-
Pancreatology : Official Journal of the... 2014The role of obesity in relation to various disease processes is being increasingly studied, with reports over the last several years increasingly mentioning its... (Review)
Review
The role of obesity in relation to various disease processes is being increasingly studied, with reports over the last several years increasingly mentioning its association with worse outcomes in acute disease. Obesity has also gained recognition as a risk factor for severe acute pancreatitis (SAP).The mortality in SAP may be as high as 30% and is usually attributable to multi system organ failure (MSOF) earlier in the disease, and complications of necrotizing pancreatitis later [9-11]. To date there is no specific treatment for acute pancreatitis (AP) and the management is largely expectant and supportive. Obesity in general has also been associated with poor outcomes in sepsis and other pathological states including trauma and burns. With the role of unsaturated fatty acids (UFA) as propagators in SAP having recently come to light and with the recognition of acute lipotoxicity, there is now an opportunity to explore different strategies to reduce the mortality and morbidity in SAP and potentially other disease states associated with such a pathophysiology. In this review we will discuss the role of fat and implications of the consequent acute lipotoxicity on the outcomes of acute pancreatitis in lean and obese states and during acute on chronic pancreatitis.
Topics: Acute Disease; Humans; Intra-Abdominal Fat; Multiple Organ Failure; Obesity; Pancreas; Pancreatitis; Pancreatitis, Acute Necrotizing; Pancreatitis, Chronic; Severity of Illness Index
PubMed: 25278311
DOI: 10.1016/j.pan.2014.06.004 -
Clinical and Translational... Oct 2019Pancreatitis, a complex disease influenced by both genetic and environmental factors, often leads to metabolic sequelae (such as exocrine pancreatic dysfunction and...
Pancreatitis, a complex disease influenced by both genetic and environmental factors, often leads to metabolic sequelae (such as exocrine pancreatic dysfunction and new-onset diabetes). Several trillion micro-organisms inhabit the gastrointestinal tract, and this community plays an important role in the regulation of functions of not only the gut but also the pancreas. Studies to parse the underlying contributions of the gut microbiota to metabolic sequelae of pancreatitis will offer important translational insights with a view to preventing exocrine pancreatic dysfunction and new-onset diabetes after pancreatitis.
Topics: Diabetes Mellitus; Gastrointestinal Microbiome; Humans; Pancreas, Exocrine; Pancreatitis
PubMed: 31609744
DOI: 10.14309/ctg.0000000000000086 -
Gut and Liver Sep 2017In the past decade, there has been a progressive paradigm shift in the management of peri-pancreatic fluid collections after acute pancreatitis. Refinements in the... (Review)
Review
In the past decade, there has been a progressive paradigm shift in the management of peri-pancreatic fluid collections after acute pancreatitis. Refinements in the definitions of fluid collections from the updated Atlanta classification have enabled better communication amongst physicians in an effort to formulate optimal treatments. Endoscopic ultrasound (EUS)-guided drainage of pancreatic pseudocysts has emerged as the procedure of choice over surgical cystogastrostomy. The approach provides similar success rates with low complications and better quality of life compared with surgery. However, an endoscopic "step up" approach in the management of pancreatic walled-off necrosis has also been advocated. Both endoscopic and percutaneous drainage routes may be used depending on the anatomical location of the collections. New-generation large diameter EUS-specific stent systems have also recently been described. The device allows precise and effective drainage of the collections and permits endoscopic necrosectomy through the stents.
