Serum Lipase Levels Research Articles

Study of serum lipase level in pregnant woman presenting with nausea and vomiting

Background: Hyperemesis gravidarum is a complex condition characterized by excessive nausea and vomiting during pregnancy. It presents with various symptoms which include disturbed nutrition, electrolyte imbalance, ketosis and extreme weight loss. The objective of this study is to compare serum lipase, amylase and glucose in Hyperemesis gravidarum with non-pregnant women.
 Materials and methods: A total of 100 subjects among which 50 were nonpregnant women as controls and 50 were women with hyperemesis gravidarum as cases were enrolled in the study. Serum lipase, amylase and glucose levels were estimated in all the subjects.
 Results: The levels of mean serum lipase were lesser in cases (23.55 ± 4.91U/L) compared to that in controls (25.45 ± 5.97U/L) with p=0.086. However, the levels of mean serum amylase were higher in cases (76.40 ± 33.86 U/L) compared to that in controls (69.66 ± 16.45U/L) with p= 0.210. Serum amylase activity was raised in 8% of the patients whereas the activity of pancreatic lipase was within normal range. Serum glucose levels were lower in cases (84.72 ± 11.28 mg/dl) than that in controls (87.04 ± 10.65 mg/dl) with p=0.293.
 Conclusions: From this study we conclude that lipase activity was statistically insignificant in hyperemesis gravidarum. Therefore, pancreatic activities were less affected by hyperemesis gravidarum. So, this condition needs further exploration regarding biochemical basis to minimize the risk associated with it.

Protective effects of carbon monoxide releasing molecule‑2 on pancreatic function in septic mice.

The present study aimed to investigate the effect of carbon monoxide (CO)-releasing molecule-2 (CORM-2) on pancreatic function in sepsis-model mice. To perform the present investigation, mice were rendered septic by cecal ligation and puncture (CLP). Then, mice were either treated with or without CORM-2 (8 mg/kg, intravenous) for different durations (6, 12 and 24 h) immediately following CLP. The levels of serum amylase and lipase, tumor necrosis factor α, interleukin-1β and interleukin-6 in addition to myeloperoxidase (MPO) activity in pancreatic tissues were determined at 6, 12 and 24 h post-CLP. Histological scores and the expression of intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), nuclear factor-κB (NF-κB) and phosphorylated inhibitor of κB (p-IκB-α) in the pancreas were also evaluated at 24 h post-CLP. The results of the present study revealed that compared with CLP-alone group, CORM-2 treatment significantly (P<0.05) reduced the levels of serum amylase, lipase and pro-inflammatory cytokines. In parallel, the severity of pancreatic histology, MPO activity and the expression levels of ICAM-1 and VCAM-1 in the pancreas of CORM-2 treated CLP mice were substantially decreased compared with the untreated group. Furthermore, CORM-2 treatment inhibited the expression levels of NF-κB and P-IκB-α in the pancreas of mice following CLP compared with the untreated group. CORM-2-liberated CO exerted protective effects on the pancreatic function of septic mice, and the beneficial effects may be due to the suppression of NF-κB activation and subsequent regulation of NF-κB-dependent expression of cytokines.

