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World Journal of Gastroenterology Nov 2014Acute pancreatitis (AP) is an inflammatory disease of the pancreas which involves the pancreas and surrounding tissue, and systemic inflammation with a characteristic... (Review)
Review
Acute pancreatitis (AP) is an inflammatory disease of the pancreas which involves the pancreas and surrounding tissue, and systemic inflammation with a characteristic systemic increase of vascular permeability and increased risk of multiple organ dysfunction. Currently, the pathogenesis of AP is fuzzy, and the diagnosis and treatment need to be standardized. Nevertheless, increased knowledge of AP may achieve more thorough understanding of the pathogenesis. The use of further advanced diagnostic tools and superior treatment, potentially will help clinicians to manage AP at an appropriate stage. However, in view of the multi factorial disease and the complex clinical manifestations, the management of patients with AP is also remaining areas for improvement.
Topics: Acute Disease; Animals; Disease Progression; Humans; Pancreatitis; Predictive Value of Tests; Treatment Outcome
PubMed: 25473166
DOI: 10.3748/wjg.v20.i43.16138 -
Diagnostic and Interventional Imaging Feb 2015The Atlanta classification of acute pancreatitis was introduced in 1992 and divides patients into mild and severe groups based on clinical and biochemical criteria.... (Review)
Review
The Atlanta classification of acute pancreatitis was introduced in 1992 and divides patients into mild and severe groups based on clinical and biochemical criteria. Recently, the terminology and classification scheme proposed at the initial Atlanta Symposium have been reviewed and a new consensus statement has been proposed by the Acute Pancreatitis Classification Working Group. Major changes include subdividing acute fluid collections into "acute peripancreatic fluid collection" and "acute post-necrotic pancreatic/peripancreatic fluid collection (acute necrotic collection)" based on the presence of necrotic debris. Delayed fluid collections have been similarly subdivided into "pseudocyst" and "walled of pancreatic necrosis". Appropriate use of the new terms describing the fluid collections is important for management decision-making in patients with acute pancreatitis. The purpose of this review article is to present an overview of complications of the acute pancreatitis with emphasis on their prognostic significance and impact on clinical management and to clarify confusing terminology for pancreatic fluid collections.
Topics: Acute Disease; Humans; Magnetic Resonance Imaging; Pancreatitis; Pancreatitis, Acute Necrotizing; Tomography, X-Ray Computed
PubMed: 24703377
DOI: 10.1016/j.diii.2013.12.018 -
Prague Medical Report 2020The incidence and prevalence of acute pancreatitis (AP) is increasing over time. The diagnosis of acute pancreatitis is established by revised Atlanta criteria (2012).... (Review)
Review
The incidence and prevalence of acute pancreatitis (AP) is increasing over time. The diagnosis of acute pancreatitis is established by revised Atlanta criteria (2012). Multiple criteria and scoring systems have been used for assessment of severity of AP. Majority of acute pancreatitis cases (80%) are mild, the challenge remains in early diagnosis, severity assessment and treatment of severe AP and its complications. Assessment of severity of AP is important part of management because line of treatment depends on aetiology and severity of acute pancreatitis. In this article a comprehensive review of recent advances in diagnosis and severity assessment of acute pancreatitis has been described.
Topics: Acute Disease; Humans; Incidence; Pancreatitis; Severity of Illness Index
PubMed: 32553091
DOI: 10.14712/23362936.2020.6 -
World Journal of Gastroenterology Dec 2014To determine the prevalence and time course of pancreatic exocrine insufficiency in individuals with newly diagnosed prediabetes or diabetes mellitus after acute... (Meta-Analysis)
Meta-Analysis Review
AIM
To determine the prevalence and time course of pancreatic exocrine insufficiency in individuals with newly diagnosed prediabetes or diabetes mellitus after acute pancreatitis.
METHODS
Relevant literature cited in three major biomedical journal databases (EMBASE, MEDLINE, and Scopus) was reviewed independently by two authors. There were no language constraints but the search was limited to human studies. Studies included were cohort studies of adult patients who were discharged after an attack of acute pancreatitis. Patients were excluded if they were under 18 years of age or had a previous diagnosis of prediabetes or diabetes mellitus, pancreatic exocrine insufficiency, or chronic pancreatitis. The main outcome measure was the prevalence of concomitant pancreatic exocrine insufficiency in patients who were diagnosed with prediabetes and diabetes mellitus after an attack of acute pancreatitis. Subgroup analysis was conducted for patients who were diagnosed with prediabetes only and those who were diagnosed with diabetes mellitus only. Subgroup analysis looking at the time course of concomitant pancreatic exocrine and endocrine insufficiency was also conducted. Pooled prevalence and corresponding 95% confidence intervals were calculated for all outcome measures and P-values < 0.05 were deemed statistically significant.
