Risk Of Pancreatitis Research Articles

S93 Native vs Non-Native Papilla: Defining and Mitigating the Post-ERCP Pancreatitis Risk

S93 Native vs Non-Native Papilla: Defining and Mitigating the Post-ERCP Pancreatitis Risk

Underweight Is Associated with a Higher Risk of Acute Pancreatitis in Type 2 Diabetes: A Nationwide Cohort Study.

Type 2 diabetes is known as a risk factor for acute pancreatitis, but the risk of acute pancreatitis according to glycemic status and body mass index (BMI) has remained unknown. Therefore, we aim to investigate the risk of acute pancreatitis according to BMI and glycemic status. We included 3,912,496 subjects from the Korean National Health Insurance System cohort who underwent the National Health Screening program in 2009. Each subject’s clinical course was examined through follow-ups until December 2018. BMI and glycemic status were each categorized into five groups. Hazard ratios (HRs) of acute pancreatitis according to BMI and glycemic status were calculated. The adjusted HRs of acute pancreatitis were the highest in the underweight group (BMI < 18.5) in all five glycemic status categories. The HR of acute pancreatitis in the underweight group increased as the glycemic status worsened, excluding the category of diabetes for more than five years (HR 1.381 for normal fasting glucose; 1.805 for impaired fasting glucose; 2.332 for new-onset diabetes; 4.51 for diabetes duration <5 years; 4.135 for diabetes duration ≥5 years). We found that the risk of acute pancreatitis was further increased in the underweight group, depending on the status and duration of type 2 diabetes.

Association Between Baseline Uric Acid and the Risk of Acute Pancreatitis

The aim of the study is explore the association between serum uric acid (UA) and acute pancreatitis (AP) risk in a Chinese population. We included 124,316 participants who enrolled in the Kailuan cohort from 2006 to 2009. We fitted Cox models to estimate the correlation between UA and AP. During an average follow-up of 11.97 years (standard deviation, 2.16 years), 396 AP developed. The incidence rates from quartile 1 to quartile 4 of AP were 20.76, 18.78, 30.58, and 36.79 per 100,000 person-years, respectively. Multivariate analysis showed a significantly increased risk in quartile 3 (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.05-1.91) and quartile 4 (HR, 1.61; 95% CI, 1.19-2.17) compared with quartile 1. The association may be modified by alcohol use (P for interaction = 0.017). The quartile 4 group with excessive alcohol consumption showed an enormously increased risk of AP (HR, 9.09; 95% CI, 1.18-70.21) than those without (HR, 1.46; 95% CI, 1.07-2.00). Elevated serum UA is an independent risk factor for AP. Surveillance of serum UA, especially among heavy drinkers, may be helpful for AP prevention.

Meta-analysis of the association between new hypoglycemic agents and digestive diseases.

Background:New hypoglycemic agents include sodium-glucose cotransporter-2 inhibitors (SGLT2is), glucagon-like peptide 1 receptor agonists (GLP1RAs), and dipeptidyl peptidase-4 inhibitors (DPP4is). The association between each class of these new hypoglycemic drugs and the risks of various digestive system diseases is unknown. We aimed to explore this relationship by performing a meta-analysis.Methods:We included large randomized trials of SGLT2is, GLP1RAs, and DPP4is. Outcomes of interest were 91 kinds of digestive diseases including 75 kinds of gastrointestinal disorders and 16 kinds of hepatobiliary disorders. Meta-analysis was done to generate pooled risk ratio (RR) and 95% confidence interval (CI). Subgroup analysis was conducted according to 3 different drug classes.Results:We included 21 large trials in this meta-analysis. Compared with placebo, GLP1RAs were associated with the higher risks of gastric ulcer hemorrhage (RR 2.68, 95% CI 1.07–6.68; Pdrug = .035; I2 = 0), pancreatitis (RR 1.48, 95% CI 1.02–2.15; Pdrug = .041; I2 = 0), cholangitis acute (RR 5.96, 95% CI 1.04–34.08; Pdrug = .045; I2 = 0), and cholecystitis acute (RR 1.52, 95% CI 1.08–2.15; Pdrug = .017; I2 = 1.5%), but were not significantly associated with the occurrences of the other 87 kinds of digestive diseases (Pdrug ranged from .064 to .999). SGLT2is versus placebo were not significantly associated with the occurrences of 91 kinds of digestive diseases (Pdrug ranged from .077 to .995). DPP4is versus placebo were not significantly associated with the occurrences of 91 kinds of digestive diseases (Pdrug ranged from .085 to .999).Conclusions:Neither SGLT2is nor DPP4is are associated with the occurrences of various kinds of digestive diseases, whereas GLP1RAs are associated with the higher risks of 4 kinds of digestive diseases, namely, gastric ulcer hemorrhage, pancreatitis, cholangitis acute, and cholecystitis acute. These findings seem to suggest that GLP1RAs are not applicable for patients at high risk of 4 specific digestive diseases, whereas SGLT2is and DPP4is are safe for patients susceptible to digestive diseases. However, our findings require to be further verified by future studies with sufficient statistical power.

