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Current Problems in Pediatric and... Aug 2020Acute pancreatitis (AP), manifesting as acute onset of abdominal pain, vomiting, and nausea, is increasingly being recognized in children secondary to increased... (Review)
Review
Acute pancreatitis (AP), manifesting as acute onset of abdominal pain, vomiting, and nausea, is increasingly being recognized in children secondary to increased awareness, more identifiable etiologies as well as advances in diagnostic capabilities, like imaging. Despite this increased awareness and ability for more frequent diagnoses, the natural history of AP remains poorly understood leading to gaps in approach and management, especially in children. Coupled with poor epidemiologic and management awareness, there remains a lack of understanding of the long term implications of severe acute pancreatitis (SAP). Hence, the role of the primary care clinician in the early diagnosis, and management, remains critical and may affect the need for consultation with pediatric sub-specialists like gastroenterologists. This review provides guidelines regarding epidemiology, diagnosis, and management strategies to address some of these gaps.
Topics: Diet; Fluid Therapy; Humans; Pain Management; Pancreatitis; Pediatrics; Primary Health Care; Severity of Illness Index
PubMed: 32859510
DOI: 10.1016/j.cppeds.2020.100839 -
Biomolecules Dec 2022Acute pancreatitis (AP) is an acute inflammatory disease of the exocrine pancreas. The pathogenesis of AP is still unclear, and there is currently no specific treatment....
Acute pancreatitis (AP) is an acute inflammatory disease of the exocrine pancreas. The pathogenesis of AP is still unclear, and there is currently no specific treatment. A variety of immune cells infiltrate in AP, which may play an important role in the progression of the disease. In this study, for the first time, scRNA-Seq and Bulk RNA-Seq data were used to show the characteristics of immune cell infiltration in AP, and to explore the specific molecular markers of different cell types. The present study also investigated cell-to-cell communication networks using the CellChat package, and AP-specific gene signatures (Clic1, Sat1, Serpina3n, Atf3, Lcn2, Osmr, Ccl9, Hspb1, Anxa2, Krt8, Cd44, Cd9, Hsp90aa1, Tmsb10, Hmox1, Fxyd5, Plin2, Pnp) were identified through integrative analysis of multiple sequencing datasets. We also defined disease-specific associated genes in different cell types, revealing dynamic changes through cell trajectory and pseudo-time analysis using the Monocle2 package. The results showed that macrophages were significantly increased in acute pancreatitis, and the number of interactions and interaction weight/strength of the macrophages in AP were significantly higher than those in the controls. The activities of various signaling pathways were abnormally regulated such as apoptosis, oxidative stress, lysosome, autophagy, ferroptosis, and inflammatory responses signaling pathways. In conclusion, this study comprehensively depicted the immune microenvironment of AP, explored the interaction network between different cell types, and defined AP-specific gene signatures, providing many new directions for basic research in AP.
Topics: Humans; Pancreatitis; RNA-Seq; Acute Disease; Single-Cell Gene Expression Analysis; Oxidative Stress; Chloride Channels
PubMed: 36671463
DOI: 10.3390/biom13010078 -
Expert Review of Gastroenterology &... Nov 2019: Pancreas divisum is the most common congenital malformation of the pancreas with the majority asymptomatic. The etiological role, pathogenesis, clinical significance... (Review)
Review
: Pancreas divisum is the most common congenital malformation of the pancreas with the majority asymptomatic. The etiological role, pathogenesis, clinical significance and management of pancreas divisum in pancreatic disease has not been clearly defined and our understanding is yet to be fully elucidated.: This review describes the role of pancreas divisum in the development of pancreatic disease and the ambiguity related to it. In our attempt to offer clarity, a comprehensive search on PubMed, Ovid, Embase and Cochrane Library from inception to May 2019 was undertaken using key words "pancreas divisum", "idiopathic recurrent acute pancreatitis" and "chronic pancreatitis".: Current research fails to define a clear association between pancreas divisum and pancreatic disease. Though debatable, several studies do suggest a pathological role of pancreas divisum in pancreatic disease and a benefit of minor papilla therapy in the setting of acute recurrent pancreatitis. Surgical and endoscopic therapeutic modalities have not been directly compared. With the current data available, it would be imprudent to advise a definitive line of management for pancreatic disease associated with pancreas divisum and should involve a comprehensive discussion with the individual patient to define expectations before embarking on any medical and/or interventional therapy.