RESULTS
Eight clinical studies comprising of 234 patients met all eligibility criteria. The pooled prevalence of newly diagnosed prediabetes or diabetes in individuals after acute pancreatitis was 43% (95%CI: 30%-56%). The pooled prevalence of pancreatic exocrine insufficiency in individuals after acute pancreatitis was 29% (95%CI: 19%-39%). The prevalence of concomitant pancreatic exocrine insufficiency in individuals with newly diagnosed prediabetes or diabetes was 40% (95%CI: 25%-55%). The prevalence of concomitant pancreatic exocrine insufficiency among individuals with prediabetes alone and diabetes mellitus alone was 41% (95%CI: 12%-75%) and 39% (95%CI: 28%-51%), respectively. Further analysis showed that the prevalence of concomitant pancreatic exocrine insufficiency in individuals with prediabetes or diabetes decreases over time after an attack of acute pancreatitis.
CONCLUSION
Pancreatic exocrine insufficiency occurs in 40% of individuals with newly diagnosed prediabetes or diabetes mellitus after acute pancreatitis. Further studies are needed to investigate the pathogenesis of diabetes in this setting.
Topics: Acute Disease; Animals; Exocrine Pancreatic Insufficiency; Humans; Islets of Langerhans; Pancreas, Exocrine; Pancreatitis; Prediabetic State; Prevalence; Time Factors
PubMed: 25493036
DOI: 10.3748/wjg.v20.i45.17196 -
Revista de Gastroenterologia de Mexico... 2023Acute pancreatitis (AP) and recurrent acute pancreatitis (RAP) are conditions, whose incidence is apparently on the rise. Despite the ever-increasing evidence regarding...
Acute pancreatitis (AP) and recurrent acute pancreatitis (RAP) are conditions, whose incidence is apparently on the rise. Despite the ever-increasing evidence regarding the management of AP in children and adults, therapeutic actions that could potentially affect having a poor prognosis in those patients, especially in the pediatric population, continue to be carried out. Therefore, the Asociación Mexicana de Gastroenterología convened a group of 24 expert pediatric gastroenterologists from different institutions and areas of Mexico, as well as 2 pediatric nutritionists and 2 specialists in pediatric surgery, to discuss different aspects of the epidemiology, diagnosis, and treatment of AP and RAP in the pediatric population. The aim of this document is to present the consensus results. Different AP topics were addressed by 6 working groups, each of which reviewed the information and formulated statements considered pertinent for each module, on themes involving recommendations and points of debate, concerning diagnostic or therapeutic approaches. All the statements were presented and discussed. They were then evaluated through a Delphi process, with electronic and anonymous voting, to determine the level of agreement on the statements. A total of 29 statements were formulated, all of which reached above 75% agreement in the first round of voting.
Topics: Adult; Humans; Child; Adolescent; Pancreatitis; Consensus; Acute Disease; Mexico
PubMed: 37336694
DOI: 10.1016/j.rgmxen.2023.04.011 -
Biochimica Et Biophysica Acta.... Jul 2021Acute pancreatitis (AP) is one of the most common gastroenterological disorders requiring hospitalization and is associated with substantial morbidity and mortality.... (Review)
Review
Acute pancreatitis (AP) is one of the most common gastroenterological disorders requiring hospitalization and is associated with substantial morbidity and mortality. Metabolomics nowadays not only help us to understand cellular metabolism to a degree that was not previously obtainable, but also to reveal the importance of the metabolites in physiological control, disease onset and development. An in-depth understanding of metabolic phenotyping would be therefore crucial for accurate diagnosis, prognosis and precise treatment of AP. In this review, we summarized and addressed the metabolomics design and workflow in AP studies, as well as the results and analysis of the in-depth of research. Based on the metabolic profiling work in both clinical populations and experimental AP models, we described the metabolites with potential utility as biomarkers and the correlation between the altered metabolites and AP status. Moreover, the disturbed metabolic pathways correlated with biological function were discussed in the end. A practical understanding of current and emerging metabolomic approaches applicable to AP and use of the metabolite information presented will aid in designing robust metabolomics and biological experiments that result in identification of unique biomarkers and mechanisms, and ultimately enhanced clinical decision-making.
Topics: Animals; Biomarkers; Disease Models, Animal; Humans; Metabolome; Pancreatitis
PubMed: 33713791
DOI: 10.1016/j.bbadis.2021.166123 -
Canadian Association of Radiologists... Aug 2015Autoimmune pancreatitis (AIP) accounts for approximately 5% of chronic pancreatitis cases and is an important consideration in the differential diagnosis of pancreatic... (Review)
Review
Autoimmune pancreatitis (AIP) accounts for approximately 5% of chronic pancreatitis cases and is an important consideration in the differential diagnosis of pancreatic pathologies. The underlying pathophysiology of AIP is thought to involve lymphocyte infiltration and associated sclerosis. Although AIP is a benign condition that is treatable with corticosteroids, it can have imaging and clinical findings indistinguishable from pancreatic cancer. As such, the radiologist plays an important management role in distinguishing AIP from more sinister conditions. In addition, there are several extrapancreatic imaging findings in the context of AIP that have been recently described. This pictorial review outlines both the pancreatic and extrapancreatic imaging features in AIP and the response to steroid therapy. Important imaging features that allow AIP to be differentiated from other pancreatic pathology, including adenocarcinoma, lymphoma, and acute pancreatitis will be discussed.