One-stage approach to cholecystocholedocholithiasis treatment: a feasible surgical strategy for emergency settings and frail patients.

Cholecystocholedocholithiasis (CCL) occurs in up to 18% of patients undergoing laparoscopic cholecystectomy (LC). The two-stage treatment using endoscopic retrograde cholangiopancreatography (ERCP) followed by LC is the treatment of choice for CCL. However, only 10 to 60% of patients have common bile duct (CBD) stones at the time of ERCP, thus exposing patients to unnecessary ERCPs, causing 3 to 15% of post-interventional pancreatitis. One-stage laparoscopic-endoscopic rendezvous (LERV) is an alternative for the treatment of CCL. Given the selective top-to-bottom CBD cannulation, LERV reduces the risk of pancreatitis and failed CBD cannulation. Additionally, LERV is performed exclusively in patients presenting CBD stones at intraoperative cholangiography, avoiding unnecessary ERCPs. Despite its advantages, considering the logistical burden of coordinating different specialties, LERV is performed in few centers. Here, we present the largest retrospective series of LERVs performed at our department, analyzing elective and emergency procedures. All consecutive patients undergoing LERV for CCL between January2014 and December2021 were included. LERV success rate, operative time, biliary outflow restoration rate, postoperative complications (POC), length of hospital stay (LOS), and recurrences were analyzed. 181patients were included (61elective LERVs, 120emergency LERVs). We reported a 100% LERV success rate, a 97.79% biliary outflow restoration rate, a 0% conversion rate, a mean intraoperative time of 120.17 ± 31.35min, and LOS of 4.00 ± 2.82days. POC included 7Clavien-Dindo type 1, 11type2, and 3type3 cases. Seven patients presented with CBD stone recurrence: 2 within 30days after discharge, 3 within 6 months after discharge, and 2patients at 1year. No statistically significant difference was found between elective and emergency patients. LERV is safe, representing a valid option even in emergency settings, thus enabling the management of CCL within a single procedure, consequently sparing additional anesthesia and decreasing post-ERCP complications.

Clinical Correlation Between Pre and Post ERCP Laboratory Values

Abstract Background: Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a diagnostic modality to a primarily therapeutic procedure for pancreatic as well as biliary disorders. However, several complications were described post-procedure such as pancreatitis, perforation, cholangitis, post-sphincterotomy bleeding, etc. Data concerning variation in laboratory values before and after ERCP and its clinical significance with respect to endoscopic findings and possible complications is lacking in the literature. Aim: To analyze the clinical significance of laboratory values in patients before and after ERCP. Methods: From a total of 723 patients, 363 with different sets of findings on ERCP were eligible to be included in the study and were divided into 8 different groups. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), Gamma-glutamyl transferase (GGT), Alkaline phosphatase (ALKP), bilirubin, amylase, lipase, c-reactive protein (CRP), white blood count (WBC), neutrophil, lymphocyte, monocyte, eosinophils, basophils, platelets counts and creatinine were determined preoperatively as well as postoperatively in these patients. Results: AST and direct bilirubin showed a significant difference in all patients between pre and post-ERCP (p-value&lt;0.01 and p-value&lt;0.05, respectively). Liver tests were significantly higher in the malignant obstruction group than in the bile duct stones group (P &lt;0.05) and decrease more significantly (P &lt;0.05) after the procedure. A significant increase in lipase (p-value&lt;0.05) among all groups was found, and interestingly, the lymphocytic count showed a significant decrease (p-value&lt;0.01). Conclusion: In conclusion, (1) ERCP significantly decreases AST, direct bilirubin, lymphocytes, and monocytes count post procedure among all stratified groups of obstructive etiology thus proving its therapeutic value for biliary system obstructions. (2) Higher baseline disturbances in laboratory values at T0, especially in liver function tests such as ALT, AST, GGT, and ALKP as well as a bigger decrease in lymphocyte count at T1 are noted to be linked with malignant obstructions (tumor group), rather than benign obstructions (stone, sludge, stone+ sludge, and stricture). (3) Finally, stone and stricture groups are at the highest risk of post-ERCP pancreatitis owing to those groups having the highest pancreatic enzyme levels post ERCP, and thus should be the best candidates for a pre-ERCP pharmacologic prophylaxis (such as diclofenac, etc) and post ERCP close monitoring.

