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Minerva Gastroenterologica E Dietologica Sep 2020Hypertriglyceridemic acute pancreatitis is an emerging issue in gastroenterology, frequently underdiagnosed in clinical practice. Despite the rarity of the disease,... (Review)
Review
Hypertriglyceridemic acute pancreatitis is an emerging issue in gastroenterology, frequently underdiagnosed in clinical practice. Despite the rarity of the disease, hypertriglyceridemia should be considered as a leading cause of acute pancreatitis, especially in defined subsets of patients. Primary and secondary forms of hypertriglyceridemia need to be considered and excluded during the diagnostic work-up of all patients with acute pancreatitis. An accurate diagnosis is crucial to establish an appropriate treatment and to reduce the risk of recurrences. The aim of the present article is to briefly review epidemiology, etiology, diagnosis and therapy of hypertriglyceridemic acute pancreatitis, based on a clinical and practical point of view.
Topics: Acute Disease; Humans; Hypertriglyceridemia; Pancreatitis; Prognosis; Recurrence
PubMed: 32724030
DOI: 10.23736/S1121-421X.19.02641-2 -
American Journal of Therapeutics Jul 2022We report a case of acute pancreatitis that developed after four days of remdesivir therapy in a patient being treated for COVID-19. Despite improvement in patient's...
We report a case of acute pancreatitis that developed after four days of remdesivir therapy in a patient being treated for COVID-19. Despite improvement in patient's respiratory status, abdominal pain worsened and clinical signs and symptoms progressed to a diagnosis of acute pancreatitis 4 days after initiation of remdesivir therapy. Withdrawal of remdesivir paired with medical management of acute pancreatitis led to the resolution of pancreatitis within three days. To our knowledge, this is the first case report depicting remdesivir as a possible cause of acute pancreatitis.
Topics: Acute Disease; Adenosine Monophosphate; Alanine; Humans; Pancreatitis; COVID-19 Drug Treatment
PubMed: 33590992
DOI: 10.1097/MJT.0000000000001266 -
PloS One 2020A current assessment of case reports of possible drug-induced pancreatitis is needed. We systematically reviewed the case report literature to identify drugs with...
OBJECTIVE
A current assessment of case reports of possible drug-induced pancreatitis is needed. We systematically reviewed the case report literature to identify drugs with potential associations with acute pancreatitis and the burden of evidence supporting these associations.
METHODS
A protocol was developed a priori (PROSPERO CRD42017060473). We searched MEDLINE, Embase, the Cochrane Library, and additional sources to identify cases of drug-induced pancreatitis that met accepted diagnostic criteria of acute pancreatitis. Cases caused by multiple drugs or combination therapy were excluded. Established systematic review methods were used for screening and data extraction. A classification system for associated drugs was developed a priori based upon the number of cases, re-challenge, exclusion of non-drug causes of acute pancreatitis, and consistency of latency.
RESULTS
Seven-hundred and thirteen cases of potential drug-induced pancreatitis were identified, implicating 213 unique drugs. The evidence base was poor: exclusion of non-drug causes of acute pancreatitis was incomplete or poorly reported in all cases, 47% had at least one underlying condition predisposing to acute pancreatitis, and causality assessment was not conducted in 81%. Forty-five drugs (21%) were classified as having the highest level of evidence regarding their association with acute pancreatitis; causality was deemed to be probable or definite for 19 of these drugs (42%). Fifty-seven drugs (27%) had the lowest level of evidence regarding an association with acute pancreatitis, being implicated in single case reports, without exclusion of other causes of acute pancreatitis.
DISCUSSION
Much of the case report evidence upon which drug-induced pancreatitis associations are based is tenuous. A greater emphasis on exclusion of all non-drug causes of acute pancreatitis and on quality reporting would improve the evidence base. It should be recognized that reviews of case reports, are valuable scoping tools but have limited strength to establish drug-induced pancreatitis associations.
REGISTRATION
CRD42017060473.
