Coexistence of alcohol-related pancreatitis and alcohol-related liver disease: A systematic review and meta-analysis

Singhvi, Ajay; Abromitis, Rebecca; Althouse, Andrew D.; Bataller, Ramón; Arteel, Gavin E.; Yadav, Dhiraj

doi:10.1016/j.pan.2020.07.412

Cited by 8 publications

(7 citation statements)

References 51 publications

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“…In our study, we found a prevalence of radiological CP of 9.2%, which is not insignificant but lower than expected. The prevalence of CP in patients with alcoholic liver disease has been described in a recent metanalysis: 16.2% (95% CI 10.4–24.5) overall and 15.5% (95% CI 8.0–27.7) when data were limited to clinical studies [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Few articles have evaluated the prevalence of ACP in patients with ALC, and we did not find any references on ACP prevalence in patients with DLD. The prevalence of ACP in patients with alcoholic liver disease was 16.2% in a recent meta-analysis [ 7 ]. The sample size of patients with decompensated liver cirrhosis was 106, which allowed us to estimate the prevalence of CP with a precision of ±7% and 95% confidence, assuming a prevalence of 16% of the variable of interest.…”

Section: Methodsmentioning

confidence: 99%

“…Existing studies present discordant results on this aspect; their different methodologies and evaluation of different parameters for each entity (clinical, functional, radiological or histopathological) make it difficult to compare them [ 4 , 5 , 6 , 7 ]. In addition, in clinical practice, the concurrence of ACP and ALC in the same patient is not very common, either because they are underdiagnosed or because they do not coexist.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Radiological Chronic Pancreatitis and Exocrine Pancreatic Insufficiency in Patients with Decompensated Liver Disease: Is Fecal Elastase Useful in This Setting?

et al. 2023

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Chronic alcohol consumption is a well-known etiological factor for both chronic pancreatitis (CP) and liver cirrhosis. However, there is discussion over how often these two entities are present together in the same patient. The main goal of our study is to establish the prevalence of CP and low fecal elastase (FE-1) in patients with decompensated liver disease (DLD). In addition, we aim to identify the demographic, epidemiological and clinical factors associated with EPI and CP in patients with decompensated liver cirrhosis. This was an observational single-center study including 119 consecutive patients hospitalized for acute decompensation of cirrhosis, mostly of alcoholic etiology. Patients underwent computed tomography (CT) or magnetic resonance imaging (MRI) to assess the radiological features of CP. We also performed two FE-1 tests and complete blood tests to assess the presence of exocrine pancreatic insufficiency (EPI) and nutritional status, including micronutrients. The results of our study show that 32 patients (26.9%) had low fecal elastase suggesting EPI and 11 (9.2%) had CP. Patients meeting radiological CP criteria had lower FE-1 than patients without CP. There were no statistically significant differences in micronutrient deficiencies according to the presence of CP or not. Likewise, we did not find any statistically significant differences in micronutrient deficiencies among patients with normal and low FE-1 indicative of EPI. FE-1 alone may not be suitable for assessing EPI in patients with acute DLD. Detecting co-existing pancreatic disease may be important in a subset of patients with DLD, when the FE-1 levels are significantly low, potentially suggestive of a pancreatic anomaly. Moreover, the clinical manifestations of EPI and CP are not useful in detecting CP in DLD patients. Likewise, CP cannot explain all causes of EPI in these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence of Radiological Chronic Pancreatitis and Exocrine Pancreatic Insufficiency in Patients with Decompensated Liver Disease: Is Fecal Elastase Useful in This Setting?

et al. 2023

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“…A recently published systematic review has revealed the pooled prevalence of alcohol-related chronic pancreatitis among the patients with ALD to be 16.2% and similarly pooled prevalence of ALD in alcohol-related chronic pancreatitis to be 21.5%. 36 Hence, in patients with ALD and chronic abdominal pain, concomitant alcohol-related chronic pancreatitis should be suspected and ruled out with appropriate investigations. Furthermore, moderate to excessive alcohol use (>3 alcoholic drinks per day) have been implicated as an important predictor for carcinoma pancreas.…”