Topics: Autoimmune Diseases; Diagnosis, Differential; Diagnostic Imaging; Humans; Pancreatitis
PubMed: 25958813
DOI: 10.1016/j.carj.2014.10.001 -
Journal of the Formosan Medical... Sep 2020The incidence of acute pancreatitis and related health care utilization are increasing. Acute pancreatitis may result in organ failure and various local complications...
The incidence of acute pancreatitis and related health care utilization are increasing. Acute pancreatitis may result in organ failure and various local complications with risks of morbidity and even mortality. Recent advances in research have provided novel insights into the assessment and management for acute pancreatitis. This consensus is developed by Taiwan Pancreas Society to provide an updated, evidence-based framework for managing acute pancreatitis.
Topics: Acute Disease; Consensus; Humans; Pancreatitis; Taiwan
PubMed: 31395463
DOI: 10.1016/j.jfma.2019.07.019 -
World Journal of Gastroenterology Nov 2022In this editorial we comment on the article published in the recent issue of the [2022; 28 (19): 2123-2136]. We pay attention to how to construct a simpler and more...
In this editorial we comment on the article published in the recent issue of the [2022; 28 (19): 2123-2136]. We pay attention to how to construct a simpler and more reliable new clinical predictive model to early identify patients at high risk of acute respiratory distress syndrome (ARDS) associated with severe acute pancreatitis (SAP), and to early predict the severity of organ failure from chest computed tomography (CT) findings in SAP patients. As we all know, SAP has a sudden onset, is a rapidly changing condition, and can be complicated with ARDS and even multiple organ dysfunction syndrome, and its mortality rate has remained high. At present, there are many clinical scoring systems for AP, including the bedside index for severity in AP, acute physiology and chronic health evaluation II, systemic inflammatory response syndrome, Japanese severe score, quick sepsis-related organ failure assessment, However, some of these scoring systems are complex and require multiple and difficult clinical parameters for risk stratification. Although the aforementioned biomarkers are readily available, their ability to predict ARDS varies. Accor-dingly, it is extremely necessary to establish a simple and valuable novel model to predict the development of ARDS in AP. In addition, the extra-pancreatic manifestations of AP patients often involve the chest, among which pleural effusion and pulmonary consolidation are the more common complications. Therefore, by measuring the semi-quantitative indexes of chest CT in AP patients, such as the amount of pleural effusion and the number of lobes involved as pulmonary consolidation, it has important reference value for the early diagnosis of SAP complicated with ARDS and is expected to provide a basis for the early treatment of ARDS.
Topics: Humans; Pancreatitis; Acute Disease; Pancreatic Diseases; Respiratory Distress Syndrome; Tomography, X-Ray Computed; Pleural Effusion
PubMed: 36504558
DOI: 10.3748/wjg.v28.i44.6206 -
Digestive Diseases and Sciences Apr 2022Early identification of patients with acute severe pancreatitis is important for prompt and adequate treatment. Existing scores for pancreatitis are often laborious or...
BACKGROUND
Early identification of patients with acute severe pancreatitis is important for prompt and adequate treatment. Existing scores for pancreatitis are often laborious or require serial patient evaluation, whereas the qSOFA score, that was established to predict outcome in patients with suspected infection, is simple to perform.
AIMS AND METHODS
In this cohort study, we analyse the potential of the qSOFA score to predict outcome of patients with acute pancreatitis and refine the qSOFA score by rapid available laboratory parameters to the emergency room assessment of acute pancreatitis (ERAP) score. Validation was performed in a separate patient cohort.
RESULTS
In total 203 patients with acute pancreatitis were recruited. The qSOFA score has the potential to predict ICU admission (AUC = 0.730, p = 0.002) and organ failure (AUC = 0.799, p = 0.013) in acute pancreatitis. Respiratory rate, mental status, blood urea nitrogen and C-reactive protein are the rapid available parameters with the highest individual impact in binary logistic regression analyses. Their combination to the ERAP score can predict severity of acute pancreatitis according to the revised Atlanta classification (AUC = 0.689 ± 0.041, p < 0.001), ICU admission (AUC = 0.789 ± 0.067, p < 0.001), multi-organ dysfunction syndrome (AUC = 0.963 ± 0.024, p < 0.001) and mortality (AUC = 0.952 ± 0.028, p = 0.001). The performance and prognostic validity for organ failure and mortality were validated in an independent patient cohort.
CONCLUSION
The qSOFA is a rapidly available prognostic score in acute pancreatitis with limited prognostic validity. A combination with the laboratory parameters BUN and CRP results in the new ERAP score with outstanding prognostic validity for multi-organ dysfunction syndrome and mortality.
Topics: Acute Disease; Cohort Studies; Emergency Service, Hospital; Hospital Mortality; Humans; Intensive Care Units; Organ Dysfunction Scores; Pancreatitis; Prognosis; ROC Curve; Retrospective Studies; Sepsis
PubMed: 33770328
DOI: 10.1007/s10620-021-06945-z