cell autoantibodies (IAA, GADA, IA-2A, and ZnT8A) and 6 (7%) had two or more positive islet cell autoantibodies. Nineteen patients out of 71 (27%) had abnormal glucose testing at or postacute pancreatitis diagnosis. A higher proportion (37%, 7/19) with abnormal glucose testing had severe acute pancreatitis compared to those with normal glucose testing (13%, 7/52) ( p = 0.04 ). Patients with normal glucose testing were more likely to be positive for one or more islet cell autoantibodies (31%, 16/52) compared to those with abnormal glucose testing (0%, 0/19) ( p = 0.004 ). Conclusions. Islet cell autoimmunity is more common in children after their index acute pancreatitis attack (29%) than in the general population (7%–8%). While the frequency of prediabetes and diabetes postacute pancreatitis is high, other mechanisms besides islet cell autoimmunity are responsible.

Application of a Machine Learning Predictive Model for Recurrent Acute Pancreatitis.

Acute pancreatitis is the main cause of hospitalization for pancreatic disease. Some patients tend to have recurrent episodes after experiencing an episode of acute pancreatitis. This study aimed to construct predictive models for recurrent acute pancreatitis (RAP). A total of 531 patients who were hospitalized for the first episode of acute pancreatitis at the Affiliated Hospital of Southwest Medical University from January 2018 to December 2019 were enrolled in the study. We confirmed whether the patients had a second episode until December 31, 2021, through an electronic medical record system and telephone or WeChat follow-up. Clinical and follow-up data of patients were collected and randomly allocated to the training and test sets at a ratio of 7:3. The training set was used to select the best model, and the selected model was tested with the test set. The area under the receiver operating characteristic curves, sensitivity, specificity, positive predictive value, negative predictive value, accuracy, decision curve, and calibration plots were used to assess the efficacy of the models. Shapley additive explanation values were used to explain the model. Considering multiple indices, XGBoost was the best model. The area under the receiver operating characteristic curves, accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the XGBoost model in the test set were 0.779, 0.763, 0.883, 0.647, 0.341, and 0.922, respectively. According to the Shapley additive explanation values, drinking, smoking, higher levels of triglyceride, and the occurrence of ANC are associated with RAP. The XGBoost model shows good performance in predicting RAP, which may help identify high-risk patients.

Natural history after a first episode of acute pancreatitis

Natural history after a first episode of acute pancreatitis

Structured alcohol cessation support program versus current practice in acute alcoholic pancreatitis (PANDA): Study protocol for a multicentre cluster randomised controlled trial

Background/objectivesThe most important risk factor for recurrent pancreatitis after an episode of acute alcoholic pancreatitis is continuation of alcohol use. Current guidelines do not recommend any specific treatment strategy regarding alcohol cessation. The PANDA trial investigates whether implementation of a structured alcohol cessation support program prevents pancreatitis recurrence after a first episode of acute alcoholic pancreatitis. MethodsPANDA is a nationwide cluster randomised superiority trial. Participating hospitals are randomised for the investigational management, consisting of a structured alcohol cessation support program, or current practice. Patients with a first episode of acute pancreatitis caused by harmful drinking (AUDIT score >7 and < 16 for men and >6 and < 14 for women) will be included. The primary endpoint is recurrence of acute pancreatitis. Secondary endpoints include cessation or reduction of alcohol use, other alcohol-related diseases, mortality, quality of life, quality-adjusted life years (QALYs) and costs. The follow-up period comprises one year after inclusion. DiscussionThis is the first multicentre trial with a cluster randomised trial design to investigate whether a structured alcohol cessation support program reduces recurrent acute pancreatitis in patients after a first episode of acute alcoholic pancreatitis, as compared with current practice. Trial registrationNetherlands Trial Registry (NL8852). Prospectively registered.

Evaluation of disease recurrence and evolution into chronic pancreatitis in 492 patients after a first episode of acute pancreatitis

Evaluation of disease recurrence and evolution into chronic pancreatitis in 492 patients after a first episode of acute pancreatitis

Diabetes mellitus as a consequence of acute severe pancreatitis: Unraveling the mystery.

