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The Turkish Journal of Gastroenterology... Nov 2015Although uncommon, acute pancreatitis is a well-recognized, but generally serious, complication following liver transplantation. In addition to being more prevalent in... (Review)
Review
Although uncommon, acute pancreatitis is a well-recognized, but generally serious, complication following liver transplantation. In addition to being more prevalent in patients who underwent liver transplantation than in the general population, it has a more aggressive course and can be responsible for significant morbidity and mortality. The post-liver transplant population has altered anatomy, increased comorbidities, and requires a myriad of drugs. These characteristics make them different from the pre-transplant population. Despite their retrospective nature, prior studies have identified numerous etiological factors that are associated with an increased risk of acute pancreatitis following liver transplantation. These can be broadly classified into the following four categories: surgical and anatomical factors, infections, post-transplant management, and post-transplant complications. The aim of this systematic review is to assimilate the available information regarding acute pancreatitis following adult liver transplantation to describe the risk factors and natural history of the disease and to highlight possible areas for further investigation.
Topics: Acute Disease; Adult; Humans; Liver Transplantation; Pancreatitis; Retrospective Studies; Risk Factors
PubMed: 26575039
DOI: 10.5152/tjg.2015.0427 -
Arquivos Brasileiros de Cirurgia... 2015Acute pancreatitis has as its main causes lithiasic biliary disease and alcohol abuse. Most of the time, the disease shows a self-limiting course, with a rapid recovery,... (Review)
Review
INTRODUCTION
Acute pancreatitis has as its main causes lithiasic biliary disease and alcohol abuse. Most of the time, the disease shows a self-limiting course, with a rapid recovery, only with supportive treatment. However, in a significant percentage of cases, it runs with important local and systemic complications associated with high mortality rates.
AIM
To present the current state of the use of these prognostic factors (predictive scores) of gravity, as the time of application, complexity and specificity.
METHOD
A non-systematic literature review through 28 papers, with emphasis on 13 articles published in indexed journals between 2008 and 2013 using Lilacs, Medline, Pubmed.
RESULTS
Several clinical, laboratory analysis, molecular and image variables can predict the development of severe acute pancreatitis. Some of them by themselves can be determinant to the progression of the disease to a more severe form, such as obesity, hematocrit, age and smoking. Hematocrit with a value lower than 44% and serum urea lower than 20 mg/dl, both at admission, appear as risk factors for pancreatic necrosis. But the PCR differentiates mild cases of serious ones in the first 24 h. Multifactorial scores measured on admission and during the first 48 h of hospitalization have been used in intensive care units, being the most ones used: Ranson, Apache II, Glasgow, Iget and Saps II.
CONCLUSION
Acute pancreatitis is a disease in which several prognostic factors are employed being useful in predicting mortality and on the development of the severe form. It is suggested that the association of a multifactorial score, especially the Saps II associated with Iget, may increase the prognosis accuracy. However, the professional's preferences, the experience on the service as well as the available tools, are factors that have determined the choice of the most suitable predictive score.
Topics: Acute Disease; Humans; Pancreatitis; Prognosis; Severity of Illness Index
PubMed: 26537149
DOI: 10.1590/S0102-67202015000300016 -
Cureus Oct 2023We aimed to identify the etiology of acute pancreatitis (AP) and its most common causes with its epidemiological features among the Saudi population in 2023 in... (Review)
Review
We aimed to identify the etiology of acute pancreatitis (AP) and its most common causes with its epidemiological features among the Saudi population in 2023 in different regions. In this systematic review, we assessed the etiology and epidemiological features of acute pancreatitis in Saudi Arabia following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guidelines. Inclusion criteria were studies conducted in Saudi Arabia, published in English, and involving participants aged 18 years or older. PubMed and Google Scholar were searched in March 2023 for English articles published between 1985 and 2023 using specific keywords. Two reviewers screened titles, abstracts, and full-text articles for eligibility, with disagreements resolved by a third reviewer. Data on study characteristics, participant demographics, and etiological factors were extracted using a standardized form. Descriptive analysis summarized the etiology of acute pancreatitis in Saudi Arabia based on the extracted data. Out of the 58 studies retrieved for screening, 10 studies were included in the final systematic review, and most of them were done in the Riyadh region. The sum of the sample size was 1,695 participants. In Saudi Arabia, the most prevalent cause of acute pancreatitis is biliary stones. The average mortality rate of acute pancreatitis in reported studies is 2.2%. In conclusion, biliary and idiopathic causes are the most frequent etiologies of AP in some different regions of Saudi Arabia, acute peripancreatic fluid collections and pancreatic pseudocysts are the two most commonly reported complications associated with AP, and the mortality rate of AP in Saudi Arabia may be higher compared to developed countries.