Topics: Digestive System Abnormalities; Humans; Pancreas; Pancreatitis; Pancreatitis, Chronic; Predictive Value of Tests; Prognosis; Recurrence; Risk Assessment; Risk Factors
PubMed: 31663403
DOI: 10.1080/17474124.2019.1685871 -
The Veterinary Clinics of North... Jan 2023Acute pancreatitis is one of the most common diseases in dogs and cats, but diagnosis is challenging. The gold standard for diagnosis of pancreatitis is pancreatic... (Review)
Review
Acute pancreatitis is one of the most common diseases in dogs and cats, but diagnosis is challenging. The gold standard for diagnosis of pancreatitis is pancreatic biopsy, which has many limitations. As such, clinical diagnosis of pancreatitis based on a consistent clinical picture (eg, signalment, clinical signs, physical examination findings), supportive laboratory screening diagnostics, pancreatitis-specific laboratory testing, consistent imaging findings, and thorough diagnostic evaluation ruling out alternate differential diagnoses is most often used in clinical patients. Alternate differential diagnoses in patients presenting with clinical findings that might be consistent with pancreatitis may have secondary reactive pancreatitis, which mimics primary pancreatitis.
Topics: Cats; Dogs; Animals; Pancreatitis; Cat Diseases; Acute Disease; Dog Diseases; Clinical Laboratory Techniques
PubMed: 36400472
DOI: 10.1016/j.cvsm.2022.07.015 -
Abdominal Radiology (New York) May 2020Acute pancreatitis (AP) is the most common gastrointestinal disease resulting in hospitalization in the United States with reports of over 270,000 hospitalizations and... (Review)
Review
Acute pancreatitis (AP) is the most common gastrointestinal disease resulting in hospitalization in the United States with reports of over 270,000 hospitalizations and costs up to 2.6 billion dollars per year. AP is highly variable in disease course and outcome. Established in 1992, the original Atlanta classification system aimed to categorize the wide spectrum of AP by creating consensus-based terminology for AP types, severity, and complications. Though the original system standardized terminology, certain terms and definitions (i.e. pancreatic abscess) were unclear and often misused. The 2012 revised Atlanta classification (RAC) system updated terms, clarified definitions, and incorporated the medical community's improved understanding of the physiology of AP. The resulting RAC effectively defined the morphologic types of pancreatitis, provided a more standardized system for disease severity grading, further classified the local retroperitoneal complications, and established objective measures to describe this highly variable but common disease. This review provides an update on the recent literature evaluating the RAC, discusses both the strengths and shortcomings of the RAC system (including problematic interobserver agreement), and considers improvements for future classification systems.
Topics: Humans; Pancreatitis; Severity of Illness Index; Terminology as Topic; United States
PubMed: 31494708
DOI: 10.1007/s00261-019-02214-w -
Jornal de Pediatria 2019To describe the epidemiology and clinical features of acute pancreatitis and recurrent acute pancreatitis in children.
OBJECTIVE
To describe the epidemiology and clinical features of acute pancreatitis and recurrent acute pancreatitis in children.
METHODS
Observational and retrospective study with an analytical component. Patients were classified into two groups: Acute pancreatitis and recurrent pancreatitis. The relationship with each parameter obtained was analyzed using the chi-squared test, Student's t-test, or the Mann-Whitney U test.
RESULTS
There were 130 patients with acute pancreatitis; recurrent pancreatitis was diagnosed in 23.8% of the cases. The most frequent causes were anatomical (29.6%), pharmacological (19.2%), and biliary (14.6%), although in 29.2% etiology was not identified. Fasting lasted 3.5±3.8 days and parenteral nutrition was indicated in 26.9% of the cases for 10.8±11.3 days. A statistical association with anatomical (p=0.02) and pharmacological causes (p=0.01) was found in the recurrent pancreatitis group; no other differences between acute pancreatitis and recurrent pancreatitis groups were observed. The mortality rate was 3.1%, it was not attributable to acute pancreatitis in any cases.
CONCLUSION
Acute pancreatitis is associated with a high frequency of acute recurrent pancreatitis. Severity and complications did not show statistically significant differences in this investigation. Anatomical etiologies were the most relevant cause in this cohort. Fasting time and parenteral nutrition use were relevant. Genetics testing is required in this population.