Topics: Acute Disease; Databases, Factual; Drug-Related Side Effects and Adverse Reactions; Humans; Pancreatitis; Pharmaceutical Preparations
PubMed: 32302358
DOI: 10.1371/journal.pone.0231883 -
Renal Failure Dec 2023Acute pancreatitis (AP) is associated with a high incidence of acute kidney injury (AKI). This study aimed to develop a nomogram for predicting the early onset of AKI in... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Acute pancreatitis (AP) is associated with a high incidence of acute kidney injury (AKI). This study aimed to develop a nomogram for predicting the early onset of AKI in AP patients admitted to the intensive care unit.
METHOD
Clinical data for 799 patients diagnosed with AP were extracted from the Medical Information Mart for Intensive Care IV database. Eligible AP patients were randomly divided into training and validation cohorts. The independent prognostic factors for the early development of AKI in AP patients were determined using the all-subsets regression method and multivariate logistic regression. A nomogram was constructed for predicting the early occurrence of AKI in AP patients. The performance of the nomogram was evaluated based on the area under the receiver operating characteristic curve (AUC), calibration curves and decision curve analysis (DCA).
RESULTS
Seven independent prognostic factors were identified as predictive factors for early onset AKI in AP patients. The AUC of the nomogram in the training and validation cohorts were 0.795 (95% CI, 0.758-0.832) and 0.772 (95% CI, 0.711-0.832), respectively. The AUC of the nomogram was higher compared with that of the BISAP, Ranson, APACHE II scores. Further, the calibration curve revealed that the predicted outcome was in agreement with the actual observations. Finally, the DCA curves showed that the nomogram had a good clinical applicability value.
CONCLUSION
The constructed nomogram showed a good predictive ability for the early occurrence of AKI in AP patients.
Topics: Humans; Acute Kidney Injury; Databases, Factual; Pancreatitis; Retrospective Studies; Models, Statistical
PubMed: 36999227
DOI: 10.1080/0886022X.2023.2194436 -
Journal of Pediatric Gastroenterology... Feb 2023
Topics: Humans; Pancreatitis; Acute Disease
PubMed: 36705693
DOI: 10.1097/MPG.0000000000003669 -
Praxis Jun 2023CME: Hypertriglyceridemia The European Society of Cardiology defines hypertriglyceridaemia as fasting triglycerides >1,7mmol/l. Most patients are asymptomatic....
CME: Hypertriglyceridemia The European Society of Cardiology defines hypertriglyceridaemia as fasting triglycerides >1,7mmol/l. Most patients are asymptomatic. Hypertriglyceridaemia is associated with an elevated risk of cardiovascular diseases and acute pancreatitis. Therapy consists mainly of lifestyle modifications, drug therapy plays a minor role.
Topics: Humans; Pancreatitis; Acute Disease; Hypertriglyceridemia; Triglycerides; Cardiovascular Diseases
PubMed: 37282527
DOI: 10.1024/1661-8157/a004060 -
Surgery Apr 2021
Topics: Acute Disease; Disease Management; Disease Susceptibility; Humans; Pancreatitis; Postoperative Complications
PubMed: 33293030
DOI: 10.1016/j.surg.2020.10.020 -
Ugeskrift For Laeger Feb 2020Hereditary pancreatitis (HP) is an autosomal dominant disease with 80% penetrance. HP is characterised by the debut of recurrent acute pancreatitis episodes during... (Review)
Review
Hereditary pancreatitis (HP) is an autosomal dominant disease with 80% penetrance. HP is characterised by the debut of recurrent acute pancreatitis episodes during childhood with gradual progression to chronic pancreatitis. Patients with phenotypic HP have a significantly increased lifetime risk of developing pancreatic ductal adenocarcinoma (PDAC). Patients with HP represent a rare but important group of high-risk individuals in need of early diagnosis and screening for potential PDAC. The aim of this review is to provide an overview of the epidemiology, genetics and clinical aspects of HP.