PubMed: 37927657
DOI: 10.7759/cureus.46511 -
Frontiers in Medicine 2022Resistin is a small secretory adipokine which is implicated to obesity and associated diseases. Recently, plenty of research papers have been conducted to explore the...
INTRODUCTION
Resistin is a small secretory adipokine which is implicated to obesity and associated diseases. Recently, plenty of research papers have been conducted to explore the association between peripheral resistin and the severity of acute pancreatitis (AP). However, the results were controversial. In this study, we aimed to confirm the effect of peripheral resistin and the development of acute pancreatitis.
METHODS
A comprehensive online search was performed using the PubMed, Embase, Web of Science, CNKI, and Wanfang databases up through January 20, 2022. The retrieved records and their references were screened to identify additional studies. Data were extracted to calculate the pooled Hedges' g and its 95% CI, which were selected to assess peripheral resistin levels and the severity of acute pancreatitis. Subgroup analyses, sensitivity analyses, meta-regression, and publication bias tests were also undertaken based on obtained information.
RESULTS
A total of eleven studies with 892 acute pancreatitis patients were enrolled in the study. Peripheral resistin levels were significantly increased in severe acute pancreatitis compared with mild acute pancreatitis (Hedges' g = 2.092, 95% CI: 0.994-3.190, < 0.001). Subgroup analyses based on sample types and ethnicity also showed similar results. A single study did not affect our results, which was verified by sensitivity analysis. Meta-regression analyses revealed that age, gender of the included subjects, sample size, and publication year did not moderate effects on the present results.
CONCLUSION
In our study, peripheral resistin levels were significantly elevated in patients with severe AP compared with patients with mild AP. Abnormal resistin levels may provide us some new insights in predicting the severity of AP.
PubMed: 35770007
DOI: 10.3389/fmed.2022.915152 -
BJS Open Jul 2023Severe acute pancreatitis, the most severe form of acute pancreatitis, can alter pancreatic morphology, physiology, and function resulting in long-term morbidity, even...
BACKGROUND
Severe acute pancreatitis, the most severe form of acute pancreatitis, can alter pancreatic morphology, physiology, and function resulting in long-term morbidity, even after a single episode. This review assesses long-term outcomes and quality of life of severe acute pancreatitis.
METHODS
A comprehensive literature review was conducted across MEDLINE, Embase, Scopus, and PubMed electronic databases on 18 January 2021 and updated on 26 April 2022 to ensure no new literature had been omitted. All studies were prospective or retrospective, included adult patients (>18 years) presenting with acute pancreatitis for whom data on long-term outcomes specifically after severe acute pancreatitis were reported. Quantitative and qualitative data extraction and synthesis were carried out and no meta-analysis was performed. Outcome measures included aetiology and mortality of severe acute pancreatitis, length of stay, endocrine and exocrine pancreatic insufficiency, chronic symptoms, and quality of life compared with healthy controls as assessed by validated questionnaires.
RESULTS
Fourteen retrospective cohort studies were included, for a total of 779 patients, using quality of life questionnaires. The most common aetiology of severe acute pancreatitis was biliary (36 per cent) followed by alcoholic (29 per cent). Mortality rate ranged from 5 to 35 per cent and length of stay ranged from 2 to 367 days. Quality of life was somewhat lower in patients with exocrine insufficiency, but unaffected by endocrine insufficiency or chronic symptoms. Quality of life was more likely to be reduced in the first 4 years but normalize thereafter and was more likely to be negatively affected where alcohol was the aetiology. In four studies, the relationship between disease severity and lower quality of life was investigated, and a significant correlation was found.
CONCLUSION
The review shows how a single episode of severe acute pancreatitis can have a variable effect on long-term quality of life, which is different to previous studies showing a strong reduction in quality of life. This could indicate that in current times treatment modalities are more effective.
Topics: Adult; Humans; Quality of Life; Pancreatitis; Retrospective Studies; Acute Disease; Prospective Studies
PubMed: 37619216
DOI: 10.1093/bjsopen/zrad067 -
Journal of Clinical Medicine Oct 2020We conducted a systematic review in order to summarize the available data on pancreatitis associated with viral hepatitis. (Review)
Review
BACKGROUND
We conducted a systematic review in order to summarize the available data on pancreatitis associated with viral hepatitis.