A homozygous variant in the GPIHBP1 gene in a child with severe hypertriglyceridemia and a systematic literature review.

Background: Due to nonspecific symptoms, rare dyslipidaemias are frequently misdiagnosed, overlooked, and undertreated, leading to increased risk for severe cardiovascular disease, pancreatitis and/or multiple organ failures before diagnosis. Better guidelines for the recognition and early diagnosis of rare dyslipidaemias are urgently required. Methods: Genomic DNA was isolated from blood samples of a Pakistani paediatric patient with hypertriglyceridemia, and from his parents and siblings. Next-generation sequencing (NGS) was performed, and an expanded dyslipidaemia panel was employed for genetic analysis. Results: The NGS revealed the presence of a homozygous missense pathogenic variant c.230G>A (NM_178172.6) in exon 3 of the GPIHBP1 (glycosylphosphatidylinositol-anchored high-density lipoprotein-binding protein 1) gene resulting in amino acid change p.Cys77Tyr (NP_835466.2). The patient was 5.5 years old at the time of genetic diagnosis. The maximal total cholesterol and triglyceride levels were measured at the age of 10 months (850.7 mg/dl, 22.0 mmol/L and 5,137 mg/dl, 58.0 mmol/L, respectively). The patient had cholesterol deposits at the hard palate, eruptive xanthomas, lethargy, poor appetite, and mild splenomegaly. Both parents and sister were heterozygous for the familial variant in the GPIHBP1 gene. Moreover, in the systematic review, we present 62 patients with pathogenic variants in the GPIHBP1 gene and clinical findings, associated with hyperlipoproteinemia. Conclusion: In a child with severe hypertriglyceridemia, we identified a pathogenic variant in the GPIHBP1 gene causing hyperlipoproteinemia (type 1D). In cases of severe elevations of plasma cholesterol and/or triglycerides genetic testing for rare dyslipidaemias should be performed as soon as possible for optimal therapy and patient management.

TU8.3 The optimal timing of Laparoscopic cholecystectomy following percutaneous cholecystostomy in Acute cholecystitis

Abstract Introduction Percutaneous cholecystostomy (PC) is an effective option for high risk and/or delayed presented Acute cholecystitis (AC). However, the optimal timing for subsequent laparoscopic cholecystectomy (LC) as a definitive treatment remains controversial. Methods This study includes 41 patients underwent LC following PC for severe AC. We compared the length of tube insertion, period from PC till LC and period from PC removal till LC against co-morbidities, another attack of AC, subsequent pancreatitis/jaundice and operative difficulties in terms of intraoperative adhesions, drain insertion, conversion to open, length of operation. Results The median time of length of tube insertion was 36 days (range 5–208) while the median time of PC insertion till LC was 144 days (range 31–744) and for period from PC removal till LC was 78 days (range 0–714). Patients with prolonged tube insertion (more than a month) showed higher risk of developing subsequent pancreatitis and or jaundice (P=0.04) while intraoperative adhesions was associated with prolonged time from tube insertion till operation (more than 4 months). There was no significant association between neither the length of tube insertion, period from PC insertion till LC nor period from PC removal till LC and other studied parameters. Conclusion Prolonged time of PC insertion and/or prolonged time form PC insertion till LC in patients with AC have higher risk of pancreatitis and surgical difficulties. Further studies including larger number of patients’ sample is warranted to confirm the outcomes and determine the optimal time of LC following PC in those patients.

