Recurrent Acute Pancreatitis

Guda, Nalini M.; Muddana, Venkata; Whitcomb, David C.; Lévy, Philippe; Garg, Pramod Kumar; Coté, Gregory A.; Uç, Aliye; Varadarajulu, Shyam; Vege, Santhi Swaroop; Chari, Suresh T.; Forsmark, Chris E.; Yadav, Dhiraj; Reddy, D. Nageshwar; Tenner, Scott; Johnson, C. D.; Akisik, Fatih; Saluja, Ashok K.; Lerch, Markus M.; Mallery, J. Shawn; Freeman, Martin L.

doi:10.1097/mpa.0000000000001053

Cited by 85 publications

(53 citation statements)

References 167 publications

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“…In children, etiologies are broader and more variable. 1 AP begins with pancreatic inflammation, which can lead to peripancreatic or multi-organ involvement. Most cases of acute pancreatitis are mild and self-limiting and have no sequelae, but complications and severe illness occurs in some cases.…”

Section: Discussionmentioning

confidence: 99%

“…AP was defined as presence 2 of the following three criteria: abdominal pain suggestive of AP; serum lipase or amylase levels 3 or more times normal; and characteristic findings of AP on imaging (trans-abdominal ultrasound, computed tomography, or magnetic resonance). 1,2 National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP-III) was used for diagnosis of MetS. 11,16 Metabolic syndrome was defined according to NCEP/ATP-III criteria by the presence of at least three of the following metabolic abnormalities: waist circumference >102 and >88 cm in men and women, triglyceride ≥150 mg/dL, high-density lipoprotein cholesterol (HDL-C) <40 and <50 mg/dL in men and women, blood pressure ≥130/85 mmHg; and fasting blood sugar ≥100 mg/dL.…”

Section: Definitionsmentioning

confidence: 99%

“…Most cases of acute pancreatitis are mild and self-limiting, but severe AP has high mortality and early detection is particularly important for proper management. 1,2 Different types of severity scoring systems have been developed to detect severe AP. The Bedside Index for Severity in Acute Pancreatitis (BISAP) is a simple scoring system that predicts the severity of disease.…”

Section: Introductionmentioning

confidence: 99%

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<p>Association Between Metabolic Syndrome and Its Components with Severity of Acute Pancreatitis</p>

Niknam¹,

Moradi²,

Jahanshahi³

et al. 2020

DMSO

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Background: Acute pancreatitis (AP) and metabolic syndrome (MetS) are common clinical problems with serious complications and high cost of treatment. The relationship between MetS and severity of AP is unknown, and because there are very few published articles, further studies had been recommended. Therefore, we designed this study to estimate the association between MetS and its components with AP severity. Patients and Methods: In this prospective analytical cross-sectional study, all AP patients who referred to two referral hospitals affiliated with Shiraz University of Medical Sciences between 2016 and 2019 were evaluated. The diagnosis of MetS syndrome as well as follow-up of patients for evaluation of severity and outcome of AP was performed in all enrolled patients. National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP-III) was used for diagnosis of MetS. Bedside Index for Severity in Acute Pancreatitis (BISAP) and revised Atlanta classification (RAC) were used to estimate the severity of AP. Finally, the association between MetS syndrome and its components at different AP severities was compared. Results: Of the 214 patients referred to our center, a total of 76 patients with AP were included in this study. Of the included patients, 40 (52.6%) were male and 36 (47.4%) were female. Frequency of patients in Mets and non-MetS groups was 34 (44.74%) and 42 (55.26%), respectively. The gender and mean age difference between Mets and non-MetS groups were not statistically significant. According to Mets groups, 25 (73.5%) and 9 (26.5%) AP patients with MetS had BISAP score of 0-2 and 3-5, respectively. BISAP score in MetS group was significantly higher than non-MetS group (P = 0.022). Overall, 20 (58.8%), 11 (32.4%), and 3 (8.8%) of AP patients with MetS had mild, moderately severe, and severe AP based on RAC, respectively. Severe RAC was significantly higher in the MetS group than in the non-MetS group (P = 0.029). The frequency of complications in MetS group was significantly higher than in non-MetS group (P= 0.008). The length of hospital stay was also significantly higher in the MetS group than in the non-MetS group (P = 0.001). Overall, three patients died, two of whom had MetS and all had severe RAC and BISAP 3-5. Waist circumference, fasting blood sugar, and triglyceride were significantly higher in the severe and moderately severe types of AP group than in the mild AP group, according to RAC. Although, mean of all components of MetS except HDL-cholesterol were higher in BISAP of 3-5 group than BISAP of 0-2 group, the difference was only significant in waist circumference. Conclusion: The present study showed that there was a significant association between the rate of MetS and its components including waist circumference, hyperglycemia and hypertriglyceridemia with increasing AP severity. This study showed that the incidence of more severe AP in patients with MetS is much higher than in patients without MetS. We recommend that the new studies with larger sample sizes are conducted wit...

