Objectives The epidemiological trends contributing to increasing acute pancreatitis (AP) hospitalizations remain unknown. We sought to analyze etiological factors and outcomes of increasing AP-hospitalizations. Methods Utilizing the Nationwide Inpatient Sample, retrospective analyses of adult (≥18 years) inpatient admissions with a primary diagnosis of AP (total N: 2,016,045) were performed. Patient hospitalizations from 2009–2012 were compared to those from 2002–2005. Results Compared to 2002–2005, there was a 13.2% (p<0.001) increase in AP-admissions in 2009–2012. Multivariate analysis adjusted for “time-period”, patient and hospital demographics, AP-etiologies, and disease associations, demonstrated an increase in the odds of associated-chronic pancreatitis (CP) (2002–2005: odds ratio [OR] 32.04, 95% confidence interval [CI] 30.51–33.64; 2009–2012: OR 35.02, 95% CI 33.94–36.14); while associated odds of gallstones (2002–2005: OR 36.37, 95% CI 35.32–37.46; 2009–2012: OR 29.85, 95% CI 29.09–30.64) decreased. Compared to 2002–2005, the AP-related mortality decreased in 2009–2012 (1.62% to 0.79%, p<0.001) and was lower in AP with associated-CP (0.65% to 0.26%; p<0.001) compared to AP without-CP. Conclusion In the preceding decade, AP-hospitalizations are increasing but associated mortality is declining. Associated-CP has emerged as a leading contributor for AP-related hospitalizations. Further research is needed to identify novel interventions to prevent disease progression of AP.

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Background & Aims: Identifying metabolic abnormalities that occur before pancreatic ductal adenocarcinomas (PDACs) are detected could increase chances for early detection. We collected data on changes in metabolic parameters (glucose, serum lipids, triglycerides; total, low-density, and high-density cholesterol; and total body weight) and soft tissues (abdominal subcutaneous fat [SAT], adipose tissue, visceral adipose tissue [VAT], and muscle) from patients 5 years before the received a diagnosis of PDAC. Methods: We collected data from 219 patients with a diagnosis of PDAC (patients) and 657 healthy individuals (controls) from the Rochester Epidemiology Project, from 2000 through 2015.

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The majority of patients with active MC responded to thiopurines, methotrexate, or anti-TNF therapy. Larger controlled studies are required to confirm the efficacy and safety of these medications in MC.

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The target audience for Mayo Clinic Proceedings is primarily internal medicine physicians and other clinicians who wish to advance their current knowledge of clinical medicine and who wish to stay abreast of advances in medical research. Statement of Need: General internists and primary care physicians must maintain an extensive knowledge base on a wide variety of topics covering all body systems as well as common and uncommon disorders. Mayo Clinic Proceedings aims to leverage the expertise of its authors to help physicians understand best practices in diagnosis and management of conditions encountered in the clinical setting. Accreditation Statement: In support of improving patient care, Mayo Clinic College of Medicine and Science is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the health care team. Credit Statements: AMA: Mayo Clinic College of Medicine and Science designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)._ Physicians should claim only the credit commensurate with the extent of their participation in the activity. MOC Credit Statement: Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1 MOC point in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.Learning Objectives: On completion of this article, you should be able to (1) detail the diagnostic work-up of a patient with suspected abdominal wall pain, (2) exhibit how to perform the Carnett's maneuver to assess for abdominal wall pain, and (3) develop a management plan for a patient with abdominal wall pain.

Celiac disease is an autoimmune disorder of the small bowel, classically associated with diarrhea, abdominal pain, and malabsorption. The diagnosis of celiac disease is made when there are compatible clinical features, supportive serologic markers, representative histology from the small bowel, and response to a gluten-free diet. Histologic findings associated with celiac disease include intraepithelial lymphocytosis, crypt hyperplasia, villous atrophy, and a chronic inflammatory cell infiltrate in the lamina propria. It is important to recognize and diagnose celiac disease, as strict adherence to a gluten-free diet can lead to resolution of clinical and histologic manifestations of the disease. However, many other entities can present with clinical and/or histologic features of celiac disease. In this review article, we highlight key clinical and histologic mimickers of celiac disease. The evaluation of a patient with serologically negative enteropathy necessitates a carefully elicited history and detailed review by a pathologist. Medications can mimic celiac disease and should be considered in all patients with a serologically negative enteropathy. Many mimickers of celiac disease have clues to the underlying diagnosis, and many have a targeted therapy. It is necessary to provide patients with a correct diagnosis rather than subject them to a lifetime of an unnecessary gluten-free diet.