A nomogram for clinical estimation of acute biliary pancreatitis risk among patients with symptomatic gallstones: A retrospective case-control study.

Background/PurposeCurrently, there are no effective tools to accurately assess acute biliary pancreatitis (ABP) risk in patients with gallstones. This study aimed to develop an ABP risk nomogram in patients with symptomatic gallstones.MethodsWe conducted a retrospective nested case-control study and data on 816 conservatively treated patients with symptomatic gallstones admitted to The First Affiliated Hospital of Harbin Medical University between January 6, 2007 and January 22, 2016 were retrospectively collected. We conducted a propensity-score matched (PSM) analysis based on follow-up time in a ratio of 1:4 between ABP group (n=65) and non-ABP group (n=260). These matched patients were randomly divided into study cohort (n=229) and validation cohort (n=96) according to a ratio of 7:3. In the study cohort, independent risk factors for ABP occurrence identified using Cox regression were included in nomogram. Nomogram performance and discrimination were assessed using the concordance index (C-index), area under the curve (AUC), calibration curve, decision curve analysis (DCA) and clinical impact curve (CIC). The model was also validated in the validation cohort.ResultsNomogram was based on 7 independent risk factors: age, diabetes history, gallbladder wall thickness, gallstone diameter, coexisting common bile duct (CBD) stones, direct bilirubin (DBIL), and white blood cell count (WBC). The C-index of nomogram was 0.888, and the 10-year AUCs of nomogram was 0.955. In the validation cohort, nomogram still had good discrimination (C-index, 0.857; 10-year AUC, 0.814). The calibration curve showed good homogeneity between the prediction by nomogram and the actual observation. DCA and CIC demonstrated that nomogram was clinically useful.ConclusionsThe ABP risk nomogram incorporating 7 features is useful to predict ABP risk in symptomatic gallstone patients.

Next generation sequencing in severe hypertrigliceridemia: Identification of a novel nonsense mutation of CREB3L3 gene

Background and Aims : Hypertriglyceridemia (HTG) is a common form of dyslipidemia associated with an increased risk of cardiovascular disease and pancreatitis. The severe forms are characterized by very high plasma levels of triglycerides (TG). Monogenic autosomal recessive forms are characterized by homozygous or compound heterozygous loss-of-function mutations of genes involved in the intravascular lipolysis of the triglyceride-rich lipoproteins, namely lipoprotein lipase, apolipoprotein C2, apolipoprotein A5, glycophosphatidylinositol (GPI)-anchored high-density lipoprotein-binding protein 1, lipase maturation factor 1, and glycerol-3-phosphate dehydrogenase 1.

Treatment of volanesorsen in a patient with familial chylmicronaemia syndrome (FCS) due to homozygous c.337T>C(p.TRP113ARG) - mutation and impact of dietary incompliance: A case report

Background and Aims : FCS is an extremely rare genetic disease resulting in severe chylomicronaemia and high risk of recurrent pancreatitis in early childhood. Genes causing the disease include LPL, APOA5, APOC2, LMF1, and GPIHBP1.

Prevalence and Impact of Acute Pancreatitis on Hospitalization Outcomes in a Cohort of Patients With Crohn's Disease.

BackgroundFew studies evaluated the risk of acute pancreatitis (AP) in patients with Crohn’s disease (CD). It’s controversial if AP can be considered as an extraintestinal manifestation of CD. We studied this potential association in a retrospective cohort of patients with CD.MethodsWe draw our cohort from the Nationwide Readmission Databases 2016 - 2018. We used the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes to identify all adult patients admitted with a diagnosis of CD. Patient with a comorbid AP were identified. We analyzed the significant impact of AP on hospitalization outcomes. A multivariate regression analysis was used to identify factors associated with AP.ResultsWe included 214,622 patients discharged from an index hospitalization for CD, 1.1% had AP. AP was independently associated with higher odds of inpatient mortality (odds ratio (OR): 1.831; 95% confidence interval (CI): 1.345 - 2.492, P < 0.001), gallstone disease (OR: 4.047; 95% CI: 3.343 - 4.9, P < 0.001), nonalcoholic fatty liver disease (NAFLD) (OR: 3.568; 95% CI: 3.08 - 4.133, P < 0.001), and hypercalcemia (OR: 1.964; 95% CI: 1.302 - 2.965, P = 0.001). Thirty-day readmission analysis showed that CD patients with AP were more commonly to be readmitted for AP than for any other reason.ConclusionsIn our nationwide cohort of CD patients, there was a significant association between AP and worse hospitalization outcomes. Additionally, we found independent associations for having AP that may help identify patients at high risk.