Pancreatic function in children with non-alcoholic fatty pancreas disease

Objective. To study the features of pancreatic function in children with pancreatic steatosis. Materials and methods. We examined 77 children; the average age of patients was (11.59 ± 2.82) years. Pancreatic steatosis was diagnosed by ultrasound examination. In addition, shear wave elastography of the pancreas was performed using UltimaPAExpert apparatus («Radmir»,Ukraine). Children were divided into groups according to the obesity/overweight and pancreatic steatosis presence as follows: the group 1–- 47 children with pancreatic steatosis and obesity / overweight; the group 2 – 20 children with obesity / overweight without signs of pancreatic steatosis; the group 3 – 10 children with normal weight who had no signs of steatosis. Examination of the exocrine pancreas function with determination of serum amylase, lipase and trypsin levels, urine amylase, fecal elastase was carried out. Results. Serum lipase level was significantly lower in the group of children with steatosis (0.83 [0.64, 0.99] nmol/s·l) compared to children with normal weight (1.05 [0.99; 1.13] nmol/s·l) (P < 0.05). The level of trypsin did not reveal any significant differences between the groups, while serum amylase level in the patient group 1 tended to be lower compared to children of the group 2. The level of fecal elastase (FE) was significantly lower in patients with steatosis (176.7 [65.8, 251.8] μg/g) compared to children with normal weight (311.40 [213.3, 363. 0] μg/g) (P < 0.05). The level of FE negatively correlated with the degree of pancreatic steatosis in the general group (r = -0,28; P < 0.05) as well as with the pancreatic parenchyma stiffness in children without obesity (r=-0,40; P < 0.05). Conclusions. Pancreatic steatosis in children can be accompanied by exocrine pancreatic insufficiency development.

Ameliorative effect of certolizumab on experimentally induced acute necrotic pancreatitis in rats.

The effects of Certolizumab, a pegylated monoclonal antibody to tumor necrosis factor α, on experimentally induced acute pancreatitis (AP) were examined. Thirty-six Wistar Albino male rats were randomly divided into four groups. Group I was the control group and no medication administered to this group. Group II was the Certolizumab group, and 100 ml/kg serum physiologic administered into the biliopancreatic duct and a single dose of 10 μg Certolizumab was simultaneously administered intraperitoneally. Acute pancreatitis was induced with a retrograde injection of 3% Na taurocholate into the common biliopancreatic duct in the study (Group III) and treatment (Groups IV) groups. Rats were sacrificed 72 hours later. Serum amylase, lipase, lactate dehydrogenase activities, along with pancreatic histopathology, were examined. Certolizumab treatment significantly decreased serum amylase, lipase, and LDH levels; histopathologically edema, hemorrhage, parenchymal necrosis, fat necrosis, and infiltration scores; immunohistochemically MDA, MPO, TNF-α and Caspase-3 activity. The results support the idea that certolizumab might be beneficial for the severity of AP.

Comparison of biochemical parameters among DPP4 inhibitor users and other oral hypoglycaemic drug users: a cross-sectional study from Anuradhapura, Sri Lanka

BackgroundHigher efficacy of incretin-based therapies for type 2 diabetes mellitus has been reported from Asia. Pancreatitis and hepatitis have also been suspected to occur due to dipeptidyl peptidase-4 inhibitor (DPP4I) treatment. The present study aims at comparing selected biochemical parameters among DPP4 inhibitor users and other oral hypoglycaemic drug users.MethodsPatients were recruited from the State Pharmaceutical Corporation, Anuradhapura, Sri Lanka, for a comparative cross-sectional study. Two groups were involved: “DPP4I” user group (n = 63) and “other oral hypoglycaemic” user group (n = 126). Mann-Whitney U test was performed to find a significant difference (p < 0.05) in the distributions of HbA1C, pancreatic amylase, serum lipase, AST and ALT levels between the two groups.ResultsContradicting to previous Asian studies, distribution of HbA1C (p = 0.569) between anti-diabetic regimes with and without DPP4 inhibitors showed no significant difference. Also, amylase (p = 0.171), AST (p = 0.238) and ALT (p = 0.347) failed to show significance. However, lipase was significantly (p = 0.012) high in the DPP4I group.ConclusionThe study showed a significantly higher lipase level among the DPP4I users in comparison to other oral hypoglycaemic drug users, and possible reasons were discussed.