The occurrence of diabetes mellitus (DM) in pancreatitis is being increasingly recognized lately. Diabetes can develop not only with chronic pancreatitis but even after the first episode of acute pancreatitis (AP). The incidence of diabetes after AP varies from 18% to 23% in 3 years and reaches up to 40% over 5 years. The exact pathogenesis of diabetes after AP is poorly understood and various mechanisms proposed include loss of islet cell mass, AP-induced autoimmunity, and alterations in the insulin incretin axis. Risk factors associated with increased risk of diabetes includes male sex, recurrent attacks of pancreatitis, presence of pancreatic exocrine insufficiency and level of pancreatitic necrosis. Diagnosis of post-pancreatitis DM (PPDM) is often excluded. Treatment includes a trial of oral antidiabetic drugs in mild diabetes. Often, insulin is required in uncontrolled diabetes. Given the lack of awareness of this metabolic disorder after AP, this review will evaluate current information on epidemiology, risk factors, diagnosis and management of PPDM and identify the knowledge gaps.

Hemorrhage From Left Hepatic Artery Pseudoaneurysm as a Complication of Acute Pancreatitis in a Patient With Fibromuscular Dysplasia

ABSTRACT Hepatic artery pseudoaneurysms are a rare complication of pancreatitis, and their rupture and bleeding cause high mortality. We present the case of a 76-year-old woman with fibromuscular dysplasia who developed a new left hepatic artery pseudoaneurysm within a week of her first episode of acute pancreatitis and later suffered an acute pseudoaneurysm bleed successfully treated with transcatheter coil embolization. To the best of our knowledge, this is the first case reported of a patient with fibromuscular dysplasia with pancreatitis-related pseudoaneurysm formation. One must consider pseudoaneurysms and associated bleeding as complications of acute pancreatitis because prompt recognition can lead to timely management.

Number of recurrences is significantly associated with the post-acute pancreatitis diabetes mellitus in a population with hypertriglyceridemic acute pancreatitis

BackgroundTwenty-three percent of patients are diagnosed with diabetes mellitus after the first episode of acute pancreatitis. The incidence of post-acute pancreatitis diabetes mellitus is significantly higher than that of type 1 diabetes mellitus. Some studies have concluded that the all-cause mortality and worse prognosis of diabetes after pancreatitis are higher. We predicted that number of recurrences of pancreatitis would be significantly associated with the incidences of metabolic syndrome, abdominal obesity, and post-acute pancreatitis diabetes mellitus.MethodsPatients admitted to our hospital for hypertriglyceridemic acute pancreatitis from 2013–2021 were selected for a cross-sectional study. Statistical analysis methods were used to analyze the effect of recurrences on the long-term prognosis of patients with hypertriglyceridemic acute pancreatitis.ResultsIn this study, 101 patients with hypertriglyceridemic acute pancreatitis were included: 60 (59.41%) in the recurrent acute pancreatitis group and 41 (40.59%) in the only one episode of acute pancreatitis group. Among all hypertriglyceridemic acute pancreatitis patients, approximately 61.4% were diagnosed with abdominal obesity, 33.7% of patients are diagnosed with metabolic syndrome, 34.7% of patients are diagnosed with diabetes mellitus, and 21.8% of patients are diagnosed with post-acute pancreatitis diabetes mellitus. Recurrent acute pancreatitis were independent risk factors for post-acute pancreatitis diabetes mellitus in patients with hypertriglyceridemic acute pancreatitis (odds ratio [OR] = 3.964, 95% confidence interval [CI] = 1.230–12.774) and the risk of post-acute pancreatitis diabetes mellitus in patients with three or more recurrent episodes was 6.607 times higher than that in patients without recurrent episodes (OR = 6.607, 95% CI = 1.412–30.916).ConclusionsRecurrence is an independent risk factor for the development of post-acute pancreatitis diabetes mellitus and is significantly associated with the number of recurrences.

The risk of recurrent pancreatitis after first episode of acute pancreatitis in relation to etiology and severity of disease: A systematic review, meta-analysis and meta-regression analysis.

