Clinical review of acute, recurrent, and chronic pancreatitis: Recent updates of 2013–2019 literature

Abstract

A BSTRACT The increasing prevalence of pancreatic disorders worldwide has provided challenges in its clinical care and management. This review was aimed to evaluate recent literature on diagnosis, treatment, and management of acute pancreatitis (AP), recurrent acute pancreatitis (RAP), as well as chronic pancreatitis (CP) documented during the past 5–6 years. An extensive literature review was carried out based on studies within the last 6 years (2013–2019). Articles were selected based on updates and therapeutic management. Critical appraisal of literature was performed using the Mixed Methods Appraisal Tool (MMAT), and a PRISMA flowchart was used to avoid bias. The study identified recent updates on the prophylactic treatment in preventing RAP. The risk factors and the therapeutic management options were evaluated and discussed. The findings show that although many lifesaving new protocols are available for implementation in clinical practice, current literature lacks detailed and comprehensive guidelines that cover special populations and comorbidities. The literature evaluated showed that eight genes were involved in pancreatitis, CASR, CFTR, CLDN2, CPA1, CTRC, PRSS1, SBDS, and SPINK1 , but the most common gene implicated was found to be CFTR , at 11%. Therefore, it is recommended that a comprehensive guideline should be formulated to facilitate the diagnosis, management, treatment, and prophylactic measures of pancreatic disease. This could in turn reduce disease complications and hospitalization time, and improve clinical practice for management of pancreatitis.

Association Between Baseline Uric Acid and the Risk of Acute Pancreatitis

“…Although AP is considered a fully reversible disease, it carries a high risk of progressing into recurrent AP or chronic pancreatitis 21 . Gradually, this may lead to type 3c diabetes, pancreatic pseudocyst, or even pancreatic cancer 22–24 . Studies have increasingly reported heightened risk for diabetes or cardiovascular diseases after a single episode of AP.…”

“…21 Gradually, this may lead to type 3c diabetes, pancreatic pseudocyst, or even pancreatic cancer. [22][23][24] Studies have increasingly reported heightened risk for diabetes or cardiovascular diseases after a single episode of AP. A systematic review based on 24 prospective studies showed that patients who develop AP have a relative risk of 2.66 (95% CI, 1.86-3.80) for developing diabetes over 5 years.…”