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Section: Discussionmentioning

confidence: 99%

Section: Definitionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

<p>Association Between Metabolic Syndrome and Its Components with Severity of Acute Pancreatitis</p>

Niknam¹,

Moradi²,

Jahanshahi³

et al. 2020

DMSO

View full text Add to dashboard Cite

show abstract

“…RAP is a syndrome of multiple distinct acute inflammatory responses originating within the pancreas in individuals with genetic, environmental, traumatic, morphologic, metabolic, biologic, and/or other risk factors who experienced 2 or more episodes of documented AP. [ 16 ] If unchecked, recurrent episodes of AP may lead to chronic pancreatitis. Approximately 9% to 31% of patients with AP develop recurrent attacks of pancreatitis.…”

Section: Discussionmentioning

confidence: 99%

Suboptimal management of hypertriglyceridemia in the outpatient setting is associated with the recurrent pancreatitis

Zhao

Chen

2020

Medicine

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Hyperlipemia is a well-established etiology of acute pancreatitis. However, few data are available in the medical literature about the management of triglyceride levels in the outpatient setting in patients with hypertriglyceridemic acute pancreatitis (HTG-AP). We evaluated the blood triglyceride levels and followed the triglyceride management of patients with HTG-AP. This retrospective study enrolled patients with HTG-AP from January 2013 to March 2019 in the Affiliated Hospital of Southwest Medical of University. By reviewing the hospitalization records and the follow-up data, the clinical features, blood triglyceride levels, use of lipid-lowering medications and rate of blood triglyceride levels monitoring after hospital discharge were analyzed. A total of 133 patients (46 women, 87 men; median age at presentation 37.4 years) diagnosed with HTG-AP were enrolled in the study. Thirty-two patients (24.1%) presented with recurrent acute pancreatitis (RAP). Patients who had RAP were younger and had higher blood triglyceride levels than those with a single attack ( P < .05). No difference in serum amylase levels, hospitalization duration or mortality rate were observed between non-recurrent acute pancreatitis and RAP patients. Lipid monitoring was only observed in 12.8% of patients and 10 patients (7.5%) took medications to control their blood triglyceride levels after hospital discharge. The follow-up of triglyceride levels in the outpatient setting were higher in RAP patients than in patients with non-recurrent acute pancreatitis ( P < .05). Among the patients who measured their triglyceride levels after discharge, 83.3% of patients with RAP had at least 1 follow-up triglyceride level that was higher than 500 mg/dL, while no patients had an HTG-AP attack with a triglyceride level higher than 500 mg/dL. Triglyceride levels after hospital discharge higher than 500 mg/dL may be associated with an increased risk of relapse of clinical acute pancreatitis events. Inappropriate management for triglyceride control in the outpatient setting may be associated with an increased risk of relapse of clinical HTG-AP events.

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“…RAP is a syndrome of multiple distinct acute inflammatory responses originating within the pancreas in individuals with genetic, environmental, traumatic, morphologic, metabolic, biologic, and/or other risk factors who experienced 2 or more episodes of documented AP [16]. If unchecked, recurrent episodes of AP may lead to chronic pancreatitis.…”

Section: Discussionmentioning

confidence: 99%

Suboptimal management of hypertriglyceridemia in the outpatient setting is associated with the recurrent pancreatitis

Yan

Zhao

Chen

2019

Preprint

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Background Hyperlipemia is a well-established etiology of acute pancreatitis (AP). However, few data are available in the medical literature about the management of triglyceride levels in the outpatient setting in patients with hypertriglyceridemic acute pancreatitis (HTG-AP). We evaluated the blood triglyceride levels and the follow-up of triglyceride management in patients with HTG-AP.Methods This retrospective study enrolled patients with HTG-AP from January 2013 to March 2019 in Affiliated Hospital of Southwest Medical of University. By reviewing the hospitalization records and the follow-up data, the clinical features, blood triglyceride levels, lipid-lowering medications use and blood triglyceride levels monitoring after hospital discharge were analyzed.Results 133 patients (46 women, 87 men; median age at presentation 37.4 years) diagnosed with HTG-AP were enrolled in the study. 32 cases (24.1%) presented with recurrent acute pancreatitis (RAP). Patients who had RAP were younger and had higher blood triglyceride levels compared with that of single attack ( P < 0.05). No difference of serum amylase levels, hospitalization duration and mortality rate were observed between non-RAP and RAP. Lipid monitoring was only observed in 12.8% of patients and 10 patients(7.5%) took medications to control blood triglyceride levels after hospital discharge. The follow-up of triglyceride levels in the outpatient setting were higher in RAP patients than that of non-recurrent cases ( P < 0.05). Among the patients who had measured their triglyceride levels after discharge, 83.3% of patients with RAP had at least 1 follow-up of triglyceride level that higher than 500 mg/dL, while no patient had one HTG-AP attack displayed triglyceride levels higher than 500 mg/dL.Conclusions Triglyceride levels after hospital discharge higher than 500 mg/dL may be associated with an increasing risk of relapse of clinical acute pancreatitis events. Inappropriate management of triglyceride control in the outpatient setting may be associated with an increasing risk of relapse of clinical HTG-AP events.

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Recurrent Acute Pancreatitis

Cited by 85 publications

References 167 publications

<p>Association Between Metabolic Syndrome and Its Components with Severity of Acute Pancreatitis</p>

<p>Association Between Metabolic Syndrome and Its Components with Severity of Acute Pancreatitis</p>

Suboptimal management of hypertriglyceridemia in the outpatient setting is associated with the recurrent pancreatitis

Suboptimal management of hypertriglyceridemia in the outpatient setting is associated with the recurrent pancreatitis

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