The study aims to determine and quantify the stratified risk of recurrent pancreatitis (RP) after the first episode of acute pancreatitis in relation to etiology and severity of disease. A systematic review and meta-analysis in compliance with PRISMA statement standards was conducted. A search of electronic information sources was conducted to identify all studies investigating the risk of RP after the first episode of acute pancreatitis. Proportion meta-analysis models using random effects were constructed to calculate the weighted summary risks of RP. Meta-regression was performed to evaluate the effect of different variables on the pooled outcomes. Analysis of 57,815 patients from 42 studies showed that the risk of RP after first episode was 19.8% (95% confidence interval [CI] 17.5-22.1%). The risk of RP was 11.9% (10.2-13.5%) after gallstone pancreatitis, 28.7% (23.5-33.9%) after alcohol-induced pancreatitis, 30.3% (15.5-45.0%) after hyperlipidemia-induced pancreatitis, 38.1% (28.9-47.3%) after autoimmune pancreatitis, 15.1% (11.6-18.6%) after idiopathic pancreatitis, 22.0% (16.9-27.1%) after mild pancreatitis, 23.9% (12.9-34.8%) after moderate pancreatitis, 21.6% (14.6-28.7%) after severe pancreatitis, and 6.6% (4.1-9.2%) after cholecystectomy following gallstone pancreatitis. Meta-regression confirmed that the results were not affected by the year of study (P=0.541), sample size (P=0.064), length of follow-up (P=0.348), and age of patients (P=0.138) in the included studies. The risk of RP after the first episode of acute pancreatitis seems to be affected by the etiology of pancreatitis but not the severity of disease. The risks seem to be higher in patients with autoimmune pancreatitis, hyperlipidemia-induced pancreatitis, and alcohol-induced pancreatitis and lower in patients with gallstone pancreatitis and idiopathic pancreatitis.

Recurrence rates and risk factors for recurrence after first episode of acute pancreatitis: A systematic review and meta-analysis

BackgroundThere are a certain number of acute pancreatitis (AP) patients who may suffer from multiple episodes and develop recurrent acute pancreatitis (RAP), but recurrence rates and associated risk factors for RAP vary significantly in the published literature. MethodsWe searched PubMed, Web of Science, Scopus, and Embase databases to identify all publications reporting AP recurrence until October 20th, 2022. Meta-analysis and meta-regression were performed to calculate the pooled estimates using the random-effects model. ResultsA total of 36 studies met the inclusion criteria and all were used in pooled analyses. The overall rate of recurrence after first-time AP was 21% (95% CI, 18%- 24%), and pooled rates in biliary, alcoholic, idiopathic, and hypertriglyceridemia etiology patients were 12%, 30%, 25%, and 30%, respectively. After managing underlying causes post-discharge, the recurrence rate decreased (14% versus 4% for biliary, 30% versus 6% for alcoholic, and 30% versus 22% for hypertriglyceridemia AP). An increased risk of recurrence was reported in patients with a smoking history (odds ratio [OR] = 1.99), alcoholic etiology (OR = 1.72), male sex (hazard ratio [HR] = 1.63), and local complications (HR = 3.40), while biliary etiology was associated with lower recurrence rates (OR = 0.38). ConclusionMore than one-fifth of AP patients experienced recurrence after discharge, with the highest recurrence rate in alcoholic and hypertriglyceridemia etiologies, and managing underlying causes post-discharge was related to decreased incidence. In addition, smoking history, alcoholic etiology, male gender, and presence of local complications were independent risks for the recurrence.

Predicting in-hospital mortality in patients with acute pancreatitis in the ED: a direct, retrospective comparison of four clinical and radiological prognostic scores.

Acute pancreatitis can be a severe disease that significantly impacts patients' quality of life and outcome. The clinical course is variable and predictive scoring systems have a debated role in early prognosis. This study aims to compare the prognostic accuracy of Balthazar, BISAP, HAPS and SOFA scores in the prediction of in-hospital mortality in patients with acute pancreatitis. This is a retrospective, single-center cohort study conducted in the Emergency Department of a third-level university hospital. Patients aged >18 years admitted from 1st January 2018 to 31st December 2021 for the first episode of acute pancreatitis were included. A total of 385 patients (mean age of 65.4 years and 1.8% in-hospital mortality) were studied. Balthazar, BISAP and SOFA scores were significantly higher in patients with in-hospital mortality and AUROCs were equal to 0.95 (95% CI 0.91-0.99, P<0.001), 0.96 (95% CI 0.89-1, P=0.001), 0.91 (95% CI 0.81-1, P=0.001) with no differences among them and absence of in-hospital mortality in patients with HAPS=0. Our data support the concept that clinical prediction scores can be useful for risk stratification in the Emergency Department. However, no single score has shown superiority in predicting acute pancreatitis-related in-hospital mortality among tested tools.