Searching for hypertriglyceridemia through routine laboratory test exploitation

Background and Aims : Familial Chylomicronemia Syndrome (FCS) is a rare genetic disorder of lipid metabolism characterized by severe hypertriglyceridemia and consequent risk of recurrent pancreatitis. Classical observational data suggest a 1:1,000,000 prevalence of FCS, however this estimate has not been validated.

Effect of aging on acute pancreatitis through gut microbiota.

BackgroundCompared to younger people, older people have a higher risk and poorer prognosis of acute pancreatitis, but the effect of gut microbiota on acute pancreatitis is still unknown. We aim to investigate the effect of aging gut microbiota on acute pancreatitis and explore the potential mechanism of this phenomenon.MethodsEighteen fecal samples from healthy adult participants, including nine older and nine younger adults were collected. C57BL/6 mice were treated with antibiotics for fecal microbiota transplantation from older and younger participants. Acute pancreatitis was induced by cerulein and lipopolysaccharide in these mice. The effect of the aged gut microbiota was further tested via antibiotic treatment before or after acute pancreatitis induction.ResultsThe gut microbiota of older and younger adults differed greatly. Aged gut microbiota exacerbated acute pancreatitis during both the early and recovery stages. At the same time, the mRNA expression of multiple antimicrobial peptides in the pancreas and ileum declined in the older group. Antibiotic treatment before acute pancreatitis could remove the effect of aging gut microbiota, but antibiotic treatment after acute pancreatitis could not.ConclusionAging can affect acute pancreatitis through gut microbiota which characterizes the deletion of multiple types of non-dominant species. This change in gut microbiota may potentially regulate antimicrobial peptides in the early and recovery stages. The level of antimicrobial peptides has negative correlations with a more severe phenotype.

Increased severity of complications after therapeutic ERCP in geriatric patients with chronic pancreatitis: An observational study.

Studies of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in geriatric patients have mainly examined patients with biliary diseases, rather than chronic pancreatitis (CP). This study aimed to evaluate the safety and success rate of therapeutic ERCP in geriatric patients with CP.The medical records of patients with CP aged over 65 years (group A) were retrospectively collected in a tertiary hospital from January 2013 to December 2018. Sex-matched CP patients under 65 years (group B) were randomly selected into the control group (matching ratio = 1:2). The success rate and the complication rate of therapeutic ERCP in 2 groups were compared. The risk factors for post-ERCP pancreatitis were investigated by univariate and multivariate analyses.A total of 268 ERCPs were performed in 179 patients of group A and 612 ERCPs in 358 patients of group B. The success rate of ERCP in group A was similar to that of group B (92.16% vs 92.32%; P = .936). The overall incidence of post-ERCP complications was 7.09% (19/268) and 5.72% (35/612) in group A and B, respectively (P = .436). However, geriatric patients had a significantly increased occurrence of moderate to severe complications (2.61% vs 0.16%; P = .002). Female gender (odds ratio [OR] = 3.40; P = .046), pancreas divisum (OR = 7.15; P = .049), dorsal pancreatogram (OR = 7.40; P = .010), and lithotripsy (OR = 0.15; P = .016) were significantly associated with risk of post-ERCP pancreatitis in geriatric patients.Therapeutic ERCP is safe and feasible in elderly patients with CP. However, occurrence of moderate to severe complications after ERCP increased in geriatric patients.

Outcomes of Hospitalized Patients Undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP) With and Without a History of Peripheral Artery Disease.