Topics: Acute Disease; Drainage; Endosonography; Gastrostomy; Humans; Necrosis; Pancreas; Pancreatic Pseudocyst; Pancreatitis; Stents
PubMed: 28494574
DOI: 10.5009/gnl16178 -
Frontiers in Cellular and Infection... 2023
Topics: Humans; Pancreatitis; Acute Disease; Pancreas; Infections
PubMed: 37026058
DOI: 10.3389/fcimb.2023.1175195 -
World Journal of Gastroenterology Apr 2010Walled-off pancreatic necrosis (WOPN), formerly known as pancreatic abscess is a late complication of acute pancreatitis. It can be lethal, even though it is rare. This... (Review)
Review
Walled-off pancreatic necrosis (WOPN), formerly known as pancreatic abscess is a late complication of acute pancreatitis. It can be lethal, even though it is rare. This critical review provides an overview of the continually expanding knowledge about WOPN, by review of current data from references identified in Medline and PubMed, to September 2009, using key words, such as WOPN, infected pseudocyst, severe pancreatitis, pancreatic abscess, acute necrotizing pancreatitis (ANP), pancreas, inflammation and alcoholism. WOPN comprises a later and local complication of ANP, occurring more than 4 wk after the initial attack, usually following development of pseudocysts and other pancreatic fluid collections. The mortality rate associated with WOPN is generally less than that of infected pancreatic necrosis. Surgical intervention had been the mainstay of treatment for infected peripancreatic fluid collection and abscesses for decades. Increasingly, percutaneous catheter drainage and endoscopic retrograde cholangiopancreatography have been used, and encouraging results have recently been reported in the medical literature, rendering these techniques invaluable in the treatment of WOPN. Applying the recommended therapeutic strategy, which comprises early treatment with antibiotics combined with restricted surgical intervention, fewer patients with ANP undergo surgery and interventions are ideally performed later in the course of the disease, when necrosis has become well demarcated.
Topics: Humans; Necrosis; Pancreas; Pancreatic Pseudocyst; Pancreatitis; Pancreatitis, Acute Necrotizing
PubMed: 20380001
DOI: 10.3748/wjg.v16.i14.1707 -
Journal of Veterinary Internal Medicine Jan 2019Acute pancreatitis in dogs is an under-diagnosed disease. Current diagnostic methods are insufficient at identifying sequelae and lack prognostic capability. Computed...
BACKGROUND
Acute pancreatitis in dogs is an under-diagnosed disease. Current diagnostic methods are insufficient at identifying sequelae and lack prognostic capability. Computed tomographic angiography (CTA) is accurate for diagnosis and prognostication of pancreatitis in humans.
OBJECTIVES
In comparison to ultrasound (US), CTA will (1) better diagnose more severe pancreatitis and sequelae and (2) provide assessment of patient outcome by identification of pancreatic contrast enhancement patterns.
ANIMALS
Twenty-six client-owned dogs suspected to have acute pancreatitis.
METHODS
US and CTA examinations performed at time of admission were compared to determine the detection of pancreatic changes and sequelae. CTA findings also were compared to outcome indicators for prognosis of dogs with acute pancreatitis. Specific canine pancreatic lipase (cPL) samples were obtained and compared with CTA findings.
RESULTS
Ten of 26 dogs had heterogeneous contrast enhancement of the pancreas. Compared to US, CTA better identified portal vein thrombosis (P = .003). Patients with heterogeneous contrast enhancement had longer hospitalization (P = .01), including hospital stays for >5 days (P = .02), had more relapses, and were more likely to have portal vein thrombosis (P = .002). Patients with heterogeneous contrast enhancement had increased spec cPL (P = .006).
CONCLUSIONS AND CLINICAL IMPORTANCE
In comparison to US, CTA better identified dogs with more severe acute pancreatitis and those with portal vein thrombosis, factors that may predict longer hospitalization and increased risk of relapse. The presence of heterogeneous contrast enhancement and portal vein thrombosis may change therapy for patients with acute pancreatitis.
Topics: Animals; Computed Tomography Angiography; Cross-Sectional Studies; Dog Diseases; Dogs; Female; Lipase; Male; Pancreas; Pancreatitis; Prospective Studies; Ultrasonography
PubMed: 30548310
DOI: 10.1111/jvim.15364 -
World Journal of Gastroenterology May 2021Progress in the fight against pancreatic cancer has been hampered by many factors. One of them is the inability to detect the disease early in overwhelming majority of... (Review)
Review
Progress in the fight against pancreatic cancer has been hampered by many factors. One of them is the inability to detect the disease early in overwhelming majority of patients. The present paper outlines a novel way in which progress could be accelerated. This includes a focus on two harbingers-post-pancreatitis diabetes mellitus and excess intra-pancreatic fat deposition-that converge at affecting the tumor macroenvironment and microenvironment specifically in the pancreas, not other organs. The two entities have the potential to be incorporated into future screening strategies with a view to early detecting of pancreatic cancer.