Hydroalcoholic extract of licorice (Glycyrrhiza glabra L.) root attenuates ethanol and cerulein induced pancreatitis in rats

Objective: To evaluate the therapeutic potential of hydroalcoholic extract of licorice root against ethanol and cerulein induced chronic pancreatitis in rats. Methods: The phytochemical profile of hydroalcoholic extract of licorice root was determined by high performance liquid chromatography (HPLC) and gas chromatography coupled to mass spectrometry (GC-MS). Chronic pancreatitis was induced in male albino Wistar rats by feeding them a diet containing ethanol (0%-36% of total calories) for 4 weeks and cerulein (20 μg/kg b.wt, i.p.) thrice a week for 3 weeks. Lipase and amylase in serum, lipid peroxides and antioxidants including reduced glutathione, glutathione peroxidase, superoxide dismutase and catalase in pancreas were determined. Inflammatory response was measured by myeloperoxidase in the pancreas, caspase-1 and the concentrations of IL-1 β and IL-18 in serum. Moreover, histological evaluation of the pancreas and liver was carried out. Results: Different flavonoids and saponins were identified in the hydroalcoholic extract of licorice root through HPLC and GC-MS. A marked increase in the levels of serum lipase, amylase, lipid peroxides, caspase-1, myeloperoxidase, IL-1 β , and IL-18 and a marked decrease in the levels of antioxidants were observed after ethanol and cerulein administration. Treatment with hydroalcoholic extract of licorice root attenuated these changes. In addition, histological observation confirmed the protective effect of the extract in the pancreas and liver against inflammatory changes induced by ethanol and cerulein. Conclusions: The licorice root extract attenuates ethanol and cerulein induced pancreatitis in rats probably due to its antioxidant phytonutrients since ethanol and cerulein-induced production of reactive oxygen species contributes to severe inflammation in the pancreas.

Sitagliptin induced acute pancreatitis: Case report and brief review of literature

Background: Sitagliptin phosphate is a dipeptidyl peptidase IV (DPP-IV) inhibitor used as oral hypoglycemic agent in the treatment of type 2 Diabetes Mellitus. Features of drug induced pancreatitis are temporal sequence, known response pattern and reversible when drug is withdrawn. Acute pancreatitis is a rare known complication of sitagliptin, which can occur at any time after initiation of the drug therapy. Case summary: A 32-year old man was presented in medical casualty with acute pain in abdomen. He was a case of T2DM taking tablet of sitagliptin 100 mg/day since last one year. Patient was obese, nonsmoker and not alcoholic. Diagnostic laboratory work up showed glycosylated hemoglobin 6.7%, raised levels of serum amylase (109 u/l Normal range 28-90 U/L) and Lipase (174 U/L Normal range- 0-64 U/L), which favored diagnosis of acute pancreatitis. We stopped his tablet sitagliptin and shifted him to insulin and metformin. Symptomatic treatment was offered and he improved clinically and discharged from the hospital. Conclusion: Acute pancreatitis among patients receiving sitagliptin is a rare entity. But physicians should always keep the possibility of sitagliptin-induced pancreatitis during follow up of the patients. Cautious monitoring for development of signs and symptoms of acute pancreatitis in patients receiving sitagliptin is important in long-term management.

Early postoperative pancreatitis following pancreaticoduodenectomy: what is clinically relevant postoperative pancreatitis?

Background/objectivesPostoperative pancreatitis (POP) has recently been shown to be the cause of pancreatic fistula (POPF) following pancreaticoduodenectomy (PD). The aim of the present study was to document the perioperative outcome associated with POP and determine potential risk factors for POP. MethodsPatients undergoing PD between 2009 and 2015 were identified from the prospective data base at a single center. The previous suggested definition of POP by Connor was used. Complications were graded according to the Clavien–Dindo classification and by the grading proposed for POP. Risk factors for POP were analyzed by univariate and multivariate analysis. ResultsOf 190 patients, a total of 100 patients (53%) developed POP of whom 22 (12%) and 13 (7%) had grade B and grade C complications, respectively. Elevated serum CRP-levels on postoperative day (POD) 2 and elevated serum lipase on POD 1 were associated with onset of cr-POP. ConclusionThe proposed definition of POP constitutes a valuable tool to assess a serious pancreatic-surgery associated complication. Routine serum CRP and serum lipase levels on the first two postoperative days enable sufficient discrimination of clinically relevant POP.