Abstract 945: Early detection of high-grade IPMN using extracellular vesicles - a successful patient story

Abstract Background/Purpose The detection of pancreatic ductal adenocarcinoma (PDAC) lesions at pre-cancerous or early-stages is critical to improving patient survival. The rise of liquid biopsies could potentially fill this unmet clinical need, such as our recently developed pancreatic LDT which isolates extracellular vesicles (EVs) from blood for detection of PDAC at earlier stages. In this case study, we describe a 60-year-old healthy male with acute pancreatitis who underwent an extensive imaging work-up that failed to detect radiographic evidence of lesions prior to surgery. Results from our EV-based early detection blood test, previously reported to have a specificity of 91.1% and sensitivity of 95.7% for stage I/II PDAC, indicated a high likelihood of PDAC. Subsequent pathology review after Whipple surgery confirmed high-grade intraductal papillary mucinous neoplasm (IPMN) and pancreatic intraepithelial neoplasms (PanINs). Case Description The patient was brought to the clinic for persistent abdominal bloating and pressure. A CT scan of the abdomen and an elevated lipase yielded a diagnosis of first episode of acute pancreatitis. Two MRIs of the abdomen confirmed an abnormal pancreatic duct dilatation, but no evident masses. An endoscopic ultrasound later demonstrated an abrupt stricture of the pancreatic duct. Due to complete duct occlusion, an endoscopic retrograde cholangiopancreatography (ERCP) was performed with stent placement. Cytology brushings from the ERCP were non-diagnostic, and CA-19-9 and CEA were non-elevated. The patient sought additional genetic analysis on his captured cyst fluid cells, which showed mutations in K-RAS and p53, raising clinical concern. Testing with a DNA-methylation test for cancer detection reported a result of “No Cancer Signal Detected”; however, blood testing with our EV-based early detection blood test indicated a high probability of PDAC. The patient decided to undergo a Whipple procedure. The final surgical pathology revealed a main-duct high-grade dysplasia IPMN with PanINs. Recovery post-surgery was unremarkable. Discussion This case report illustrates the successful clinical utility of an EV-based blood assay for detection of high-grade IPMN and PanINs, lesions not identified through extensive imaging workup lesion and destined, with high probability (~60-70%), to progress to a pancreatic cancer. The eventual impetus for this patient to undergo surgery was the combination of his known pancreatic duct pathology and other clinicopathological characteristics, with the results of the EV-based liquid biopsy test acting as an adjunct clinical tool to support to his decision. Conclusions PDAC is a lethal malignancy with a long-term survival of &amp;lt;10%. Detection at the earliest stage can be associated with &amp;gt;80% survival. A prospective, multi-center, observational registry study - ExoLuminate - is underway to further evaluate patients at high-risk for PDAC. Citation Format: Harmeet Dhani, Juan Hinestrosa, Heath I. Balcer, Edward Nolan, Razelle Kurzrock, Paul Billings. Early detection of high-grade IPMN using extracellular vesicles - a successful patient story [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 945.

Radiomics analysis of contrast-enhanced T1W MRI: predicting the recurrence of acute pancreatitis

To investigate the predictive value of radiomics based on T1-weighted contrast-enhanced MRI (CE-MRI) in forecasting the recurrence of acute pancreatitis (AP). A total of 201 patients with first-episode of acute pancreatitis were enrolled retrospectively (140 in the training cohort and 61 in the testing cohort), with 69 and 30 patients who experienced recurrence in each cohort, respectively. Quantitative image feature extraction was obtained from MR contrast-enhanced late arterial-phase images. The optimal radiomics features retained after dimensionality reduction were used to construct the radiomics model through logistic regression analysis, and the clinical characteristics were collected to construct the clinical model. The nomogram model was established by linearly integrating the clinically independent risk factor with the optimal radiomics signature. The five best radiomics features were determined by dimensionality reduction. The radiomics model had a higher area under the receiver operating characteristic curve (AUC) than the clinical model for estimating the recurrence of acute pancreatitis for both the training cohort (0.915 vs. 0.811, p = 0.020) and testing cohort (0.917 vs. 0.681, p = 0.002). The nomogram model showed good performance, with an AUC of 0.943 in the training cohort and 0.906 in the testing cohort. The radiomics model based on CE-MRI showed good performance for optimizing the individualized prediction of recurrent acute pancreatitis, which provides a reference for the prevention and treatment of recurrent pancreatitis.

