Hypertriglyceridemia-induced pancreatitis: updated review of current treatment and preventive strategies

Abstract

Hypertriglyceridemia (HTG) is an uncommon but well-established cause of acute pancreatitis (AP) comprising up to 7% of the cases. The clinical course of HTG-induced pancreatitis (HTGP) is highly similar to that of AP of other etiologies with HTG being the only distinguishing clinical feature. However, HTGP is often correlated with higher severity and elevated complication rate. At present, no approved treatment guideline for the management of HTGP is available, although different treatment modalities such as insulin, heparin, fibric acids, and omega 3 fatty acids have been successfully implemented to reduce serum triglycerides (TG). Plasmapheresis has also been used to counteract elevated TG levels in HTGP patients. However, it has been associated with complications. Following the management of acute phase, lifestyle modifications including dietary adjustments and drug therapy are essential in the long-term management of HTGP and the prevention of its relapse. Results from studies of small patient groups describing treatment and prevention of HTGP are not sufficient to draw solid conclusions resulting in no treatment algorithm being available for effective management of HTGP. Therefore, prospective randomized, active-controlled clinical studies are required to find a better treatment regimen for the management of HTGP. Until date, one randomized clinical trial has been performed to compare clinical outcomes of different treatment approaches for HTGP. However, further studies are required to outline a generalized and efficient treatment regimen for the management of HTGP.

Analytical complex of biochemical markers for preclinical diagnosis and prevention of cardiovascular diseases

“…Устойчиво повышенный уровень инсулина также может привести к дислипидемии [18]. Одна из разновидностей дислипидемии -гипертриглицеридемия, характеризуется устойчивым повышением уровня ТГ в сыворотке крови натощак, и является одним из критериев диагностики МС [33,34]. Повышенный уровень ТГ имеет взаимосвязь с развитием атеросклероза даже в отсутствие гиперхолистеринемии [35].…”

Review of Current Evidence in Acute Pancreatitis

“…Hypertriglyceridemia occupies the third position among the causes of AP (2%-5%) in the absence of other etiological factors, with a risk factor of 1.5%, and when the levels are >1000 mg/dL, the risk increases to 20.2%. Type I, IV, and V dyslipidemia have also been reported to be associated with AP (Frederickson Classification) [12].…”

“…The use of heparin (preferably the one with low molecular weight) in moderately severe to severe AP has been associated with better evolution with a lower incidence of necrosis, ability to improve pancreatic microcirculation and anti-inflammatory effect through a reduction in the stimulation of macrophages and monocytes [89]. Additionally, experimental studies have revealed that heparin reduces the levels of amylase, endothelin-1, inflammatory cytokines, and TNF-α, and causes the activation of NF-kB [12]. Simvastatin has been reported as a promising drug for the prophylaxis of new episodes in recurrent AP [12].…”

“…Additionally, experimental studies have revealed that heparin reduces the levels of amylase, endothelin-1, inflammatory cytokines, and TNF-α, and causes the activation of NF-kB [12]. Simvastatin has been reported as a promising drug for the prophylaxis of new episodes in recurrent AP [12]. Various clinical trials have demonstrated the benefit of using anti-TNF-α in selected patients, as TNF-α plays a central role in the pathogenesis of local and systemic complications in PA (4).…”

Advantages of Modified Computed Tomography Severity Index of Acute Pancreatitis Over Other Scoring System

“…SIRS is the cause of bacterial (Gram negative) translocation from the patient's colon. 1,2,8,12 No single laboratory or clinical sign is pathognomonic for acute pancreatitis. Many bio-markers and inflammatory mediators for predicting the severity of acute pancreatitis are being evaluated.…”