Chronic Calcific Pancreatitis Associated Diabetes Presenting as Involuntary Weight Loss and Multiple Soft Tissue Calcifications in a Young Male

Introduction: Chronic Calcific Pancreatitis, a rare form of secondary diabetes occurs due to recurrent alcohol induced acute pancreatitis.&#x0D; Case Summary: A 28 year old male patient presented with significant involuntary weight loss associat-ed with a history of passing clay colored sticky stools for the past 1 year. He was also detected to have deranged blood sugars on routine work up at a local hospital for increased thirst and increased urine output. There was a history of recurrent bouts of moderate to severe abdominal pain over the past 3 to 4 years. At the time of initial presentation his Random blood sugar values was 468 mg/dL. Other routine tests tests were within normal limits. His serum amylase levels were 185 U/L and serum Lipase levels were 467 U/L.&#x0D; Conclusions: Chronic fibro calcific pancreatitis is a rare cause of diabetes in young patients but has a characteristic clinical picture with a young patient presenting with features of malabsorption and low BMI, low propensity for DKA , low beta cell reserve and sensitivity to Insulin.

Dual-energy CT in early acute pancreatitis: improved detection using iodine quantification

To evaluate the diagnostic performance of a dual-energy computed tomography (DECT)-based technique using iodine quantification and fat fraction analysis for the diagnosis of early acute pancreatitis METHODS: In this retrospective study, 45 patients (35 men and 10 women; mean age, 54.9 ± 14.0years) with early acute pancreatitis were included. Serum lipase levels and follow-up examinations served as the reference standard. A matched control group (n = 45) was assembled for evaluation of material decomposition values of normal pancreatic parenchyma. Three blinded radiologists independently interpreted all cases on conventional grayscale DECT series. In addition, readers re-evaluated all cases by manually performing region-of-interest (ROI) measurements on pancreatic-phase DECT material density images of the head, body, and tail of each patient's pancreas. Receiver operating characteristic (ROC) curve analysis was performed to estimate the optimal threshold for discriminating between inflammatory and normal pancreas parenchyma. DECT-based iodine density values showed significant differences between inflammatory (1.8 ± 0.3mg/mL) and normal pancreatic parenchyma (2.7 ± 0.7mg/mL) (p ≤ 0.01). Fat fraction measurements showed no significant differences (p = 0.08). The optimal iodine density threshold for the diagnosis of acute pancreatitis was 2.1mg/mL with a sensitivity of 96% and specificity of 77%. Iodine quantification revealed an area under the curve (AUC) of 0.86, significantly higher compared to standard image evaluation of the radiologists (AUC, 0.80; sensitivity, 78%; specificity, 82%) (p < 0.01). DECT using iodine quantification allows for diagnosis of early acute pancreatitis with higher sensitivity compared to standard image evaluation. • Iodine density values showed significant differences between inflammatory and normal pancreatic parenchyma. • DECT using iodine quantification allows for diagnosis of early acute pancreatitis. • An iodine density of ≤ 2.1mg/mL optimizes the diagnosis of acute pancreatitis.

Development of an acute pancreatitis porcine model based on endoscopic retrograde infusion of contrast medium or sodium taurocholate.

Background/AimsA reproducible, endoscope-based, large animal model, of acute pancreatitis was developed to meet the need for a suitable means of preclinically testing treatments. The aim of this study was to develop an endoscope-based animal model of acute pancreatitis.MethodsThis experimental study was conducted on six mini-pigs. The pancreatitis model was induced by infusing contrast medium (CM) or sodium taurocholate (TCA) under high pressure (100 mmHg) into the main pancreatic duct by endoscopic retrograde pancreatography. Animals were randomly allocated to three groups: a CM group, a 10% TCA group, and a 20% TCA group. Pancreatic injuries were evaluated histologically, and serum amylase and lipase levels were measured.ResultsAcute pancreatitis was observed in all animals during hematologic and histologic examinations. Serum amylase and lipase levels were significantly higher (> 10 times baseline), and pancreatic edema, vacuolization of acinar cells, and hemorrhagic necrosis were observed. Severity of pancreatitis tended to be greater in the TCA groups than in the CM group as assessed using histologic scores, and degrees of pancreatitis were found to be dose-dependently related to TCA concentration.ConclusionsThe two endoscopic procedures described are effective and safe for creating a swine model of acute pancreatitis. The authors hope the described endoscopic methods will assist in the development of a suitable treatment strategy.

