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16 pages, 1015 KiB

Open AccessArticle

Incidence and Management of Hypertriglyceridemia-Associated Acute Pancreatitis: A Prospective Case Series in a Single Australian Tertiary Centre

by Hong Lin Evelyn Tan, Georgina McDonald, Alexander Payne, William Yu, Zahrul Ismadi, Huy Tran, Jon Gani and Katie Wynne

J. Clin. Med. 2020, 9(12), 3954; https://doi.org/10.3390/jcm9123954 - 6 Dec 2020

Cited by 12 | Viewed by 6276

Abstract

Background: Hypertriglyceridemia-associated acute pancreatitis (HTGAP) has been linked with increased severity and morbidity. In this study, triglyceride levels were measured in all patients admitted with acute pancreatitis (AP) to establish the incidence of HTGAP in an Australian center. Methods: A prospective cohort with [...] Read more.

Background: Hypertriglyceridemia-associated acute pancreatitis (HTGAP) has been linked with increased severity and morbidity. In this study, triglyceride levels were measured in all patients admitted with acute pancreatitis (AP) to establish the incidence of HTGAP in an Australian center. Methods: A prospective cohort with AP was collated over an 18-month period in a single tertiary referral hospital. HTGAP was defined as AP with triglycerides ≥ 11.2 mmol/L (1000 mg/dL). Incidence, clinical co-morbidities, severity and management strategies were recorded. Results: Of the 292 episodes of AP, 248 (85%) had triglycerides measured and were included. HTGAP was diagnosed in 10 of 248 (4%) AP cases. Type 2 diabetes, obesity, alcohol misuse and gallstones were common cofactors. The HTGAP group demonstrated severe hypertriglyceridemia compared to the non-HTGAP group (median 51 mmol/L vs. 1.3 mmol/L). Intensive care unit (ICU) admissions were significantly increased (odds ratio (OR) 16; 95% CI 4–62) in the HTGAP group (5/10 vs. 14/238 admissions, p < 0.001) and constituted 26% (5/19) of total ICU admissions for AP. Four patients received intravenous insulin with fasting and had a rapid reduction in triglyceride levels by 65–77% within 24 h; one patient had mild hypoglycemia secondary to therapy. Conclusion: HTGAP occurred in 4% of AP cases and was associated with higher risk of ICU admission. Intravenous insulin and fasting appear safe and efficacious for acutely lowering triglyceride levels in HTGAP. Full article

(This article belongs to the Special Issue Management of Acute Pancreatitis in Children and Adults: Current Practice and Future Opportunities)

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9 pages, 1179 KiB

Open AccessArticle

Atherogenic Index of Plasma Is a Potential Biomarker for Severe Acute Pancreatitis: A Prospective Observational Study

by Seung Kook Cho, Jae Woo Kim, Ji Hye Huh and Kyong Joo Lee

J. Clin. Med. 2020, 9(9), 2982; https://doi.org/10.3390/jcm9092982 - 15 Sep 2020

Cited by 9 | Viewed by 2576

Abstract

Background: The atherogenic index of plasma (AIP) reflects the levels of triglycerides (TG) and high-density lipoprotein (HDL) cholesterol. The purpose of this study was to assess the relationship between the AIP and severe acute pancreatitis (SAP). Materials and methods: Patients with acute pancreatitis [...] Read more.

Background: The atherogenic index of plasma (AIP) reflects the levels of triglycerides (TG) and high-density lipoprotein (HDL) cholesterol. The purpose of this study was to assess the relationship between the AIP and severe acute pancreatitis (SAP). Materials and methods: Patients with acute pancreatitis (AP) were prospectively enrolled from March 2015 to June 2019. The severity of AP was classified according to the 2012 revised Atlanta classification. Mild and moderately severe AP were categorized as non-SAP. The AIP is calculated as log(TG/HDL). Results: A total of 323 patients were enrolled. The etiologies of AP were gallstone in 171 patients (52.9%), alcohol in 122 patients (37.8%), and hypertriglyceridemia in 30 patients (9.3%). Twenty-four patients (7.4%) were classified as SAP. The AIP was significantly higher in the SAP group compared to the non-SAP group (p < 0.001). The AIP was positively correlated with the Atlanta classification (R = 0.256, p < 0.001). In multivariate analysis, the AIP was found to be an independent predictive factor for SAP (OR = 4.571; CI = 1.913–10.922; p = 0.001). Conclusions: The AIP is a potential biomarker for the prediction of SAP in clinical practice. This result provides that impaired lipid metabolism is associated with the severity of pancreatitis. Full article

