We aimed to systematically review the relationship between severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection and acute pancreatitis (AP). The global pandemic of coronavirus disease 2019 (COVID‐19) caused by SARS‐CoV‐2 infection causes respiratory symptoms and notably also affects the gastrointestinal (GI) system. A systematic review of the available literature on the topic was performed with a search key using the terms “SARS COV 2,” “Pancreatitis,” “COVID‐19” and synonyms. The search was conducted on 27 December 2020 using PubMed, EMBASE, CENTRAL, Web of Science, and Scopus. A meta‐analysis was not conducted due to the low quality and poor comparability of the studies. We reviewed 66 studies that reported data on patients with polymerase chain reaction‐confirmed SARS‐CoV‐2 infection and AP using the Atlanta Criteria. Our evaluation revealed a wide age range and diverse clinical presentation of COVID‐19 with or without symptoms of AP, some of which preceded typical COVID‐19 symptoms. We observed a myriad of complications and one study revealed that patients with both conditions were more likely to require mechanical ventilation and had longer lengths of hospital stay compared with patients with AP without COVID‐19. Treatment for AP was mostly supportive, with varied therapies employed for COVID‐19. Most cases were considered idiopathic and presumed to be SARS‐CoV‐2‐induced as established etiological factors were not reported. AP should be considered in COVID‐19 patients, especially in those exhibiting GI symptoms. Evidence to establish a causal relationship between SARS‐CoV‐2 infection and AP is currently lacking.

Background and Aim The impact of the Coronavirus disease‐2019 (COVID‐19) pandemic on patients with liver disease is not well described at the population level in the United States. We used the largest, nationwide inpatient dataset to describe inpatient liver disease outcomes in the United States during the first year of the pandemic (2020) using 2018 and 2019 as comparator years. Methods Using the National Inpatient Sample (2018–2020), we explored year‐to‐year and 2020 month‐to‐month trends in hospitalizations, length of stay, and inpatient mortality for liver‐related complications including cirrhosis, alcohol‐associated liver disease (ALD) and alcoholic hepatitis using regression modeling. We reported relative change (RC) in the study period. Results Decompensated cirrhosis hospitalizations decreased in 2020 compared with 2019 (RC: −2.7%, P < 0.001) while all‐cause mortality increased by 15.5% (P < 0.001). Hospitalizations for ALD increased compared with pre‐pandemic years (RC: 9.2%, P < 0.001) with a corresponding increase in mortality in 2020 (RC 25.2%, P = 0.002). We observed an increase in liver transplant surgery mortality during the peak months of the pandemic. Importantly, mortality from COVID‐19 was higher among patients with decompensated cirrhosis (adjusted odds ratio [OR] 1.72, 95% confidence interval [CI] [1.53–1.94]), Native Americans (OR 1.76, 95% CI [1.53–2.02]), and patients from lower socioeconomic groups. Conclusions Cirrhosis hospitalizations decreased in 2020 compared with pre‐pandemic years but were associated with higher all‐cause mortality rates particularly in the peak months of the COVID‐19 pandemic. In‐hospital COVID‐19 mortality was higher among Native Americans, patients with decompensated cirrhosis, chronic illnesses, and those from lower socioeconomic groups.

The objective of this report is to discuss a case of drug-induced acute pancreatitis in a patient on a combination of dulaglutide and glipizide. The patient was a 61-year-old African American male with a past medical history of diabetes mellitus type 2 and essential hypertension, who was admitted for acute pancreatitis after presenting with upper abdominal pain. He was initially on glipizide but dulaglutide was added to improve control. The patient was a social drinker and an ex-cigarette smoker. He had serum lipase greater than 900 U/L, serum alcohol was negative, and abdominal computed tomography reported significant pancreatic edema consistent with acute pancreatitis but without features of necrotizing pancreatitis and no evidence of cholelithiasis or choledocholithiasis. His clinical state deteriorated after being complicated by paralytic ileus. He was managed conservatively, improved clinically, and was discharged home.Seeing that the incidence of pancreatitis is higher in patients with diabetes when compared to non-diabetics, it is important to counsel and monitor patients for risk factors of pancreatitis including medications. In the absence of other common causes in this case and considering the temporal relationship between presentation and the addition of dulaglutide to ongoing glipizide regimen, the combination of both drugs may have induced acute pancreatitis.

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Introduction: Insulin-like growth factor 1 (IGF1) disturbances are observed in liver cirrhosis. IGF1 deficiency resulting variety of metabolic complications. Changes in IGF1 concentrations, depending on the clinical stage of liver cirrhosis. This study aimed to prove the role of IGF1 as predictor for prognosis in Liver cirrhosis. Methods: A cross-sectional analytic study was performed in liver cirrhosis patients. Serum IGF-1 levels were measured using the Bioassay Technology with the Enzyme-Linked Immunosorbent Assay (ELISA) method. The results were expressed in units of ng/ml. Patient's prognosis determine using the Child-Pugh-Turcotte score (CTP). CTP B-C are assigned a poor prognosis with a mortality risk of 20-55% at 1 year. The cut off for IGF1 is determined by the ROC curve. Data were analyzed using computer software.Results: The research subjects consisted of 62 males (80.5%) and 15 females (19.5%), with a mean age of 47.64 6 7.47 years. Based on CTP scores, 32 (41.5%) samples had CTP B-C and 45 (58.4%) had CTP A. The mean IGF1 levels were 2.06 6 1.08 ng/mL (0.46 ng/ml -5.73 ng/ ml). The mean CTP score was 6.84 6 2.18 (5-13). The mean IGF1 in CTP A and BC was 2.43 6 1.08 ng/mL and 1.54 6 0.82 ng/mL (p, 0.001; 95% CI 0.43-1.34). Based on the ROC curve, IGF1 levels greater than or equal to 1.62 ng/mL were defined as high levels. There was a significant relationship between IGF1 levels and CTP scores (p, 0.001; OR56.7, 95%CI: 2.4-18.4). Low IGF1 levels are associated with poor prognosis, liver cirrhosis patients with IGF1 values less than 1.62 ng/mL are 6.7 times more likely to have a 20-55% mortality risk at 1 year. Conclusion: Mean IGF1 levels were significantly lower in CTP B-C than in CTP A, and low IGF1 levels suggest a possibly poorer prognosis in patients with liver cirrhosis. IGF1 concentration decreased with the severity of cirrhosis (Child-Pugh score), reaching significantly low values in class C. The CTP score has been validated as a predictor of postoperative mortality after portocaval shunt surgery and predicts mortality risk associated with other major operations. The CTP score can help predict all-cause mortality risk and development of other complications from liver dysfunction, such as variceal bleeding, as well. Reported the overall mortality for these patients at 1 year was 0% for Child class A, 20% for Child class B, and 55% for Child class C. Based on the results of this study, it can be concluded that low IGF1 is a predictor of poor prognosis in patients with liver cirrhosis.