IntroductionPeripheral artery disease (PAD) is a common illness associated with an increased risk of complications and mortality. Gastroenterologists considering endoscopic retrograde cholangiopancreatography (ERCP) in these patients should weigh the benefits and risks carefully. Our goal is to analyze the hospital burden and complication rates in patients with PAD undergoing ERCP.MethodsUsing data from the National Inpatient Sample (NIS), patients over the age of 18 with and without PAD undergoing ERCP were identified utilizing the International Classification of Diseases (ICD)-9 codes. Primary outcomes included inpatient mortality, length of stay, and hospital charges. Secondary outcomes included rates of bile duct perforation, post-ERCP bleeding, acute pancreatitis, and cholangitis. Supplemental data, including household income and primary payer, were also analyzed. Independent t-tests were used for continuous data, chi-square tests for categorical data, and confounding variables (diabetes, age, gender, race) were controlled via multiple logistic regression.ResultsMost of the PAD group were male, while those in the non-PAD group were female (adjusted p<0.05). Mortality was higher in the PAD group (11.2% versus 8%; adjusted p<0.05). Members of the PAD group had longer lengths of stay (11.6 days versus 11 days; adjusted p<0.05) and more costly hospital stays ($108,006.49 versus $94,399.09; p<0.05). Members of the PAD group had higher rates of post-ERCP bleeding (5.2% versus 3.7%; adjusted p<0.05) and lower rates of cholangitis (6% versus 4%; adjusted p<0.05) and acute pancreatitis (6.9% versus 3.4%; adjusted p<0.05). ConclusionPatients with PAD had an increased hospital burden but had a decreased risk of post-ERCP complications, including cholangitis and pancreatitis. Physicians performing risk stratification for patients with PAD undergoing ERCP must consider these specific complications and ensure that patients undergoing this procedure are fully aware of the dangers and benefits of ERCP prior to consenting to the procedure.

Genetic Testing for Hypertriglyceridemia in Academic Lipid Clinics - Implications for Precision Medicine

<h3>Lead Author's Financial Disclosures</h3> Nothing to disclose. <h3>Study Funding</h3> GN HealthWatch. <h3>Background/Synopsis</h3> Most cases of severe hypertriglyceridemia (HTG) are polygenic disorders caused by the presence of rare heterozygous pathogenic variants (PV) and/or the accumulation of multiple common single-nucleotide polymorphisms (SNPs) as quantified by polygenic risk scores (PRSs). A high PRS (<b>≥</b>90th percentile in the general population) and the presence of PV have been shown to predict risk severe HTG. However, no data are available on the potential effects of PV and PRSs with respect to the risk for acute pancreatitis. We examined the association of PVs and PRSs on severity of HTG and risk for acute pancreatitis. <h3>Objective/Purpose</h3> Determine if genetic testing for hypertriglyceridemia provide additional clinical information beyond measurement of triglycerides regarding the risk for pancreatitis. <h3>Methods</h3> We conducted a multicenter retrospective cohort study through 3 academic lipid clinics in patients with hypertriglyceridemia who underwent genetic testing. The presence of HTG pathogenic variants (PVs) and polygenic risk scores (PRSs) were assessed by GBinsight Comprehensive Dyslipidemia Panel. Patients' highest recorded fasting TG level was included for analysis. HTG was categorized as moderate (200-499 mg/dL), severe (500-999 mg/dL), and very severe (<b>≥</b>1000 mg/dL). Multivariable logistic regression analysis was used to calculate odds ratio (OR) for acute pancreatitis in patients with PV, high PRS, or both. <h3>Results</h3> The risk for very severe HTG was increased in the presence of either PV or high PRS alone; however, this risk was attenuated when controlling for demographic factors (age, sex, BMI, and diabetes mellitus). In contrast, patients with both genetic risk factors (PV and high PRS) had significantly higher risk compared with those with neither genetic risk factor after adjustment for demographics (OR 58.72; 95% CI 8.29 - 415.57, p<0.001). Similarly, the risk for acute pancreatitis in those with PV or high PRS alone was attenuated after controlling for demographic factors and TG levels, whereas the increased risk for acute pancreatitis in patients with both PV and high PRS remained statistically significant (OR 4.28 (95% CI 1.01 - 18.14, p=0.048). <h3>Conclusions</h3> Patients with both a PV and a high PRS related to HTG have significantly higher risk for pancreatitis compared to those without a PV and a low PRS. However, the presence of a PV or high PRS alone did not result in a significant increase in risk. Genetic testing for patients with HTG has the potential to identify individuals at higher risk for pancreatitis and who are likely to benefit from novel therapies.