Section: Pancreatic Disordersmentioning

confidence: 99%

Extrahepatic Manifestations in Alcoholic Liver Disease

Nath

Anand

2022

Journal of Clinical and Experimental Hepatology

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“…Furthermore, emerging data from the United States in recent years suggests that coexistent disease (CD) represent only a small fraction of patients with AUD. Although estimates of prevalence of CD in the literature range widely from 0%-75%, a meta-analysis performed by our group revealed a pooled prevalence of ACP in ALC and ALC in ACP to be 16.2% and 21.5% respectively[ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Coexistent alcohol-related cirrhosis and chronic pancreatitis have a comparable phenotype to either disease alone: A comparative retrospective analysis

Lu¹,

Sun²,

Feldman³

et al. 2023

World J Hepatol

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BACKGROUND Alcohol use disorder is a prevalent disease in the United States. It is a well-demonstrated cause of recurrent and long-standing liver and pancreatic injury which can lead to alcohol-related liver cirrhosis (ALC) and chronic pancreatitis (ACP). ALC and ACP are associated with significant healthcare utilization, cost burden, and mortality. The prevalence of coexistent disease (CD) ranges widely in the literature and the intersection between ALC and ACP is inconsistently characterized. As such, the clinical profile of coexistent ALC and ACP remains poorly understood. We hypothesized that patients with CD have a worse phenotype when compared to single organ disease. AIM To compare the clinical profile and outcomes of patients with CD from those with ALC or ACP Only. METHODS In this retrospective comparative analysis, we reviewed international classification of disease 9/10 codes and electronic health records of adult patients with verified ALC Only ( n = 135), ACP Only ( n = 87), and CD ( n = 133) who received care at UPMC Presbyterian-Shadyside Hospital. ALC was defined by histology, imaging or clinical evidence of cirrhosis or hepatic decompensation. ACP was defined by imaging findings of pancreatic calcifications, moderate-severe pancreatic duct dilatation, irregularity or atrophy. We compared demographics, pertinent clinical variables, healthcare utilization, and mortality for patients with CD with those who had single organ disease. RESULTS Compared to CD or ACP Only, patients with ALC Only were more likely to be older, Caucasian, have higher body mass index, and Hepatitis B or C infection. CD patients ( vs ALC Only) were less likely to have imaging evidence of cirrhosis and portal hypertension despite possessing similar MELD-Na and Child C scores at the most recent contact. CD patients ( vs ACP Only) were less likely to have acute or recurrent acute pancreatitis, diabetes mellitus, insulin use, oral pancreatic enzyme therapy, and need for endoscopic therapy or pancreatic surgery. The number of hospitalizations in patients with CD were similar to ACP Only but significantly higher than ALC Only. The overall mortality in patients with CD was similar to ALC Only but trended to be higher than ACP Only ( P = 0.10). CONCLUSION CD does not have a worse phenotype compared with single organ disease. The dominant phenotype in CD is similar to ALC Only which should be the focus in longitudinal follow-up.

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Coexistence of alcohol-related pancreatitis and alcohol-related liver disease: A systematic review and meta-analysis

Cited by 8 publications

References 51 publications

Prevalence of Radiological Chronic Pancreatitis and Exocrine Pancreatic Insufficiency in Patients with Decompensated Liver Disease: Is Fecal Elastase Useful in This Setting?

Prevalence of Radiological Chronic Pancreatitis and Exocrine Pancreatic Insufficiency in Patients with Decompensated Liver Disease: Is Fecal Elastase Useful in This Setting?

Extrahepatic Manifestations in Alcoholic Liver Disease

Coexistent alcohol-related cirrhosis and chronic pancreatitis have a comparable phenotype to either disease alone: A comparative retrospective analysis

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