Discontinuation of proton pump inhibitor use reduces the number of endoscopic procedures required for resolution of walled-off pancreatic necrosis

Powers, Patrick; Siddiqui, Ali A.; Sharaiha, Reem Z.; Yang, Guangning; Dawod, Enad; Novikov, Aleksey; Javia, Amy; Edirisuriya, Cynthia; Noor, Arish; Mumtaz, Tayebah; Iqbal, Usama; Loren, David E.; Kowalski, Thomas E.; Cosgrove, Natalie; Alicea, Yordano; Tyberg, Amy; Andalib, Iman; Kahaleh, Michel; Adler, Douglas G.

doi:10.4103/eus.eus_59_18

Cited by 32 publications

(12 citation statements)

References 18 publications

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“…Although PPIs were found to be associated with a decreased risk of PP, they were not associated with the occurrence of WON, IPN, and total hospital stay or mortality in our study. In previous studies, PPIs have been reported to increase the risk of necrosis and infection (Min et al, 2019;Powers et al, 2019). Drainage is the main option for pancreatic necrosis, but a recent study revealed that reducing PPIs use can decrease the number of endoscopic procedures for treating WON (Powers et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…In previous studies, PPIs have been reported to increase the risk of necrosis and infection (Min et al, 2019;Powers et al, 2019). Drainage is the main option for pancreatic necrosis, but a recent study revealed that reducing PPIs use can decrease the number of endoscopic procedures for treating WON (Powers et al, 2019). Peripancreatic infection can be caused by intestinal bacteria translocation after compromised gastrointestinal barrier function (Demcsak et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

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Proton Pump Inhibitors Were Associated With Reduced Pseudocysts in Acute Pancreatitis: A Multicenter Cohort Study

et al. 2021

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Background: Acute pancreatitis (AP) is a systemic inflammatory disorder with a wide spectrum of clinical symptoms that can range from mild to severe. Previous preclinical study results suggest that proton pump inhibitors (PPIs) can inhibit exocrine pancreatic secretion and exert anti-inflammatory properties, which might in turn improve the outcome of AP.Aim: We conducted this multicenter, retrospective cohort study to investigate the potential effects of PPIs on the mortality, and total duration of hospital stay and local complication occurrence of patients with AP.Methods: A total of 858 patients with AP were included. All patients presented to the hospital within 48 h of symptom onset and were divided into the following two groups: patients who were treated with PPIs (n = 684) and those not treated with PPIs (n = 174). We used propensity score matching (PSM) analysis to reduce confounding bias before comparing the outcomes between the two groups.Results: Before PSM analysis, there were significant differences in a number of parameters between the two groups, including age, sex, hematocrit, blood urea nitrogen, peritonitis signs, Ranson’s score, and Acute Physiology Chronic Health Evaluation II score and organ failure occurrence. Before PSM, the PPIs group had a higher rate of mortality than the control group [RR = 1.065; 95% confidence ratio (CI) 1.045–1.086; p = 0.001]. After PSM, there was no significant difference in mortality (RR = 1.009; 95% CI, 0.999–1.019; p = 0.554) or total hospital stay (p = 0.856), although the PPIs group had a lower occurrence of pancreatic pseudocyst (RR = 0.416; 95% CI 0.221–0.780; p = 0.005).Conclusion: This study showed that PPIs therapy was not associated with reduced mortality or total hospital stay, but was associated with a reduction in the occurrence of pseudocysts in patients with acute pancreatitis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Proton Pump Inhibitors Were Associated With Reduced Pseudocysts in Acute Pancreatitis: A Multicenter Cohort Study

et al. 2021

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“…Moreover, aggressive lavage with large-volume warmed antibiotic solution has also been reported as an efficient alternative to saline irrigation, and reduced rates of adverse events and mortality have been noted in previous studies[ 91 ]. In addition, cessation of PPIs, local infusion of antibiotics, maximal fragmentation of necrotic tissue, and disruption of internal septate structures during the first necrosectomy can also improve drainage and reduce debridements[ 91 - 93 ].…”

Section: Endoscopic Transluminal Necrosectomymentioning

confidence: 99%

Endoscopic transluminal drainage and necrosectomy for infected necrotizing pancreatitis: Progress and challenges

Zeng¹,

Yang²,

Zhang³

2023

World J Clin Cases

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Infected necrotizing pancreatitis (INP) represents a severe condition in patients with acute pancreatitis. Invasive interventions are recommended in symptomatic INP. Growing evidence has suggested interventional strategies of INP evolving from traditional surgery to minimally invasive step-up endoscopic procedures. However, there is still no standardized protocol for endoscopic interventions. Recently, various studies have been published about the endoscopic management of INP. This article reviews published articles and guidelines to present the progress and challenges of endoscopic transluminal drainage and necrosectomy in INP.

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“…Proton pump inhibitors (PPIs) and other antacids are not recommended after a cystenterostomy because it is thought that the acidity of the stomach assists in the elimination of the necrotic tissue. Discontinuing PPIs has been shown to reduce the number of endoscopic procedures required 25. Antibiotics are only indicated in patients with infected necrosis and are not recommended for patients with necrotizing pancreatitis without infection.…”

Section: Managementmentioning

confidence: 99%

Managing severe acute and necrotizing pancreatitis

Wieren¹,

Guild²,

Raucci³

et al. 2022

Jaapa

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2002 to 2005. 4 Gallstone-related disorders may be the cause of this increase in the United States, because of increases in obesity and the aging population, although it also may be related to an increased frequency of testing (Figure 1). 4 This comes at a huge cost to the healthcare system, with more than $2.4 billion spent per year in the United States alone. 5 Management of acute pancreatitis has changed considerably in the past 10 years, including a multidisciplinary methodology, and tailored interventions with a minimally invasive endoscopic approach rather than open surgical intervention for complications. 6 To reduce patient morbidity and mortality, clinicians must be familiar with the presentation, diagnosis, and management of this disease.© MEDICALSTOCKS/SHUTTERSTOCK.COM I n most patients, acute pancreatitis is mild, self-limited, and follows an uncomplicated course. 1 However, 15% to 20% of all patients have severe acute pancreatitis, and 5% to 10% of them will develop necrosis of the pancreatic glands, peripancreatic tissue, or both. 2 In severe cases, if the necrotic collection becomes infected, patient mortality can reach 30%. 3 The incidence of acute pancreatitis requiring hospitalization in the United States continues to rise, with a 13.2% increase between 2009 and 2012 compared with ABSTRACT Acute pancreatitis is associated with signifi cant morbidity and mortality, and is one of the most common gastrointestinal disorders requiring hospitalization. This article describes current concepts in the diagnosis and management of severe acute and necrotizing pancreatitis. Management of this disease requires IV fl uids, pain control, and advanced medical and interventional care. Early identifi cation and intervention may help to prevent patient morbidity and mortality.

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Discontinuation of proton pump inhibitor use reduces the number of endoscopic procedures required for resolution of walled-off pancreatic necrosis

Cited by 32 publications

References 18 publications

Proton Pump Inhibitors Were Associated With Reduced Pseudocysts in Acute Pancreatitis: A Multicenter Cohort Study

Proton Pump Inhibitors Were Associated With Reduced Pseudocysts in Acute Pancreatitis: A Multicenter Cohort Study

Endoscopic transluminal drainage and necrosectomy for infected necrotizing pancreatitis: Progress and challenges

Managing severe acute and necrotizing pancreatitis

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