Topics: Diabetes Mellitus; Humans; Hypercholesterolemia; Pancreas; Pancreatic Neoplasms; Pancreatitis; Tumor Microenvironment
PubMed: 34007131
DOI: 10.3748/wjg.v27.i17.1936 -
World Journal of Gastroenterology Apr 2011Endoscopic ultrasonography is an established diagnostic tool for pancreatic masses and chronic pancreatitis. In recent years there has been a growing interest in the... (Review)
Review
Endoscopic ultrasonography is an established diagnostic tool for pancreatic masses and chronic pancreatitis. In recent years there has been a growing interest in the worldwide medical community in autoimmune pancreatitis (AIP), a form of chronic pancreatitis caused by an autoimmune process. This paper reviews the current available literature about the endoscopic ultrasonographic findings of AIP and the role of this imaging technique in the management of this protean disease.
Topics: Autoimmune Diseases; Bile Ducts; Endosonography; Pancreas; Pancreatitis
PubMed: 21547126
DOI: 10.3748/wjg.v17.i16.2080 -
World Journal of Gastroenterology Mar 2010The association between alcohol consumption and pancreatitis has been recognized for over 100 years. Despite the fact that this association is well recognized, the... (Review)
Review
The association between alcohol consumption and pancreatitis has been recognized for over 100 years. Despite the fact that this association is well recognized, the mechanisms by which alcohol abuse leads to pancreatic tissue damage are not entirely clear. Alcohol abuse is the major factor associated with pancreatitis in the Western world. Interestingly, although most cases of chronic pancreatitis and many cases of acute pancreatitis are associated with alcohol abuse, only a small percentage of individuals who abuse alcohol develop this disease. This situation is reminiscent of the association between alcohol abuse and the incidence of alcoholic liver disease. The liver and the pancreas are developmentally very closely related. Even though these two organs are quite different, they exhibit a number of general structural and functional similarities. Furthermore, the diseases mediated by alcohol abuse in these organs exhibit some striking similarities. The diseases in both organs are characterized by parenchymal cell damage, activation of stellate cells, aberrant wound healing, and fibrosis. Because of the similarities between the liver and the pancreas, and the alcohol-associated diseases of these organs, we may be able to apply much of the knowledge that we have gained regarding the effects of alcohol on the liver to the pancreas.
Topics: Acute Disease; Animals; Cell Death; Central Nervous System Depressants; Ethanol; Humans; Liver; Pancreas; Pancreatitis, Alcoholic; Pancreatitis, Chronic; Regeneration
PubMed: 20238397
DOI: 10.3748/wjg.v16.i11.1314 -
World Journal of Gastroenterology Dec 2014It is currently difficult for conventional treatments of acute pancreatitis (AP), which primarily consist of anti-inflammatory therapies, to prevent the progression of... (Review)
Review
It is currently difficult for conventional treatments of acute pancreatitis (AP), which primarily consist of anti-inflammatory therapies, to prevent the progression of AP or to improve its outcome. This may be because the occurrence and progression of AP, which involves various inflammatory cells and cytokines, includes a series of complex immune events. Considering the complex immune system alterations during the course of AP, it is necessary to monitor the indicators related to immune cells and inflammatory mediators and to develop more individualized interventions for AP patients using immunomodulatory therapy. This review discusses the recent advances in immunomodulatory therapies. It has been suggested that overactive inflammatory responses should be inhibited and excessive immunosuppression should be avoided in the early stages of AP. The optimal duration of anti-inflammatory therapy may be shorter than previously expected (< 24 h), and appropriate immunostimulatory therapies should be administered during the period from the 3(rd) d to the 14(th) d in the course of AP. A combination therapy of anti-inflammatory and immune-stimulating drugs would hopefully constitute an alternative to anti-inflammatory drug monotherapy. Additionally, the detection of the genotypes of critical inflammatory mediators may be useful for screening populations of AP patients at high risk of severe infections to enable the administration of early interventions to improve their prognosis.
Topics: Acute Disease; Adjuvants, Immunologic; Animals; Anti-Inflammatory Agents; Cytokines; Drug Administration Schedule; Drug Therapy, Combination; Humans; Immunologic Factors; Immunosuppressive Agents; Inflammation Mediators; Pancreas; Pancreatitis; Signal Transduction; Treatment Outcome
PubMed: 25493006
DOI: 10.3748/wjg.v20.i45.16935