The characteristics and prognostic role of acute abdominal on-admission pain in acute pancreatitis: A prospective cohort-analysis of 1432 cases

Földi, M.; Gede, Noémi; Kiss, Szabolcs; Vincze, Áron; Bajor, Judit; Szabó, Imre; Szepes, Zoltán; Izbéki, Ferenc; Gervain, Judit; Hamvas, József; Vitális, Zsuzsanna; Fehér, Eszter; Crai, Stefan; Sallinen,; Moldando, E Ramirez; Meczker, Ágnes; Varjú, Péter; Poropat, Goran; Štimac, Davor; Faluhegyi, N.; Miseta, Attila; Nagy, Tamás; Vereczkei, András; Márton, Zsolt; Hegyi, P.; Hegyi, Péter; Párniczky, Andrea; Szentesi, Andrea

doi:10.1016/j.pan.2021.05.101

Cited by 4 publications

(6 citation statements)

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“…The pain in AP is characteristically an upper abdominal pain, often described as “belt‐like”, radiating to the back 13 . Thus the right upper abdominal quadrant (RUQ) will often be affected—in a cohort analysis of more than 1400 AP patients, 54.0% of all cases and 57.3% of biliary cases had RUQ pain or tenderness 14 . In a meta‐analysis of three studies, Murphy's sign had a specificity of 87% and a subpar sensitivity of 65% for CC, and since it likely stems from the same pathophysiological process as RUQ pain—local inflammation and peritoneal irritation—it might be even less reliable in biliary AP 15 .…”

Section: Discussionmentioning

confidence: 99%

“… 13 Thus the right upper abdominal quadrant (RUQ) will often be affected—in a cohort analysis of more than 1400 AP patients, 54.0% of all cases and 57.3% of biliary cases had RUQ pain or tenderness. 14 In a meta‐analysis of three studies, Murphy's sign had a specificity of 87% and a subpar sensitivity of 65% for CC, and since it likely stems from the same pathophysiological process as RUQ pain—local inflammation and peritoneal irritation—it might be even less reliable in biliary AP. 15 A 3‐fold elevation of AST or ALT is a good indicator of biliary etiology in AP, while ALP and bilirubin are seemingly less useful in the etiological workup.…”

Section: Discussionmentioning

confidence: 99%

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Invalidity of Tokyo guidelines in acute biliary pancreatitis: A multicenter cohort analysis of 944 pancreatitis cases

et al. 2023

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BackgroundThere is a noteworthy overlap between the clinical picture of biliary acute pancreatitis (AP) and the 2018 Tokyo guidelines currently used for the diagnosis of cholangitis (AC) and cholecystitis (CC). This can lead to significant antibiotic and endoscopic retrograde cholangiopancreatography (ERCP) overuse.ObjectivesWe aimed to assess the on‐admission prevalence of AC/CC according to the 2018 Tokyo guidelines (TG18) in a cohort of biliary AP patients, and its association with antibiotic use, ERCP and clinically relevant endpoints.MethodsWe conducted a secondary analysis of the Hungarian Pancreatic Study Group's prospective multicenter registry of 2195 AP cases. We grouped and compared biliary cases (n = 944) based on the on‐admission fulfillment of definite AC/CC according to TG18. Aside from antibiotic use, we evaluated mortality, AC/CC/AP severity, ERCP performance and length of hospitalization. We also conducted a literature review discussing each criteria of the TG18 in the context of AP.Results27.8% of biliary AP cases fulfilled TG18 for both AC and CC, 22.5% for CC only and 20.8% for AC only. Antibiotic use was high (77.4%). About 2/3 of the AC/CC cases were mild, around 10% severe. Mortality was below 1% in mild and moderate AC/CC patients, but considerably higher in severe cases (12.8% and 21.2% in AC and CC). ERCP was performed in 89.3% of AC cases, common bile duct stones were found in 41.1%.ConclusionAround 70% of biliary AP patients fulfilled the TG18 for AC/CC, associated with a high rate of antibiotic use. Mortality in presumed mild or moderate AC/CC is low. Each of the laboratory and clinical criteria are commonly fulfilled in biliary AP, single imaging findings are also unspecific—AP specific diagnostic criteria are needed, as the prevalence of AC/CC are likely greatly overestimated. Randomized trials testing antibiotic use are also warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Invalidity of Tokyo guidelines in acute biliary pancreatitis: A multicenter cohort analysis of 944 pancreatitis cases

et al. 2023

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“…Pain management: AP patients often have severe pain in the pancreatic region, which is the main reason and symptom for AP patients to be hospitalized [13] . Pain management requires a variety of drugs, including: Non-steroidal anti-inflammatory drugs (NSAIDS): such as acetaminophen and ibuprofen.…”