(This article belongs to the Special Issue Management of Acute Pancreatitis in Children and Adults: Current Practice and Future Opportunities)

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16 pages, 2626 KiB

Open AccessArticle

Significant Remodeling Affects the Circulating Glycosaminoglycan Profile in Adult Patients with both Severe and Mild Forms of Acute Pancreatitis

by Ewa M. Koźma, Kornelia Kuźnik-Trocha, Katarzyna Winsz-Szczotka, Grzegorz Wisowski, Paweł Olczyk, Katarzyna Komosińska-Vassev, Mariusz Kasperczyk and Krystyna Olczyk

J. Clin. Med. 2020, 9(5), 1308; https://doi.org/10.3390/jcm9051308 - 1 May 2020

Cited by 4 | Viewed by 2319

Abstract

Acute pancreatitis (AP) manifests itself either as a mild, self-limiting inflammation or a severe, systemic inflammatory process that is associated with various complications and a high mortality rate. It is unknown whether these two forms of the disease can differ in the profile [...] Read more.

Acute pancreatitis (AP) manifests itself either as a mild, self-limiting inflammation or a severe, systemic inflammatory process that is associated with various complications and a high mortality rate. It is unknown whether these two forms of the disease can differ in the profile of circulating glycosaminoglycans, which are molecules with huge biological reactivity due to a high density of negative electric charge. Plasma glycosaminoglycans were characterized/quantified in 23 healthy controls, 32 patients with mild AP, and 15 individuals with severe disease using electrophoresis with enzymatic identification (chondroitin sulfate and heparan sulfate) or an ELISA-based test (hyaluronan). Moreover, the correlations between the glycosaminoglycan levels and clinical parameters were evaluated. Both forms of AP showed similar remodeling of the plasma profile of the sulfated glycosaminoglycans. In contrast, only in the patients with mild AP was the level of circulating hyaluronan significantly decreased as compared to the healthy controls. Both forms of AP are associated with systemic changes in the metabolism of glycosaminoglycans. However, the alterations in hyaluronan metabolism may contribute to the disease evolution. The circulating hyaluronan may have some clinical value to predict the severity of AP and to evaluate the clinical status of patients with severe AP. Full article

(This article belongs to the Special Issue Management of Acute Pancreatitis in Children and Adults: Current Practice and Future Opportunities)

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Review

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9 pages, 516 KiB

Open AccessReview

A Practical Approach to Management of Acute Pancreatitis: Similarities and Dissimilarities of Disease in Children and Adults

by Zachary M. Sellers, Monique T. Barakat and Maisam Abu-El-Haija

J. Clin. Med. 2021, 10(12), 2545; https://doi.org/10.3390/jcm10122545 - 8 Jun 2021

Cited by 8 | Viewed by 3717

Abstract

Acute pancreatitis (AP) is associated with significant morbidity and mortality, and it substantially contributes to the healthcare burden of gastrointestinal disease and quality of life in children and adults. AP across the lifespan is characterized by similarities and differences in epidemiology, diagnostic modality, [...] Read more.