Unique Case of Management of Severe Hypertriglyceridemia Secondary to Familial Chylomicronemia Syndrome

<h3>Lead Author's Financial Disclosures</h3> Nothing to disclose. <h3>Study Funding</h3> None. <h3>Background/Synopsis</h3> We review a case of a 61-year-old female diagnosed at age 21 with severe hypertriglyceridemia with debilitating, recurrent episodes of acute pancreatitis. <h3>Objective/Purpose</h3> To review a clinical scenario involving severe hypertriglyceridemia and the role of novel therapies in management. <h3>Methods</h3> Clinical management at tertiary care lipid program. <h3>Results</h3> A 61-year-old slightly overweight female with a history of congenital aplasia of the pancreas, coronary artery disease post stents, pre-diabetes, and non-alcoholic fatty liver disease was diagnosed with severe hypertriglyceridemia secondary to chylomicronemia syndrome at age 21. No secondary causes were identified. She was trialed on several cholesterol and triglyceride lowering medications including niacin, rosuvastatin, gemfibrozil, fenofibrate, fish oil supplements with minimal improvement in symptoms and/or reduction in recurrent hospitalizations for acute pancreatitis. Interestingly, she showed a dramatic ∼70% reduction in triglycerides on evinacumab based on compassionate use, resulting in significant improvement in quality of life with no episodes of acute pancreatitis while on therapy for 12 months. <h3>Conclusions</h3> Familial chylomicronemia syndrome (FCS) is an autosomal recessive disorder with a lack of lipoprotein lipase (LPL) functionality, thereby markedly impairing clearance of chylomicrons from the plasma. The primary reason for concern is an increased risk of acute pancreatitis with an estimated odds ratio of 360 in patients with FCS. Acute pancreatitis, in fact, is responsible for a significant economic burden in the United States with an estimated annual cost of care of over $2 billion, accounting for about 50% higher healthcare-related costs compared to patients without acute pancreatitis. Additionally, studies have shown that patients on statin with high residual cardiovascular risk as well as high triglycerides had higher risk for nonfatal myocardial infarction and nonfatal stroke compared to patients with normal triglycerides. Unfortunately, there are currently no FDA-approved treatments for FCS. For this reason, novel therapies are crucially needed to relieve the debilitating state of these patients. One such concept is the use of ANGPTL3 inhibitor, evinacumab, currently FDA approved for homozygous familial hypercholesterolemia. ANGPTL3 inhibition enhances the activities of endothelial lipase and lipoprotein lipase, thereby reducing levels of LDL-C independent of LDL receptor activity, HDL and triglycerides. Based on meta-analysis and a few Phase 1-2 trials, evinacumab is shown to reduce triglycerides from 50% to 80% in patients with severe hypertriglyceridemia. In our patient, with TG/TC ratio >8:1 and normal to low apoB, FCS is more likely the culprit for severe triglyceride burden, contributing to recurrent acute pancreatitis. Furthermore, our patient also suffers from mixed dyslipidemia and metabolic syndrome, which significantly raises her lifetime atherosclerotic cardiovascular risk. Thus, we propose the use of evinacumab in such patients to not only target high triglycerides to reduce risk of acute pancreatitis but also optimize overall cardiovascular risk.

Loperamide-related risk of acute pancreatitis

Loperamide-related risk of acute pancreatitis

A Case Control Study on Alcohol Consumption and Pancreatitis

Introduction: In Western population, a threshold of 5 drinks per day may exist for alcohol to increase pancreatitis risk. Given ethnic differences in alcohol metabolism, we examined the associations between smoking, alcohol, and pancreatitis in Western Indians. Methods: A case control study was conducted in a surgery department of a hospital in western India. Information on drinking was collected by in-person interview. Baseline characteristics and alcohol consumption was compared between cases of pancreatitis and control (without pancreatitis). Results: Baseline characteristics of cases and control are Among 4% of the cases and 2% of the control, bile stone was found to be present and this difference was also statistically not significant. Alcohol use was associated with pancreatitis in a dose-dependent way. Those who were taking heavy amount of alcohol had more than five and half-time risk of developing pancreatitis compared to those who are not taking alcohol. Conclusions: Indians are more prone to alcohol-related pancreatitis than Westerners, and alcohol consumption is the leading cause of pancreatitis in India.