Clinical practice of acute pancreatitis in Japan: An analysis of nationwide epidemiological survey in 2016

Masamune, Atsushi; Kikuta, Kazuhiro; Hamada, Shin; Tsuji, Ichiro; Takeyama, Yoshifumi; Shimosegawa, Tooru; Okazaki, Kazuichi; Matsumoto, Ryotaro; Kaneda, Kiyoshi; Miura, Shin; Takikawa, Tetsuya; Hongō, Seiji; Tanaka, Yu; Sakai, Toshitaka; Ueno, Masayuki; Unno, Jun; Toki, Masao; Nishimura, Mamoru; Kitamura, Katsuya; Kobashigawa, Kasen; Ashida, Kiyoshi; Takahashi, Kuniyuki; Watanabe, Takashi; Sato, Yuichirou; Satoh, Akihiko; Yoshida, Naoki; Tanaka, Kei; Kondo, Hiromu; Suzuki, Noriaki; Sato, Hiroko; Mitoro, Akira; Minami, Kazuhiro; Iwasaki, Eisuke; Okuwaki, Kosuke; Mukai, Tsuyoshi; Kudo, Yasusei; Azuma, Shunjiro; Takeda, Yasuhito; Setsuda, Morimichi; Tsuchida, Kenji; Irisawa, Atsushi; Motoya, Daisuke; Shirahata, Nakao; Iwata, Koichi; Oza, Noriko; Kawaguchi, Yasunori; Hoshino, Atsumi; Hirano, Atsuyuki; Sakakihara, Ichiro; Watanabe, Noriko; Funayama, Hiroyuki; Nakamura, Yuji; Yamamoto, Tatuo; Uchida, Hideo; Iizawa, Yusuke; Imamura, Mahiro; Sekine, Masanari; Inui, Kentaro; Yamamoto, Satoshi; Sato, Syuichi; Ishii, Shuji; Yakushijin, Takayuki; Yamamoto, Katsutoshi; Masaka, Tomohiro; Yoshida, Motoyuki; Arizumi, Toshihiko; Goto, Manabu; Takenaka, Mamoru; Miyakawa, Hiroyoshi; Otsuka, Yuichiro; Nishi, Masaaki; Suwa, Kanetoshi; Sato, Junichi; Satoh, Masahiro; Koga, Hideaki; Takagi, Tadayuki; Nagahama, Masatsugu; Hatayama, Katsuko; Kaneko, Naoya; Mori, Masafumi; Nakai, Yousuke; Iwashita, Yuji; Iwatsuka, Kunio; Hayashi, Kazunao; Terai, Shuji; Kaneto, Hiroyuki; Nishikawa, Takao; Uchi, Midori; Honjo, Megumi; Takagi, Tomofumi; Mizukami, Kazuhiro; Tamura, Tetsuo; Gushima, Toshifumi; Sato, Ai; Shimizu, Kyoko; Aruga, Yukio; Nonogaki, Kouji; Kaino, Miyuki; Iwashita, Takuji; Tsuruoka, Mio; Miura, Motoi; Hasegawa, Hiroo; Takai, Tetsunari; Yokota, Hiroyuki; Fujisawa, Toshio; Uetsuki, Kota; Kobayashi, Takashi; yamaji, Naohisa; Itoi, Takao; Muraki, Takamura; Watanabe, Takayuki; Inatomi, Osamu; Ushijima, Toshikazu; Takehara, Yusuke; Kawamura, Hiroshi; Fukasawa, Mitsuharu; Hagiwara, Hideki; Tamura, Hiroyuki; Moriya, Takuya; Kuwatani, Masaki; Kawaji, Yuki; Kamisawa, Terumi; Abue, Makoto; Fukunishi, Masanori; Onoyama, Hirohiko; Mochizuki, Seibu; Sumimoto, Kimi; Koyabu, Masanori; Nishio, Akiyoshi; Sakao, Masayuki; Imamura, Yoshiki; Ohta, Hiroyuki; Nishimura, Naruo; Shiihara, Masahiro; Anan, Hideaki; Motoya, Masayo; Chiba, Mitsuru; Deguchi, Tomohiro; Kofunato, Yasuhide; Sawada, Naoya; Katada, Kazuhiro; Matsumoto, Shimpei; Higashide, Syunichi; Okano, Hiroyuki; Yamazaki, Masato; Tamura, Naoshi; Muraoka, Takeshi; Uza, Norimitsu; Kodama, Yuzo; Muro, Shinichiro; Fujimori, Nao; Ikeda, Takaaki; Shimokawahara, Naoto; Otsu, Naoya; Yano, Yoichi; Sugawara, Shuichiro; Takaura, Kenta; Ogura, Yasuhiro; Furuuchi, Takayuki; Shibasaki, Masayuki; Kishimoto, Masanobu; Ishida, Masaharu