Acute pancreatitis (AP) is associated with significant morbidity and mortality, and it substantially contributes to the healthcare burden of gastrointestinal disease and quality of life in children and adults. AP across the lifespan is characterized by similarities and differences in epidemiology, diagnostic modality, etiologies, management, adverse events, long-term outcomes, and areas in greatest need of research. In this review, we touch on each of these shared and distinctive features of AP in children and adults, with an emphasis on recent advances in the conceptualization and management of AP. Full article

(This article belongs to the Special Issue Management of Acute Pancreatitis in Children and Adults: Current Practice and Future Opportunities)

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8 pages, 208 KiB

Open AccessReview

Nutrition and Acute Pancreatitis

by Allison L. Yang

J. Clin. Med. 2021, 10(4), 836; https://doi.org/10.3390/jcm10040836 - 18 Feb 2021

Cited by 9 | Viewed by 6021

Abstract

Acute pancreatitis (AP) is an acute inflammatory process of the pancreas that is characterized by severe abdominal pain, elevated pancreatic enzymes, and pancreatic changes on abdominal imaging. AP is, by nature, an inflammatory process that leads to protein catabolism and an increased metabolic [...] Read more.

Acute pancreatitis (AP) is an acute inflammatory process of the pancreas that is characterized by severe abdominal pain, elevated pancreatic enzymes, and pancreatic changes on abdominal imaging. AP is, by nature, an inflammatory process that leads to protein catabolism and an increased metabolic rate, highlighting the strong need for early nutritional support in the initial management of the disease process. The goal of nutritional support in acute pancreatitis is to correct the negative nitrogen balance to reduce inflammation and improve outcomes. Many trials and multiple systemic reviews and meta-analyses have examined the best modality, timing, and composition of nutritional support for acute pancreatitis. Early enteral nutrition has emerged as an important aspect of the clinical management of AP. This narrative review aimed to provide an overview of the clinical management of nutrition in acute pancreatitis based on the currently available data. Full article

(This article belongs to the Special Issue Management of Acute Pancreatitis in Children and Adults: Current Practice and Future Opportunities)

11 pages, 300 KiB

Open AccessReview

Sex-Related Differences of Acute and Chronic Pancreatitis in Adults

by Madeline Drake, Shah-Jahan M. Dodwad, Joy Davis, Lillian S. Kao, Yanna Cao and Tien C. Ko

J. Clin. Med. 2021, 10(2), 300; https://doi.org/10.3390/jcm10020300 - 15 Jan 2021

Cited by 34 | Viewed by 3826

Abstract

The incidence of acute and chronic pancreatitis is increasing in the United States. Rates of acute pancreatitis (AP) are similar in both sexes, but chronic pancreatitis (CP) is more common in males. When stratified by etiology, women have higher rates of gallstone AP, [...] Read more.

The incidence of acute and chronic pancreatitis is increasing in the United States. Rates of acute pancreatitis (AP) are similar in both sexes, but chronic pancreatitis (CP) is more common in males. When stratified by etiology, women have higher rates of gallstone AP, while men have higher rates of alcohol- and tobacco-related AP and CP, hypercalcemic AP, hypertriglyceridemic AP, malignancy-related AP, and type 1 autoimmune pancreatitis (AIP). No significant sex-related differences have been reported in medication-induced AP or type 2 AIP. Whether post-endoscopic retrograde cholangiopancreatography pancreatitis is sex-associated remains controversial. Animal models have demonstrated sex-related differences in the rates of induction and severity of AP, CP, and AIP. Animal and human studies have suggested that a combination of risk factor profiles, as well as genes, may be responsible for the observed differences. More investigation into the sex-related differences of AP and CP is desired in order to improve clinical management by developing effective prevention strategies, diagnostics, and therapeutics. Full article

(This article belongs to the Special Issue Management of Acute Pancreatitis in Children and Adults: Current Practice and Future Opportunities)

12 pages, 2935 KiB

Open AccessReview

Endoscopic Management of Pancreatic Fluid Collections

by Robert Dorrell, Swati Pawa and Rishi Pawa

J. Clin. Med. 2021, 10(2), 284; https://doi.org/10.3390/jcm10020284 - 14 Jan 2021

Cited by 20 | Viewed by 4408

Abstract

Pancreatic fluid collections (PFCs) are a common sequela of pancreatitis. Most PFCs can be managed conservatively, but symptomatic PFCs require either surgical, percutaneous, or endoscopic intervention. Recent advances in the therapeutics of PFCs, including the step-up approach, endoscopic ultrasound-guided transmural drainage with lumen [...] Read more.