Clinical pattern of acute pancreatitis in eastern India and comparison of Ranson, BISAP and APACHE II as a predictor of severity, local complications and mortality

Background: Acute pancreatitis is the single most frequent gastrointestinal cause of hospital admissions. Scoring systems have been used since the 1970s for assessment of its severity. This study was aimed to assess the clinical pattern of acute pancreatitis and to compare various predicting systems like Ranson, BISAP and APACHE II in predicting severity, local complications and mortality in acute pancreatitis.Methods: In this prospective study, 91 consecutive cases of acute pancreatitis admitted, between April 2015 to March 2017, were studied. The diagnostic criteria include the presence of at least two of the three features; abdominal pain, serum amylase and lipase levels and findings on imaging studies. Patients were divided into two groups each, BISAP Ranson ≥3 and &lt;3, APACHE II ≥8 and &lt;8, and analyzed statistically.Results: Out of total of 91 patients, 81 were male and 14 were female with mean age was 36.14 years. Commonest aetiological factor was alcoholism in 57.89% followed by gallstones in 23.16%. Serum amylase was raised in 83.26% patients while 95.79% had raised serum lipase levels. 75.79% patients were of MAP while 24.21% patients were of MSAP and SAP. 7.37% patients developed local complications and mortality rate was 6.32%. All the scoring systems were found similar in predicting severity, local complication and mortality, had low sensitivity and high specificity (P value &lt; 0.05).Conclusions: There is no ideal predicting system for acute pancreatitis. These scoring systems can be used to triage patients for better healthcare delivery.

Serum Amylase Added Value to Non-Diagnostic Serum Lipase in Acute Pancreatitis: Retrospective Study

Introduction: It is widely accepted that serum lipase is more sensitive than serum amylase in diagnosing acute pancreatitis. However, since the sensitivity of serum lipase is not 100%, serum amylase may have an added value when serum lipase level is not diagnostic. Methods: We retrospectively reviewed all lipase and amylase tests that were simultaneously performed over a 6-month period at a university-affiliated teaching hospital in Florida. We considered amylase and lipase levels to be diagnostic if they were >3 times upper normal limit. We determined the percentage of simultaneous tests that showed normal or borderline lipase level but diagnostic amylase level. Abdominal computed tomography reports were reviewed when available. Results: Out of 3716 simultaneous serum lipase and amylase tests, 171 had diagnostic and 3545 normal or borderline lipase results, respectively. Out of the later, 21 (0.6%) tests had diagnostic amylase results. Abdominal computed tomography was available in association with 13 of the 21 tests with diagnostic amylase and normal or borderline lipase results, none showed evidence of acute pancreatitis. Five of the remaining 8 tests were associated with cardiac arrest, two with diagnostic serum lipase results on presentation, and one with pancreatic cancer and obstructive jaundice. Conclusion: We conclude that serum amylase has no added value to serum lipase in the setting of acute pancreatitis. Simultaneous amylase and lipase tests in this setting should be abandoned to avoid unnecessary healthcare spending.