Topics: Acute Disease; Genetic Predisposition to Disease; Humans; Mutation; Pancreatic Neoplasms; Pancreatitis; Pancreatitis, Chronic
PubMed: 32138812
DOI: No ID Found -
Pancreas Feb 2021Hypercalcemia of malignancy confers a poor prognosis. This systematic review evaluated published cases of hypercalcemia of malignancy presenting with acute pancreatitis...
OBJECTIVES
Hypercalcemia of malignancy confers a poor prognosis. This systematic review evaluated published cases of hypercalcemia of malignancy presenting with acute pancreatitis (AP), in terms of clinical presentation and outcomes.
METHODS
A comprehensive review of PubMed and Embase until March 18, 2020, was conducted. Studies were included if they reported on patients with hypercalcemia of malignancy and AP with attempts to exclude other etiologies of hypercalcemia and AP. Two independent reviewers selected and appraised studies using the Murad tool.
RESULTS
Thirty-seven cases were identified. Mean (standard deviation) age was 44.8 (2.46) years. Mean (standard deviation) presenting corrected calcium was 14.5 (0.46) mg/dL. Parathyroid carcinoma (21.6%) and multiple myeloma (21.6%) were the most common malignancies. Cases were classified as severe (37.8%), mild (21.6%), and moderately severe (18.9%), whereas 21.6% did not report severity. Necrotizing pancreatitis developed in 21.6% of cases. Most cases were treated with intravenous hydration and bisphosphonates or calcitonin/calcitonin analogues. Mortality was 32.4% during the same presentation of AP. Among mortality cases, 10 of 12 had severe AP, and 5 of 12 had necrotizing pancreatitis. Degree of hypercalcemia did not influence mortality.
CONCLUSION
Acute pancreatitis associated with hypercalcemia of malignancy is rare. One in 3 patients with this presentation may not survive AP.
Topics: Adult; Aged; Calcitonin; Calcium-Regulating Hormones and Agents; Diphosphonates; Female; Fluid Therapy; Humans; Hypercalcemia; Male; Middle Aged; Neoplasms; Pancreatitis; Pancreatitis, Acute Necrotizing; Risk Assessment; Risk Factors; Treatment Outcome; Young Adult
PubMed: 33565797
DOI: 10.1097/MPA.0000000000001741 -
Current Opinion in Clinical Nutrition... Sep 2021This review aims to discuss recent developments in different topics regarding nutrition and acute pancreatitis (AP), including oral refeeding, nutritional therapy, and... (Review)
Review
PURPOSE OF REVIEW
This review aims to discuss recent developments in different topics regarding nutrition and acute pancreatitis (AP), including oral refeeding, nutritional therapy, and implications of gut microbiota.
RECENT FINDINGS
Obesity increases the risk for severe AP and mortality. Considering the worldwide obesity rates, this finding could have major implications in the global outcomes of patients admitted with AP. Recent research confirms that early oral feeding leads to shorter length of stay, fewer complications, and lower costs. In case of intolerance to oral feeding or severe disease, nutritional therapy should be offered within 24-72 h, whereas enteral nutrition (EN) has been shown superior to parenteral nutrition. EN can be administered through gastric or jejunal feeding, depending on digestive tolerance and the presence of ileus. Nevertheless, modalities of EN in patients undergoing endoscopic drainage of pancreatitis-related collections are still undetermined. Weight-loss after discharge occurs frequently and could reflect post-AP pancreatic exocrine failure. Finally, novel research regarding gut microbiota could open new therapeutic opportunities to prevent bacterial translocation and pancreatic necrosis' infection.
SUMMARY
Despite available evidence many questions regarding nutritional management in patients with AP remain open. Modulation of gut microbiota could play an important role in further therapeutic management.
Topics: Acute Disease; Enteral Nutrition; Humans; Pancreatitis; Parenteral Nutrition; Parenteral Nutrition, Total
PubMed: 34127607
DOI: 10.1097/MCO.0000000000000776