doi:10.1016/j.pan.2020.04.013

Cited by 37 publications

(42 citation statements)

References 39 publications

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“…Majority of these patients were classified as patients with severe AP merely due to the progression of inflammation beyond the lower pole of the kidney, resulting in the absence or limited presence of hypoenhanced area in the pancreas. 6 If 15,263 patients who were diagnosed based on CT grading only were classified as patients with mild AP, patients with severe AP would account for 8.4% (6707/79,455) of the patients in whom the severity of AP was determined, and the mortality in patients with severe AP would be 13.4% (896/6707). Importantly, patients who were diagnosed with severe AP based on both prognostic factors and CT grading had a mortality of 15.0% in this study and 19.8% in the latest nationwide survey.…”

Section: Discussionmentioning

confidence: 99%

“…Because the majority of the patients with AP are admitted to acute care hospitals, the DPC database, which mainly consists of the data from acute care hospitals, 10,11 is useful for clarification of the clinical management of AP in an unbiased manner. We obtained data of more than 100,000 patients with AP or 25,000 patients with AP annually from the DPC database, which accounted for more than 30% of the estimated annual number of patients with AP (78,500 in 2016) 6 . The latest Japanese nationwide epidemiological survey targeting patients with AP who were treated in 2016 reported a male-to-female sex ratio of 2.0 and a mean age at onset of 59.9 years in males and 66.5 years in females 6 .…”

Section: Discussionmentioning

confidence: 99%

“…The Japanese guidelines for the management of AP were revised in 2015 8 ; however, the impact of the revision on the clinical management of AP remains unclear. To clarify the current status of AP, nationwide epidemiological surveys of AP have been conducted every 4 to 5 years in Japan 6,9 . The estimated number of cases of AP has continuously increased over the last 3 decades, reaching 78,450 in 2016, which is 25% higher than that in 2011 9 .…”

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confidence: 99%

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Acute Pancreatitis in Japan

Ikeda¹,

Hamada²,

Kikuta³

et al. 2022

Pancreas

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ObjectivesCases of acute pancreatitis (AP) are increasing worldwide, and mortality remains high in severe cases. In 2015, the Japanese guidelines for the management of AP were revised. We aimed to clarify the clinical practice of AP in Japan and its trend during the revision of the guidelines using a Japanese nationwide administrative database.MethodsWe retrospectively analyzed 102,119 patients with AP who were hospitalized between April 2014 and March 2018. The study period was divided into the first period (the time before the revision: fiscal years 2014 and 2015) and second period (after the revision: 2016 and 2017).ResultsSevere cases of AP accounted for 27.7% of total cases. The in-hospital mortality in severe cases was 5.7%. The mortality within 14 days of admission improved from 3.2% in the first period to 2.6% in the second period (P = 0.022). Referred patients had more severe diseases and a higher mortality. The mortality in patients who underwent endoscopic ultrasound-guided fistuloplasty for local complications (11.6%) was lower than that in patients who underwent percutaneous drainage (23.4%) or AP surgery (22.6%) (P < 0.001).ConclusionsWe clarified the clinical practice of AP including the improved mortality after the revision of the guidelines.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Acute Pancreatitis in Japan

Ikeda¹,

Hamada²,

Kikuta³

et al. 2022

Pancreas

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“…On the other hand, several metabolites activate PSCs, leading to fibrogenesis. Alcohol is a major cause of acute and chronic pancreatitis ( Masamune et al, 2020a , b ). Alcohol metabolism involves two types of metabolic pathways in the pancreas: oxidative and non-oxidative ( Srinivasan et al, 2021 ).…”