PANCREATIC-PLEURAL FISTULA PRESENTING AS RECURRENT UNILATERAL PLEURAL EFFUSION

SESSION TITLE: Critical Care 3 SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Pancreatic-pleural fistula (PPF) is a rare complication of pancreatitis. Pleural effusion seen with pancreatitis is usually clinically insignificant but PPF can produce recurrent and large volume pleural effusions. CASE PRESENTATION: A 58-year-old male with a medical history significant for alcohol abuse and recurrent alcoholic pancreatitis presented to our institute with worsening shortness of breath for 2 days.He was recently admitted for the third time to the hospital with similar presentation and was diagnosed with massive left-sided pleural effusion requiring drainage for symptom relief. He started feeling short of breath the very next day after discharge, more on exertion. On admission, his vitals were: HR 118, BP 140/97, RR 22, Temp 98.2F. Physical examination was remarkable for dullness to percussion with reduced air entry up to the left 5th intercostal space.Laboratory workup revealed a serum lipase level of > 600 U/L, serum amylase of 459 U/L mm/hr.Chest x-ray showed opacification of left hemithorax. CT chest confirmed large left-sided pleural effusion with compression collapse of the left lower lung.Pleural fluid analysis showed an exudative effusion with an amylase level of 17675 U/L. MRCP of the abdomen revealed diffusely dilated pancreatic ducts.Despite repeated aspiration, recurrent accumulation of pleural effusion was seen, so a chest tube was inserted.An ERCP was performed for the concern of pancreatic-pleural fistula which was consistent with moderate ductal stenosis and contrast extravasation from the ventral pancreatic duct in the head of the pancreas but did not demonstrate a clearcut fistulous tract. A stent was placed in the stenotic duct. The pleural fluid drainage from the tube decreased markedly, the chest tube was removed next day and a follow-up chest X-ray after 2 weeks revealed no evidence of recurrent pleural effusion. DISCUSSION: Although uncommon, pancreatic-pleural fistula can present with recurrent unilateral clinically significant pleural effusion. Although there is no cutoff level to establish the diagnosis, pleural fluid amylase is usually greater than 1000U/L, with levels of> 50,000U/L highly suggestive of a PPF.ERCP is essential in both the diagnosis and treatment of PPF; it does not only show the site of the leak but also reveals the ductal morphology, it demonstrates the fistulous tract in 59% to 74% of the cases. In our patient, the diagnosis was initially suggested by the very high level of pleuritic fluid amylase level and was confirmed by imaging and ERCP. Treatment was successful after a stent was placed at the site of leakage. CONCLUSIONS: Pancreatic-pleural fistula (PPF) should be included in the differential diagnosis of recurrent and large pleural effusions especially in middle-aged men with a history of alcohol consumption and recurrent pancreatitis. Reference #1: A. R. Dhebri and N. Ferran, “Nonsurgical management of pancreaticopleural fistula,” Journal of the Pancreas, vol. 6, no. 2, pp. 152–161, 2005. Reference #2: R. Materne, P. Vranckx, C. Pauls, E. E. Coche, P. Deprez, and B. E. Van Beers, “Pancreaticopleural fistula: diagnosis with magnetic resonance pancreatography,” Chest, vol. 117, no. 3, pp. 912–914, 2000. Reference #3: E. W. Pottmeyer, C. F. Frey, and S. Matsuno, “Pancreaticopleural fistulas,” Archives of Surgery, vol. 122, no. 6, pp. 648–654, 1987. DISCLOSURES: No relevant relationships by Taha Ahmed, source=Web Response No relevant relationships by TALHA AHMED, source=Web Response No relevant relationships by Basma Ricaurte, source=Web Response

Successful management of acute bismuth intoxication complicated with acute renal failure, seizures and acute pancreatitis in a child

Bismuth salts, including bismuth subcitrate, are commonly used for gastrointestinal disorders. Overdose of bismuth salts can lead to renal failure. Seizures and pancreatitis have not been reported as complications of bismuth overdose and/or chelator treatment up-to-date. An 8-year-old girl was presented with history of taking 18 grams of bismuth subcitrate, headache, agitations and anuria. She was hypertensive and her serum creatinine was 6.5 mg/dL with the estimated glomerular filtration rate of 9.61 ml/min/1.73 m2. Antihypertensive drugs and hemodialysis were initiated. Fifteen hemodialysis sessions were performed during a month. At the sixth day of hospitalization dimercaptosuccinic acid (DMSA) treatment was initiated for chelating bismuth. Because of intense headache and seizures were observed after 7 days of DMSA therapy, DMSA was stopped and anticonvulsive drugs were given. Meanwhile pancreatitis was diagnosed based on ultrasound findings and increased serum lipase (maximum, 1363 IU/L) and amylase (maximum, 798 IU/L) levels. Following 10 days of anuria, polyuria developed. Clinical and laboratory findings of her returned to normal at the 35th day of hospitalization. In conclusion, seizures and pancreatitis may develop following chelator treatment for bismuth overdose. Chelation therapy should be used cautiously in bismuth intoxication.