Pancreatitis and the Risk of Developing Gastric Neuromuscular Dysfunction.

Most gastroparesis and functional dyspepsia cases (collectively, gastric neuromuscular dysfunction [GND]) remain idiopathic. It is believed that some idiopathic cases of GND may be triggered by an inflammatory insult to the gastrointestinal tract. We theorized that the profound foregut inflammation induced by pancreatitis could result in increased risk of GND. This was a case-control study of all patients undergoing gastric emptying scintigraphy between October 2017 and 2020 in an urban medical center with presumed GND. These were age-, sex-, and comparative health-matched to control patients with newly diagnosed microscopic colitis. Adjusted odds ratios (aORs) were calculated using conditional logistic regression. Among the 650 patients with GND, 359 had gastroparesis, and 9.2% had a history of acute pancreatitis (vs 3.1% of controls). Patients with GND demonstrated increased odds of having a history of acute pancreatitis (aOR 2.27, 95% confidence interval [CI] 1.33-4.03, P = 0.004) and recurrent pancreatitis (aOR 2.08, 95% CI 1.67-3.48, P = 0.002). Median time to GND diagnosis after first acute pancreatitis episode was 1,544 days (477.5, 3,832). Patients with a history of pancreatitis-associated GND had increased mortality vs controls (aOR 3.41, 95% CI 0.96-5.48). In addition, patients with pancreatitis-associated GND had more hospitalizations vs GND alone (13.8 vs 3.7, P < 0.0001) during the study period. This is the first study demonstrating an independent association between pancreatitis and the risk of GND, which occurred ∼4.2 years after the first episode of acute pancreatitis. Pancreatitis should therefore be regarded as a possible risk factor for developing GND with important consequences for healthcare utilization.

Mortality and recurrence risk after a first episode of acute pancreatitis in the elderly: population-based study.

Mortality and recurrence risk after a first episode of acute pancreatitis in the elderly: population-based study.

Association of Statin Usage and the Development of Diabetes Mellitus after Acute Pancreatitis

BackgroundPatients with acute pancreatitis (AP) have at least a 2-fold higher risk for developing postpancreatitis diabetes mellitus (PPDM). No therapies have prevented PPDM. Statins were demonstrated to possibly lower the incidence and severity of AP but have not been studied to prevent PPDM. MethodsData from a commercial insurance claim database (Optum Clinformatics) were used to assess the impact of statins on patients without pre-existing DM admitted for a first episode of AP in 118,479 patients. Regular statin usage was defined as filled statin prescriptions for at least 80% of the year prior to AP. The primary outcome was defined as PPDM. We constructed a propensity score and applied inverse probability of treatment weighting to balance baseline characteristics between groups. Using Cox proportional hazards regression modeling, we estimated the risk of PPDM, accounting for competing events. ResultsWith a median of 3.5 years of follow-up, the 5-year cumulative incidence of PPDM was 7.5% (95% confidence interval [CI], 6.9% to 8.0%) among regular statin users and 12.7% (95% CI, 12.4% to 12.9%) among nonusers. Regular statin users had a 42% lower risk of developing PPDM compared with nonusers (hazard ratio, 0.58; 95% CI, 0.52 to 0.65; P < .001). Irregular statin users had a 15% lower risk of PPDM (hazard ratio, 0.85; 95% CI, 0.81 to 0.89; P < .001). Similar benefits were seen with low, moderate, and high statin doses. ConclusionsIn a large database-based study, statin usage reduced the risk of developing DM after acute pancreatitis. Further prospective studies with long-term follow-up are needed to study the impact of statins on acute pancreatitis and prevention of PPDM.