METHODS
A comprehensive literature search of Medline, Scopus and ISI Web of Science databases was conducted and papers eligible for the inclusion identified.
RESULTS
In total, 46 studies reporting data on 73 patients were included in the analysis. Most of the cases were diagnosed in Asia (57.53%), followed by North America (23.29%), and Europe (13.70%). Most of the patients were affected by hepatitis A virus (HAV) (42.47%), followed by hepatitis E virus (HEV) (28.77%), hepatitis B virus (HBV) (8.22%), and hepatitis C virus (HCV) (1.37%), while 17.81% at the time of diagnosis were classified as affected by "hepatitis virus". Pancreatitis was severe in 32.88% of cases. The respiratory system was affected in 2.74% of patients, 6.85% experienced renal failure, while 5.48% experienced a multiorgan dysfunction syndrome (MODS). Four patients (5.48%) needed pancreatic surgery. Despite the treatment, 21.92% of patients died. We identified fulminant hepatitis ( < 0.0001), MODS ( < 0.0001) and severe pancreatitis ( < 0.0001) to be significantly more present in patients who died in comparison to cured ones.
CONCLUSION
Increased awareness of pancreatic involvement in viral hepatitis is needed because it can have a substantial impact on therapeutic approaches and outcomes.
PubMed: 33076353
DOI: 10.3390/jcm9103309 -
HPB : the Official Journal of the... Aug 2022Chronic pancreatitis (CP) is a progressive inflammatory disorder of the pancreas. Sarcopenia is a degenerative loss of skeletal muscle mass, quality, and strength and is... (Review)
Review
BACKGROUND
Chronic pancreatitis (CP) is a progressive inflammatory disorder of the pancreas. Sarcopenia is a degenerative loss of skeletal muscle mass, quality, and strength and is commonly associated with chronic pancreatitis. Regular physical activity and adequate functional fitness have been found to ameliorate the risk and effects of sarcopenia in other chronic diseases. The objective of this systematic review was to collate all the published evidence which has examined any type of physical activity as an intervention in the chronic pancreatitis patient population.
METHODS
This systematic review was conducted in accordance with the PRISMA guidelines. The search strategy was designed by the medical librarian (DM) for Embase and then modified for the other search platforms. Two of the researchers (BM) and (AM) then performed the literature search using the databases Embase, Medline, CINAHL, and Web of Science.
RESULTS
An electronic identified a total of 571 references imported to Covidence as 420 when the duplicates (151) were removed. 420 titles were screened and 390 were removed as not relevant from their titles. 30 full text papers were selected and from these, only one full text paper was deemed suitable for inclusion.
CONCLUSIONS
There is currently insufficient evidence to advise physical activity in the chronic pancreatitis population. However, given the evidence to support physical activity in many other chronic diseases this review highlights the need for urgent investigation of physical activity as an intervention on this specific patient population.
Topics: Chronic Disease; Exercise; Humans; Pancreas; Pancreatitis, Chronic; Sarcopenia
PubMed: 35289280
DOI: 10.1016/j.hpb.2022.02.003 -
Clinical and Translational... Aug 2023Individuals with chronic pancreatitis (CP) are at increased risk for nutritional complications during their clinical course. We appraised the literature to provide... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Individuals with chronic pancreatitis (CP) are at increased risk for nutritional complications during their clinical course. We appraised the literature to provide updated estimates of the prevalence and predictors of osteoporosis, osteopenia, and osteopathy in CP using a systematic review and meta-analysis.
METHODS
Search strategies were developed for major databases from inception through October 2021. Outcomes of interest included rates of osteopenia and osteoporosis based on dual-energy X-ray absorptiometry scans and risk factors. A random-effects model was used for analysis, and results were expressed as pooled cumulative rates along with 95% confidence interval (CI).
RESULTS
From an initial total of 1,704 identified articles, we ultimately selected 17 studies that involved 1,659 subjects (n = 1,067 men) with CP. The pooled rate of osteopathy was 58% (95% CI: 49%-67%; P < 0.001; I 2 = 91.8%). The pooled rate of osteoporosis was 18% (95% CI: 12%-23%; P < 0.001; I 2 = 86.3%), and the pooled rate of osteopenia was 39% (95% CI: 31%-48%; P < 0.001; I 2 = 91.53%). In the systematic review, factors associated with decreased bone mineral density included smoking, alcohol consumption, older age, female sex, low body mass index, decreased vitamins D and K, and fecal elastase levels.
DISCUSSION
Patients with CP have high rates of osteopathy when assessed with dual-energy X-ray absorptiometry imaging. Additional studies with longitudinal follow-up are needed to understand the observed heterogeneity, the cumulative burden of disease, and rate of bone loss in CP.