Section: Metabolic Alterations In Pscsmentioning

confidence: 99%

Pancreatic Stellate Cells and Metabolic Alteration: Physiology and Pathophysiology

2022

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Pancreatic stellate cells play a pivotal role in the development of pancreatic fibrosis. A wide variety of external stimuli can cause PSC activation accompanied by metabolic changes, which alters the tissue microenvironment by producing extracellular matrix proteins, cytokines, growth factors, and other mediators. Several metabolites aggravate fibrosis and inflammation by acting as key activating factors for PSCs. In other words, PSCs sense systemic metabolic changes. The detrimental effects of PSC activation on normal pancreatic cells, especially islet cells, further complicate metabolic imbalance through the dysregulation of glucose metabolism. PSC activation promotes cancer by altering the metabolism in pancreatic cancer cells, which collaborate with PSCs to efficiently adapt to environmental changes, promoting their growth and survival. This collaboration also contributes to the acquisition of chemoresistance. PSCs sequester chemotherapeutic agents and produce competing molecules as additional resistance mechanisms. The application of these metabolic targets for novel therapeutic strategies is currently being explored. This mini-review summarizes the role of PSCs in metabolic regulation of normal and cancerous cells.

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“…The worldwide incidence of acute pancreatitis is 34 cases per 100,000 persons, and the number of hospitalizations has gradually increased in recent years. 1 , 2 A majority of those with hospitalizations due to AP make a full recovery, but it is noteworthy that approximately 17–29% of patients have recurrent AP (RAP) after complete or near recovery, and 3% to 14% of these patients develop chronic pancreatitis (CP). 3 Some recent reports indicated that the mortality rate was approximately 2% in patients with moderately severe acute pancreatitis (MSAP) and significantly increased (36–50%) in patients with severe acute pancreatitis (SAP).…”

Section: Introductionmentioning

confidence: 99%

Assessment of Acute Pancreatitis Severity and Prognosis with CT-Measured Body Composition

Zhou¹,

Hao²,

Duan³

et al. 2021

IJGM

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The aim of this study was to investigate the possible association of muscle and adipose parameters with the severity and prognosis of patients hospitalized with acute pancreatitis (AP). Methods: A total of 392 hospitalized patients and 309 controls were enrolled in the study analysis from April 1, 2016, to February 1, 2021. The computed tomography scans of each population were evaluated for muscle and adipose parameters. The effects of parameters on developing moderately severe acute pancreatitis (MSAP) or severe acute pancreatitis (SAP) were evaluated using univariate and multivariate logistic regression analyses. Associations with disease recurrence and death were analyzed through Cox regression analysis. Results: The AP patients had higher levels of visceral adipose tissue (144.25 vs 97.81 cm 2 , p < 0.001) and subcutaneous adipose tissue (135 vs 120 cm 2 , p < 0.001) but lower levels of adipose tissue attenuation (visceral and subcutaneous) and skeletal muscle attenuation (SMA) than the controls (p < 0.05, respectively). Visceral adipose tissue (VAT) and SMA differed significantly with p-values of 0.014 and 0.003 in the different severity groups of AP. In multivariate analysis, VAT and SMA were associated with MSAP or SAP, with odds ratios of 1.003 and 0.973, respectively (95% CI 1.000-1.006, p = 0.041; 95% CI 0.953-0.993, p = 0.010). Cox regression analysis showed that low SMA was strongly associated with an increased mortality in MSAP and SAP patients (HR 10.500, 95% CI 1.344-82.025, p = 0.025). Regression analysis also showed an association of VAT loss of more than 17% with reduced 1-year recurrence of acute pancreatitis (HR 0.427, 95% CI 0.189-0.967, p = 0.041). Conclusion:VAT and SMA were influential factors for the severity and prognosis of patients with AP. Patients should proper diet and exercise after discharge to reduce VAT and strengthen muscle function to improve prognosis.

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Clinical practice of acute pancreatitis in Japan: An analysis of nationwide epidemiological survey in 2016

Cited by 37 publications

References 39 publications

Acute Pancreatitis in Japan

Acute Pancreatitis in Japan

Pancreatic Stellate Cells and Metabolic Alteration: Physiology and Pathophysiology

Assessment of Acute Pancreatitis Severity and Prognosis with CT-Measured Body Composition

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