Dynamic changes of proteasome and protective effect of bortezomib, a proteasome inhibitor, in mice with acute pancreatitis

The proteasome is involved in the activation of NF-κB and can regulate the progression of inflammatory diseases. However, the role of proteasome in acute pancreatitis (AP) has not been demonstrated. In this study, we first observed that the protein level and activity of proteasome 20S were increased significantly in pancreatic injury tissues after caerulein-induced mild acute pancreatitis (MAP) induction, which was in consistent with the expression of the NF-κB nucleoprotein and positively correlated with the severity of AP. Then, bortezomib, a classical proteasome inhibitor, was used to intervene the progression of MAP in mice. The results showed that bortezomib administration reduced the serum amylase and lipase levels and mitigated histopathological manifestation of pancreatic injury in mice. Meanwhile, bortezomib decreased the expression of NF-κB p65 nucleoprotein as well as total proteasome 20S protein, and inhibited the activity of 20S in pancreatic tissues. In addition, we found that bortezomib could protect pancreatic acinar cell against necrosis and mitigate the severity of AP in a severe acute pancreatitis model induced by sodium taurocholate hydrate. Taken together, our study for the first time confirmed that the proteasome participated in the pathogenesis of AP and its inhibitor bortezomib could protect against AP in mice.

Serum lipase level at postoperative day 1 is a more useful biomarker in objective evaluation of pancreatic exocrine function: a preliminary study

Serum lipase level at postoperative day 1 is a more useful biomarker in objective evaluation of pancreatic exocrine function: a preliminary study

PS01.105: PANCREATITIS IN THE ESOPHAGEAL ECTOPIC PANCREAS: A RARE CONDITION WITH DIFFERENT PRESENTATIONS! TREATMENTS AND REVIEW OF THE LITERATURE

Abstract Background Ectopic pancreas is an extremely rare genetic malformation in the esophagus. It is defined by pancreatic tissue outside the pancreas and usually presents as a subepithelial lesion in the esophagus. To date, there are fewer than 15 patients reported in the literature. Methods We present 2 cases of pancreatitis in the esophageal ectopic pancreas with different presentation, treatment and development, as well as a review of the literature. Results 1. A 48-year-old woman admitted to the ER with acute dysphagia and chest pain. There were elevation of amylasemia and lipasemia, as well as presence of a tumor in the Gastroesophageal junction with hypersignal at the CT scan, suggesting acute inflammation. An echoendoscopy with biopsy, diagnosed ectopic pancreas in the distal esophagus. The patient was then submitted to laparoscopic resection of subepithelial tumor of the cardia, recovered by a fundoplication. The specimen confirmed pancreatic tissue with acute inflammation. 2. A 33-year-old woman with a history of episodic chest pain confused with GERD, nausea and vomiting pain episodes accompanied by elevated serum amylase and lipase levels. She was submitted to an ERCP without alterations to investigate the clinical complains. After some crisis she was hospitalized with a septic condition, where a CT scan revealed a cystic lesion in the lower mediastinum in the esophageal wall. Endoscopy was performed, showing a drainage orifice with purulent secretion in the cardia. She was treated with antibiotics and fasting. She had two more crises and was referred to our specialized service. Thoracoscopic subtotal esophagectomy with cervical anastomosis was performed for treatment of a suspected esophageal duplication cyst with recurrent infections. The specimen showed the presence of organized pancreatic tissue characterizing ectopic pancreas complicated with chronic pancreatitis. Conclusion The ectopic esophageal pancreas can be present as a differential of these lesions. The second case, was first admitted at a secondary care unit and the diagnosis was delayed, probably leading to a worse development and necessity of a esophagectomy. In the literature, there is only one description of 1 case of recurrent pancreatitis. We have shown that complications can range from dysphagia to abscess, requiring more invasive treatment. Disclosure All authors have declared no conflicts of interest.