Topics: Male; Humans; Female; Bone Diseases, Metabolic; Bone Density; Prevalence; Osteoporosis; Pancreatitis, Chronic
PubMed: 37477620
DOI: 10.14309/ctg.0000000000000623 -
Pancreatology : Official Journal of the... Jan 2021Altered intestinal microbiota has been reported in pancreatic disorders, however, it remains unclear whether these changes alter the course of disease in patients with...
BACKGROUND
Altered intestinal microbiota has been reported in pancreatic disorders, however, it remains unclear whether these changes alter the course of disease in patients with acute (AP) and chronic pancreatitis (CP), or whether these disease states alter the environment to enable pathogenic microbial composition changes to occur. We undertook a systematic review to characterize the gut microbiome in pancreatitis patients.
METHODS
MEDLINE and EMBASE were searched for studies on microbiota in pancreatitis published from January 1, 2000 to June 5, 2020. Animal studies, reviews, case reports, and non-English articles were excluded. A frequency analysis was performed for outcomes reported in ≥2 studies and studies were analyzed for risk of bias and quality of evidence.
RESULTS
22 papers met inclusion criteria; 15 included AP, 7 included CP. No studies were appropriately designed to assess whether alterations in the gut microbiome exacerbate pancreatitis or develop as a result of pancreatitis. We did identify several patterns of microbiome changes that are associated with pancreatitis. The gut microbiome demonstrated decreased alpha diversity in 3/3 A P studies and 3/3 C P studies. Beta diversity analysis revealed differences in bacterial community composition in the gut microbiome in 2/2 A P studies and 3/3 C P studies. Functionally, gut microbiome changes were associated with infectious pathways in AP and CP. Several studies suffered from high risk of bias and inadequate quality.
CONCLUSIONS
Detecting differences in microbial composition associated with AP and CP may represent a diagnostic tool. Appropriately controlled longitudinal studies are needed to determine whether microbiome changes are causative or reactive in pancreatitis.
Topics: Gastrointestinal Microbiome; Humans; Pancreatitis; Pancreatitis, Chronic
PubMed: 33376062
DOI: 10.1016/j.pan.2020.12.013 -
Clinical Nutrition (Edinburgh, Scotland) Feb 2015Acute pancreatitis is a systemic immunoinflammatory response to auto-digestion of the pancrease and peri-pancreatic organs. Patients with acute pancreatitis can rapidly... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND & AIMS
Acute pancreatitis is a systemic immunoinflammatory response to auto-digestion of the pancrease and peri-pancreatic organs. Patients with acute pancreatitis can rapidly develop nutritional deficiency; hence nutritional support is important and critical. Sometimes parenteral nutrition (PN) is inevitable in acute pancreatitis. Due to immunosuppressive and inflammatory nature of the disease, it seems that immunonutrients like glutamine and omega-3 fatty acids (ω-3 FAs) added to parenteral formulas may improve the conditions. We conducted a meta-analysis to evaluate the effects of parenteral immunonutrition on clinical outcomes (infectious complications, length of hospital stay (LOS) and mortality) in patients with acute pancreatitis.
METHODS
A computerized literature search on four databases (PubMed, Cochrane, ISI Web of Science, and Iran Medex) was performed to find all the randomized controlled trials (RCTs) assessed the effects of parenteral immunonutrition in acute pancreatitis. Necessary data were extracted and quality assessment of RCTs was performed with consensus in the study team. Fixed effects model was used to conduct the meta-analysis.
RESULTS
One hundred and ninety four references were found via our search in which 7 articles matched our criteria for enrolling the meta-analysis. Parenteral immunonutrition significantly reduced the risk of infectious complications (RR = 0.59; 95% CI, 0.39-0.88; p ≤ 0.05) and mortality (RR = 0.26; 95% CI, 0.11-0.59; p ≤ 0.001). LOS was also shorter in patients who received immunonutrition (MD = -2.93 days; 95% CI, -4.70 to -1.15; p ≤ 0.001).
CONCLUSION
Immunonutrients like glutamine and ω-3 FAs added to parenteral formulas can improve prognoses in patients with acute pancreatitis.
Topics: Acute Disease; Fatty Acids, Omega-3; Glutamine; Humans; Infections; Length of Stay; Nutritional Support; Pancreatitis; Parenteral Nutrition; Prognosis; Randomized Controlled Trials as Topic
PubMed: 24931755
DOI: 10.1016/j.clnu.2014.05.008