Post-ERP pancreatitis as a model for cytokine induced acute phase response in acute pancreatitis.

Abstract

Background/Aims-By contrast with animal models, in most cases it is not possible to examine the systemic response in patients in the first hours after onset of acute pancreatitis. The aim was to determine whether endoscopic retrograde cholangiopancreaticography (ERP)-induced pancreatitis can be used as a human model for the study ofcytokine release and acute phase response in the first hours of the disease. Patients and methods-Seventy consecutive patients undergoing ERP for different reasons were prospectively evaluated by sampling blood before and 0, 1, 4, 12, 24, and 48 hours after ERP and, in patients who developed an acute post-ERP pancreatitis, daily until C reactive protein (CRP) was within normal range. A post-ERP pancreatitis was defined as a threefold increase of amylase or lipase and at least two of the clinical symptoms: abdominal pain, nausea, vomiting, and peritonism during 24 hours after ERP. Results-Nine out of 70 patients developed an acute pancreatitis. Cytokines and other biochemical variables were measured in those nine and in 34 patients out of the 61 not developing pancreatitis. In the nine patients amylase and lipase increased within the first hour after ERP with maximum values between four and 12 hours. Interleukin-6 increased to maximal concentrations after 24-48 hours and the highest CRP concentrations were found 72 hours after ERP. Tumour necrosis factor did not change. Conclusion-Post-ERP pancreatitis is an ideal model in which to examine the initial cytokine and acute phase response in the first hours after the initiation of the disease.

Efecto de la administración de indometacina rectal sobre los niveles séricos de amilasa posteriores a colangiopancreatografía retrógrada endoscópica y su impacto en la aparición de episodios de pancreatitis secundaria

“…Los eventos intracelulares iniciales provocan daño acinar pancreático seguido de respuesta inflamatoria local liberando citocinas proinflamatorias a la circulación (12). La severidad del ataque se determina por la magnitud de la respuesta inflamatoria sistémica resultante (13).…”

“…Debido a que el evento inicial está bien identificado, hace de la pancreatitis aguda post-CPRE un modelo úni-co de estudio para valorar el beneficio de la inmunomodulación temprana (11)(12)(13)(14)(15).…”

Clinical Value of Severity Markers in Acute Pancreatitis

“…It distinguishes between severe and mild acute pancreatitis with 86 % to 100 % sensitivity and 71 % to 100 % specificity (30,31). Peak concentrations of IL-6 are reached 24 to 48 h before those of CRP (32). A rapid assay for serum concentration of IL-6 is available for the routine use (30).…”

Towards a Novel Treatment Strategy for Acute Pancreatitis

“…Analysis of peripheral venous blood by electron spin resonance spectroscopy (ESR) identifies a free radical burst as soon as the procedure is over [13]. Acinar cell injury is evident by the first sampling point at around 1 h in published studies, from surges in lipase, amylase [14, 15]and anionic trypsinogen [16]. The surge precedes epigastric pain from pancreatic inflammation by a median of 4.5 h, range 3–7 h [14].…”