Amoxicillin/clavulanic acid-induced pancreatitis: case report

BackgroundAcute pancreatitis is an acute inflammation of the pancreas that varies in severity from mild to life threatening usually requiring hospitalization. The true incidence of drug-induced pancreatitis (DIP) is indeterminate due to the inadequate documentation of case reports of DIP. Here we present the case of amoxicillin/clavulanic acid-induced pancreatitis in a previously healthy male after excluding all other causes of pancreatitis.Case presentationA 58-year-old Caucasian man presenting for acute sharp abdominal pain with associated nausea and heaves. Pain was non-radiating and worsening with movement. Patient had no constitutional symptoms. The only medication he received prior to presentation was amoxicillin/clavulanic acid as prophylaxis for a dental procedure with his symptoms starting on day 9th of therapy. Laboratory studies revealed mild leukocytosis, increased levels of serum lipase, amylase, and C-reactive protein (CRP). Abdominal computed tomography (CT) was notable for acute pancreatitis with no pseudocyst formation. Hence, patient was diagnosed with mild acute pancreatitis that was treated with aggressive intravenous (IV) hydration and pain management with bowel rest of 2 days duration and significant improvement being noticed within 72 h. On further questioning, patient recalled that several years ago he had similar abdominal pain that developed after taking amoxicillin/clavulanic acid but did not seek medical attention at that time and the pain resolved within few days while abstaining from food intake. All other causes of pancreatitis were ruled out in this patient who is non-alcoholic, non-smoker, and never had gallstones. Abdominal ultrasound and magnetic resonance cholangiopancreatography (MRCP) eliminated out the possibility of gallstones, biliary ductal dilatation, or choledocholithiasis. Patient had no hypertriglyceridemia nor hypercalcemia, never had endoscopic retrograde cholangiopancreatography (ERCP), never took steroids, has no known malignancy, infection, trauma, or exposure to scorpions.ConclusionThis case describes a patient with DIP after the intake of amoxicillin/clavulanic acid and when all other common causes of acute pancreatitis were excluded. Only two other case reports were available through literature review regarding amoxicillin/clavulanic acid- induced pancreatitis.We again stress on the importance of identifying and reporting cases of DIP to raise awareness among physicians and clinicians.

Sustained-Release Curcumin Microparticles for Effective Prophylactic Treatment of Exocrine Dysfunction of Pancreas: A Preclinical Study on Cerulein-Induced Acute Pancreatitis

Acute pancreatitis (AP) is a serious inflammatory disorder of the pancreas with considerable mortality. The clinical therapy is hampered due to lack of any approved drug for AP. In this study, we developed curcumin (cur)-loaded poly (lactic-co-glycolic acid) cur microparticles (CuMPs) for sustained release. CuMPs were prepared by emulsion solvent evaporation method and characterized for shape, size, compatibility, and entrapment efficiency. The in vitro drug release and in vivo pharmacokinetic studies confirmed sustained release pattern of cur from CuMPs. The pharmacodynamic study was conducted in cerulein induced AP model. Prophylactic treatment was planned with single dose of CuMPs (equivalent to 7.5 mg/kg of cur) and compared with free cur given orally (100 mg/kg) and intraperitoneally (7.5 mg/kg) daily for 7 days. Interestingly, the effects of CuMPs were superior compared to the free drug administered either orally or intraperitoneally through repeated administrations. CuMPs showed significant decrease of serum amylase and lipase levels, oxidative and nitrosative stress was also significantly decreased. Moreover, CuMPs impressively decreased inflammatory cytokines. Our results may pave a way to propose similar strategy for many of promising natural products to combat several oxidative stress–mediated disorders via sustained release microparticle approaches.