Section: The Main Methods Of Treating Acute Pancreatitismentioning

confidence: 99%

The state of the art in acute pancreatitis research

2023

medsc

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This paper comprehensively analyzes the treatment methods for acute pancreatitis. By delving into the advantages and disadvantages of various current treatment strategies in terms of efficacy, safety, and feasibility, it aims to provide a useful reference for clinical treatment. Furthermore, the paper also focuses on the shortcomings and challenges of current treatments, seeking to explore emerging therapeutic methods to improve patient outcomes and quality of life. To achieve this goal, the effectiveness and limitations of existing treatments are summarized, with attention paid to emerging strategies such as exosome therapy and targeted treatments, highlighting their potential as shown in clinical trials and practice. The paper further elaborates on the potential benefits these new treatments may offer to patients with acute pancreatitis, and discusses the current technical challenges and future directions. Ultimately, this paper aims to provide a reference for research and clinical treatment of acute pancreatitis. It hopes to offer useful information to medical professionals, scholars, and patients, aiding in a better understanding of the condition and treatment methods of acute pancreatitis, contributing to the improvement of cure rates and the enhancement of patients' quality of life. The definition and epidemiology of acute pancreatitisAcute pancreatitis (AP) is a serious inflammatory disease that involves acute intense inflammatory response and sudden damage to the pancreas. It is a life-threatening disease, with typical clinical manifestations of upper abdominal or back pain, accompanied by nausea, vomiting and fever. Acute pancreatitis may cause various severe complications, such as pancreatic necrosis, infection, ascites, etc. In recent years, the incidence of acute pancreatitis has increased globally, with about 13 to 45 per 100,000 cases per year [1] . Among them, the incidence rate of males is higher than that of females [2] . Lifestyle factors are one of the main causes of acute pancreatitis. The two most common factors are gallstones and alcohol abuse [3] , and other possible factors include hyperlipidemia, viral infection, trauma, etc.

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“…Cụ thể, trong đó có 11 người bệnh (52,4%) có đau bụng thượng vị mức độ đau nhiều (NRS-O 7-10 điểm) ở thời điểm vào. Kết quả này tương tự với nghiên cứu của Phillip V. & cs 2013 và Földi M. & cs 2021 [5], [6].…”

Section: Bàn Luậnunclassified

“…Điều đó cho thấy mức độ cảm nhận đau của người bệnh không nhất thiết đi song hành cùng mức độ nặng của suy tạng. Đau bụng nói chung không có mối liên quan với mức độ nặng, tỉ lệ tử vong, biến chứng, thời gian nằm viện ở người bệnh viêm tụy cấp, tính chất đau nhói liên quan đến mức độ nặng của bệnh và thời gian đau bụng đến khi nhập viện là yếu tố tiên lượng mức độ nặng viêm tụy cấp [5], [6].…”

Section: Bàn Luậnunclassified

Đánh Giá Điểm Đau NRS-O Và Các Yếu Tố Liên Quan Ở Người Bệnh Viêm Tụy Cấp Do Tăng Triglycerid Tại Trung Tâm Hồi Sức Tích Cực Bệnh Viện Bạch Mai

Huy¹,

Hoài²

2022

VMJ

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Mục tiêu: Kiểm soát đau là một mục tiêu điều trị ở người bệnh viêm tụy cấp do tăng triglycerid. Thang điểm đánh giá đau NRS-O (oral Numeric Rating Scale) cho phép lượng hóa trực tiếp cảm giác chủ quan của người bệnh [1]. Mục đích của nghiên cứu là nhận xét mức độ đau bằng thang điểm NRS-O và một số yếu tố liên quan ở người bệnh viêm tụy cấp do tăng triglycerid tại Trung tâm Hồi sức tích cực bệnh viện Bạch Mai. Đối tượng và phương pháp: Nghiên cứu tiến cứu ở 21 người bệnh viêm tụy cấp tăng triglycerid theo thang điểm đánh giá số (NRS-O: Nummeric Rating Scale) tại trung tâm Hồi sức tích cực Bệnh viện Bạch Mai. Kết luận: Vấn đề đau từ vừa đến nhiều ở người bệnh viêm tụy cấp do tăng triglycerid là phổ biến và còn người bệnh đau mức độ nhiều sau giai đoạn 6 giờ đầu điều trị tại Trung tâm hồi sức tích cực. Tình trạng đau nhiều có thể xảy ra ở nhóm có điểm suy tạng thấp và áp lực ổ bụng thấp với tỉ lệ tương đương ở nhóm có điểm suy tạng cao và áp lực ổ bụng tăng cao.

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The characteristics and prognostic role of acute abdominal on-admission pain in acute pancreatitis: A prospective cohort-analysis of 1432 cases

Cited by 4 publications

References 41 publications

Invalidity of Tokyo guidelines in acute biliary pancreatitis: A multicenter cohort analysis of 944 pancreatitis cases

Invalidity of Tokyo guidelines in acute biliary pancreatitis: A multicenter cohort analysis of 944 pancreatitis cases

The state of the art in acute pancreatitis research

Đánh Giá Điểm Đau NRS-O Và Các Yếu Tố Liên Quan Ở Người Bệnh Viêm Tụy Cấp Do Tăng Triglycerid Tại Trung Tâm Hồi Sức Tích Cực Bệnh Viện Bạch Mai

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