Pancreatic fluid collections (PFCs) are a common sequela of pancreatitis. Most PFCs can be managed conservatively, but symptomatic PFCs require either surgical, percutaneous, or endoscopic intervention. Recent advances in the therapeutics of PFCs, including the step-up approach, endoscopic ultrasound-guided transmural drainage with lumen apposing metal stents, and direct endoscopic necrosectomy, have ushered endoscopy to the forefront of PFCs management and have allowed for improved patient outcomes and decreased morbidity. In this review, we explore the progress and future of endoscopic management of PFCs. Full article

(This article belongs to the Special Issue Management of Acute Pancreatitis in Children and Adults: Current Practice and Future Opportunities)

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13 pages, 288 KiB

Open AccessReview

Acute Pancreatitis: Genetic Risk and Clinical Implications

by Frank U. Weiss, Felix Laemmerhirt and Markus M. Lerch

J. Clin. Med. 2021, 10(2), 190; https://doi.org/10.3390/jcm10020190 - 7 Jan 2021

Cited by 19 | Viewed by 4410

Abstract

Acute pancreatitis (AP) is one of the most common gastroenterological indications for emergency admittance and hospitalization. Gallstones, alcohol consumption or the presence of additional initiating factors give rise to a disease with a diverse clinical appearance and a hard-to predict course of progression. [...] Read more.

Acute pancreatitis (AP) is one of the most common gastroenterological indications for emergency admittance and hospitalization. Gallstones, alcohol consumption or the presence of additional initiating factors give rise to a disease with a diverse clinical appearance and a hard-to predict course of progression. One major challenge in the treatment of AP patients is the early identification of patients at risk for the development of systemic complications and organ failure. In addition, 20%–30% of patients with a first episode of AP later experience progress to recurrent or chronic disease. Complex gene–environment interactions have been identified to play a role in the pathogenesis of pancreatitis, but so far no predictive genetic biomarkers could be implemented into the routine clinical care of AP patients. The current review explains common and rare etiologies of acute pancreatitis with emphasis on underlying genetic aberrations and ensuing clinical management. Full article

(This article belongs to the Special Issue Management of Acute Pancreatitis in Children and Adults: Current Practice and Future Opportunities)

11 pages, 240 KiB

Open AccessReview

Cutaneous Manifestations in Pancreatic Diseases—A Review

by Raluca Miulescu, Daniel Vasile Balaban, Florica Sandru and Mariana Jinga

J. Clin. Med. 2020, 9(8), 2611; https://doi.org/10.3390/jcm9082611 - 12 Aug 2020

Cited by 23 | Viewed by 4888

Abstract

Pancreatic pathology, comprising acute and chronic pancreatitis, autoimmune pancreatitis and pancreatic neoplasms, primarily presents with gastrointestinal symptoms and signs; however, it is well recognized that it can also associate a wide range of extra-digestive features. Among these systemic manifestations, cutaneous involvement plays an [...] Read more.

Pancreatic pathology, comprising acute and chronic pancreatitis, autoimmune pancreatitis and pancreatic neoplasms, primarily presents with gastrointestinal symptoms and signs; however, it is well recognized that it can also associate a wide range of extra-digestive features. Among these systemic manifestations, cutaneous involvement plays an important role both as a diagnostic clue for the pancreatic disease itself and serving as a prognostic factor for the severity of the condition. Recognition of these cutaneous signs is, however, far from being satisfactory, all the more as some of them are relatively rare. In the current review, we discuss skin involvement in pancreatic diseases, referring to pancreatic panniculitis, cutaneous hemorrhagic manifestations, skin metastasis, acanthosis nigricans, livedo reticularis, necrolytic migratory erythema and cutaneous fistula. We highlight the clinical characteristics, treatment and prognostic value of these lesions. Better awareness among medical specialties other than dermatology is needed for detection of the skin clues associated with pancreatic pathology. Full article

(This article belongs to the Special Issue Management of Acute Pancreatitis in Children and Adults: Current Practice and Future Opportunities)

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