International consensus statements on early chronic Pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with The International Association of Pancreatology, American Pancreatic Association, Japan Pancreas Society, PancreasFest Working Group and European Pancreatic Club

Whitcomb, David C.; Shimosegawa, Tooru; Chari, Suresh T.; Forsmark, Christopher E.; Frulloni, Luca; Garg, Pramod Kumar; Hegyi, Péter; Hirooka, Yoshiki; Irisawa, Atsushi; Ishikawa, Takuya; Isaji, Syuji; Lerch, Markus M.; Lévy, Philippe; Masamune, Atsushi; Wilcox, C. Mel; Windsor, John A.; Yadav, Dhiraj; Sheel, Andrea; Neoptolemos, John P.

doi:10.1016/j.pan.2018.05.008

Cited by 138 publications

(116 citation statements)

References 106 publications

(133 reference statements)

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“…[ 5 ] The type of surgical intervention should be tailored individually for each patient based on disease state. [ 6 ] Moreover, a PD should be considered if pancreatic cancer cannot be ruled out with certainty. [ 4 ] Otherwise, the possibility of parenchyma-sparing resections for preservation of maximum functional pancreatic tissue should be evaluated.…”

Section: Introductionmentioning

confidence: 99%

Disease duration before surgical resection for chronic pancreatitis impacts long-term outcome

et al. 2020

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Many patients with chronic pancreatitis (CP) undergo a step-up approach with interventional procedures as first-line treatment and resection reserved for later stages. The aim of this study was to identify predictive factors for a significant clinical improvement (SCI) after surgical treatment. All patients operated for CP between September 2012 and June 2017 at our center was retrospectively reviewed. A prospective patient survey was conducted to measure patients postoperative outcome. The primary endpoint SCI was defined as stable health status, positive weight development and complete pain relief without routine pain medication. Additionally, risk factors for relaparotomy were analyzed. A total of 89 patients with a median follow-up of 38 months were included. In most cases, a duodenum-preserving pancreatic head resection (n = 48) or pancreatoduodenectomy (n = 28) was performed. SCI was achieved in 65.3% (n = 47) of the patients after the final medium follow-up of 15.0 months (IQR: 7.0–35.0 months), respectively. Patients with a longer mean delay (7.7 vs 4 years) between diagnosis and surgical resection were less likely to achieve SCI ( P = .02; OR .88; 95%CI .80–98). An endocrine insufficiency was a negative prognostic factor for SCI ( P = .01; OR .15; 95%CI .04–68). In total, 96.2% of the patients had a complete or major postoperative relief with a mean pain intensity reduction from 8.1 to 1.9 on the visual analogue scale. The results support that surgical resection for CP should be considered at early stages. Resection can effectively reduce postoperative pain intensity and improve long-term success.

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Section: Introductionmentioning

confidence: 99%

Disease duration before surgical resection for chronic pancreatitis impacts long-term outcome

et al. 2020

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“…7,9 In mice, acinar cell-specific disruption of the PTHrP gene (Pthlh) significantly reduced the pancreatic injury induced by either bile duct ligation or treatment with the cholecystokinin receptor agonist, cerulein. 8 Recent clinical efforts towards a mechanistic understanding of chronic pancreatitis 10 suggest that pharmacologic disruption of RAP could be an effective therapeutic strategy to slow or stop disease progression. To begin testing this concept, we have identified the naturallyoccurring polyphenol apigenin (4',5,7-trihydroxyflavone) as a potential lead compound.…”

Section: Introductionmentioning

confidence: 99%

Apigenin Decreases Acinar Cell Damage in Pancreatitis

Mrazek¹,

Bhatia²,

Falzon

et al. 2019

Pancreas

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Objective: Chronic pancreatitis is the consequence of multiple episodes of recurrent acute pancreatitis (RAP). We hypothesized that apigenin can minimize the sequelae of RAP by limiting acinar cells' pro-inflammatory signaling pathways. Methods: AR42J acinar cells were treated in vitro with transforming growth factor beta (TGF-β), apigenin, and other inhibitors. Dual luciferase reporter assay measured parathyroid hormone related protein (PTHrP) promoter activity. MAPK/ERK pathway activity was assessed by immunoblotting and in vivo by immunohistochemistry with a cerulein-induced RAP mouse model. Nuclear factor kappa B (NF-κB) nuclear localization was analyzed in vitro in cells stimulated with tumor necrosis factor alpha (TNF-α). Primary acini were isolated and treated with cerulein; interleukin 6 (IL-6) mRNA were measured comparing PTHrP wild-type and knockout mice. Results: Apigenin and PD98059 each downregulated TGF-β stimulation of PTHrP P3 promoter activity. In a RAP mouse model, apigenin reduced pERK nuclear localization in acinar cells and preserved acinar cell architecture. Apigenin suppressed TNF-α mediated signaling by decreasing NF-κB nuclear localization and decreased IL-6 mRNA levels via a PTHrP-dependent mechanism. Conclusions: Apigenin reduced inflammatory responses in experimental models of RAP. The mechanisms mediating the actions of apigenin, in part, are due to attenuation of PTHrP and TGF-β pro-inflammatory signaling.

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“…5 There is also a need to better stratify patients for prognostication and to guide surveillance for CP related complications. An international working group supported by four major pancreas societies sought to develop a consensus definition and diagnostic criteria for early CP.…”

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confidence: 99%

“…The conclusion was that new approaches to the accurate diagnosis of early CP would require development and validation of a mechanistic definition that considers risk factors, biomarkers, clinical context, and new models of disease. 5 There is also a need to better stratify patients for prognostication and to guide surveillance for CP related complications. The study by Liu et al addressed DM development.…”

mentioning

confidence: 99%

Disease stratification and outcome prediction in chronic pancreatitis: Can we do better?

Ang

2020

J of Gastro and Hepatol

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Cited by 138 publications

References 106 publications

Disease duration before surgical resection for chronic pancreatitis impacts long-term outcome

Disease duration before surgical resection for chronic pancreatitis impacts long-term outcome

Apigenin Decreases Acinar Cell Damage in Pancreatitis

Disease stratification and outcome prediction in chronic pancreatitis: Can we do better?

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