Topics: Acute Disease; Child; Child, Preschool; Colombia; Comorbidity; Cross-Sectional Studies; Fasting; Female; Humans; Male; Pancreatitis; Parenteral Nutrition; Recurrence; Retrospective Studies
PubMed: 30075118
DOI: 10.1016/j.jped.2018.06.011 -
The New England Journal of Medicine Sep 2022
Topics: Acute Disease; Fluid Therapy; Humans; Pancreatitis; Pancreatitis, Acute Necrotizing
PubMed: 36103418
DOI: 10.1056/NEJMe2209132 -
Frontiers in Immunology 2022Severe acute pancreatitis (SAP), one of the most serious abdominal emergencies in general surgery, is characterized by acute and rapid onset as well as high mortality,... (Review)
Review
Severe acute pancreatitis (SAP), one of the most serious abdominal emergencies in general surgery, is characterized by acute and rapid onset as well as high mortality, which often leads to multiple organ failure (MOF). Acute lung injury (ALI), the earliest accompanied organ dysfunction, is the most common cause of death in patients following the SAP onset. The exact pathogenesis of ALI during SAP, however, remains unclear. In recent years, advances in the microbiota-gut-lung axis have led to a better understanding of SAP-associated lung injury (PALI). In addition, the bidirectional communications between intestinal microbes and the lung are becoming more apparent. This paper aims to review the mechanisms of an imbalanced intestinal microbiota contributing to the development of PALI, which is mediated by the disruption of physical, chemical, and immune barriers in the intestine, promotes bacterial translocation, and results in the activation of abnormal immune responses in severe pancreatitis. The pathogen-associated molecular patterns (PAMPs) mediated immunol mechanisms in the occurrence of PALI binding with pattern recognition receptors (PRRs) through the microbiota-gut-lung axis are focused in this study. Moreover, the potential therapeutic strategies for alleviating PALI by regulating the composition or the function of the intestinal microbiota are discussed in this review. The aim of this study is to provide new ideas and therapeutic tools for PALI patients.
Topics: Acute Disease; Acute Lung Injury; Bacterial Translocation; Gastrointestinal Microbiome; Humans; Pancreatitis
PubMed: 35774796
DOI: 10.3389/fimmu.2022.913178 -
Clinical and Translational... Aug 2023Drug induced acute pancreatitis is a difficult diagnosis for clinicians. We previously published an "Evidence-Based Classification System" on Drug-Induced Acute...
INTRODUCTION
Drug induced acute pancreatitis is a difficult diagnosis for clinicians. We previously published an "Evidence-Based Classification System" on Drug-Induced Acute Pancreatitis widely used by clinicians to assist in the identification of drugs. Unfortunately, this prior analysis based only on published case reports has been misunderstood. The prior review did not include studies with higher evidentiary value, such as randomized trials, case-control studies, and/or pharmacoepidemiologic studies. The use of the prior classification system has led to many patients being inappropriately labeled as having drug-induced acute pancreatitis. We now propose a "Revised" Evidence- Based Classification System for the purpose of determining which drugs cause acute pancreatitis based on the Grading of Recommendations, Development, and Evaluation criteria.
METHODS
A search of the English Language literature was performed to identify all case reports with medication and/or drug induced acute pancreatitis. We divided the drugs implicated as causing acute pancreatitis into four groups based on the quality of evidence as defined by GRADE quality parameters.
RESULTS
Although 141 drugs were identified in the literature as causing acute pancreatitis, only 106 drugs published in the literature as causing acute pancreatitis were high quality case reports. Only 3 drugs had evidence as causing acute pancreatitis from randomized controlled clinical trials, including 6-mercaptopurine and azathioprine.
DISCUSSION
The vast majority of drugs implicated as causing acute pancreatitis in the literature have low or very low quality of evidence supporting those claims.
Topics: Humans; Pancreatitis; Acute Disease; Case-Control Studies
PubMed: 37440319
DOI: 10.14309/ctg.0000000000000621 -
World Journal of Gastroenterology May 2020Acute pancreatitis (AP) is a common gastrointestinal disorder. Approximately 15%-20% of patients develop severe AP. Systemic inflammatory response syndrome and multiple... (Review)
Review
Acute pancreatitis (AP) is a common gastrointestinal disorder. Approximately 15%-20% of patients develop severe AP. Systemic inflammatory response syndrome and multiple organ dysfunction syndrome may be caused by the massive release of inflammatory cytokines in the early stage of severe AP, followed by intestinal dysfunction and pancreatic necrosis in the later stage. A study showed that 59% of AP patients had associated intestinal barrier injury, with increased intestinal mucosal permeability, leading to intestinal bacterial translocation, pancreatic tissue necrosis and infection, and the occurrence of multiple organ dysfunction syndrome. However, the real effect of the gut microbiota and its metabolites on intestinal barrier function in AP remains unclear. This review summarizes the alterations in the intestinal flora and its metabolites during AP development and progression to unveil the mechanism of gut failure in AP.
Topics: Disease Progression; Gastrointestinal Microbiome; Humans; Intestinal Mucosa; Pancreatitis; Permeability; Severity of Illness Index
PubMed: 32476785
DOI: 10.3748/wjg.v26.i18.2187