Comparison of clinical course and outcome of acute pancreatitis according to the two main etiologies: alcohol and gallstone

Cho, Joon Hyun; Kim, Tae Nyeun; Kim, Sung Bum

doi:10.1186/s12876-015-0323-1

Cited by 58 publications

(62 citation statements)

References 27 publications

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“…Similar results were observed in the current study, where 97.3% of males had alcohol‐induced AP, while 93.7% females had GS‐related AP. Alcohol‐induced AP was found in a relatively younger population compared to the GS‐related AP in this study (37.08 ± 9.9 vs 43.29 ± 14.8; P < 0.001), as also demonstrated in various other studies . Recurrent attacks of pancreatitis were evidently found in a higher percentage of patients with alcohol‐related, than GS‐related, AP (11.4 vs 5.2%, P = 0.011), as had been established in previous studies .…”

Section: Discussionsupporting

confidence: 90%

“…Recent studies also demonstrate varying data. Cho et al , in an analysis of 126 patients, found a significantly higher percentage of persistent OF in the alcohol group compared to the biliary group. Zhu et al reported differences between the two groups with regard to the young and middle‐aged patients but not in the elderly.…”

Section: Discussionmentioning

confidence: 95%

“…While some had reported higher mortality and severity with biliary pancreatitis, others had found more complications and mortality rates with alcohol, and some had reported no difference . In recent times, some studies have shown more local complications and higher mortality in the alcohol group, while others found no difference . The basic pathophysiology of pancreatitis, irrespective of the etiology, is premature activation of the digestive enzymes within the acinar cell, causing autodigestion.…”

Section: Introductionmentioning

confidence: 99%

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Comparative study of the outcome between alcohol and gallstone pancreatitis in a high‐volume tertiary care center

et al. 2019

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Background and Aim The two most common etiologies of acute pancreatitis (AP) are alcohol and gallstone. Whether etiology contributes to the outcome in patients with AP is an unresolved issue, more so in the severe form of the disease. The aim is to study the effects of the etiological factors of alcohol and gallstone on the disease course and the role of etiology in the subgroup of severe AP. Methods Consecutive patients of AP with alcohol or gallstone etiology were included. Various severity parameters and various outcome measures, such as need for organ support, intensive care, surgical or radiological intervention, hospital stay, and mortality, were evaluated between the two groups. Results Of the 759 patients, alcoholic pancreatitis was seen in 368 (48.5%), while gallstone disease was observed in 246 (32.4%). Gallstone pancreatitis occurred in older age ( P < 0.0001), had a higher female predilection ( P < 0.001), and a higher body mass index ( P = 0.002) compared to alcohol pancreatitis. Both groups were similar in terms of development of various organ failures and various severity assessment scores. Alcoholic AP had higher rates of necrosis ( P = 0.05) and the need for percutaneous catheter drainage ( P = 0.02). Outcome measures such as length of hospital stay, need for intensive care, organ support, surgical intervention, or mortality were similar between the two groups. Subset analysis of severe AP (303 patients) showed no difference between the two etiologies with regard to outcome. Conclusion The outcome of AP was independent of the etiology of the disease, alcohol or gallstone, and more so in the severe form of the disease. The number of local complications tends to be slightly higher in the alcoholic group.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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Comparative study of the outcome between alcohol and gallstone pancreatitis in a high‐volume tertiary care center

et al. 2019

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“…[8][9][10] Severity scoring systems for acute pancreatitis assign the same parameters, but there is evidence that etiology or patient phenotype may also affect disease outcome. [12][13][14] In contrast, the effect of ABP on hospital outcomes in patients with cirrhosis is unknown. [12][13][14] In contrast, the effect of ABP on hospital outcomes in patients with cirrhosis is unknown.…”

Section: Introductionmentioning

confidence: 99%

Index admission cholecystectomy for acute biliary pancreatitis favorably impacts outcomes of hospitalization in cirrhosis

Patel

Mumtaz

et al. 2019

J of Gastro and Hepatol

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Background and Aim Despite higher rates of gallstones in patients with cirrhosis, there are no population‐based studies evaluating outcomes of acute biliary pancreatitis (ABP). Therefore, we sought to evaluate the predictors of early readmission and mortality in this high‐risk population. Methods We utilized the Nationwide Readmission Database (2011–2014) to evaluate all adults admitted with ABP. Multivariable logistic regression models were used to assess independent predictors for 30‐day readmission, index admission mortality, and calendar year mortality. Results Among 184 611 index admissions with ABP, 4344 (2.4%) subjects had cirrhosis (1649 with decompensation). Subjects with cirrhosis, when compared with those without, incurred higher rates of 30‐day readmission (20.9% vs 11.2%; P < 0.001), index mortality (2.0% vs 1.0%; P < 0.001), and calendar year mortality (4.2% vs 0.9%; P < 0.001). Decompensation in cirrhosis was associated with significantly fewer cholecystectomies (26.7% vs 60.2%; P < 0.001) and endoscopic retrograde cholangiopancreatographies (23.3% vs 29.9%; P < 0.001). Multivariate analysis revealed that severe acute pancreatitis (odds ratio [OR]: 14.8; 95% confidence interval [CI]: 5.3, 41.2), sepsis (OR: 12.6; 95% CI: 5.8, 27.4), and decompensation (OR: 3.1; 96% CI: 1.4, 6.6) were associated with increased index admission mortality. Decompensated cirrhosis (OR: 1.8; 95% CI: 1.1, 3.0) and 30‐day readmission (OR: 5.6; 95% CI: 3.3, 9.5) were predictors of calendar year mortality. However, index admission cholecystectomy was associated with decreased 30‐day readmissions (OR: 0.6; 95% CI: 0.4, 0.7) and calendar year mortality (OR: 0.44; 95% CI: 0.25, 0.78). Conclusions The presence of cirrhosis adversely impacts hospital outcomes of patients with ABP. Among modifiable factors, index admission cholecystectomy portends favorable prognosis by reducing risk of early readmission and consequent calendar year mortality.

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“…They are more commonly seen in patients with alcohol-associated pancreatitis (20%) than with gallstone pancreatitis (6.6%)[3]. Although most commonly immediately peripancreatic or intrapancreatic, they can occur in truly extrapancreatic locations throughout the peritoneal cavity as well as the mediastinum[4,5].…”

Section: Introductionmentioning

confidence: 99%

Intrahepatic pancreatic pseudocyst: A review of the world literature

Demeusy

Hosseini

Sill

et al. 2016

WJH

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AIMTo investigate and summarize the literature regarding the diagnosis and management of intrahepatic pancreatic pseudocysts (IHPP).METHODSA literature search was performed using PubMed (MEDLINE) and Google Scholar databases, followed by a manual review of reference lists to ensure that no articles were missed. All articles, case reports, systematic reviews, letters to editors, and abstracts were analyzed and tabulated. Bivariate analyses were performed, with significance accepted at P < 0.05. Articles included were primarily in the English language, and articles in other languages were reviewed with native speakers or, if none available, were translated with electronic software when possible.RESULTSWe found 41 published articles describing 54 cases since the 1970s, with a fairly steady rate of publication. Patients were predominantly male, with a mean age of 49 years. In 42% of published cases, the IHPP was the only reported pseudocyst, but 58% also had concurrent pseudocysts in other extrapancreatic locations. Average IHPP size was 9.5 cm and they occurred most commonly (48%) in the left hemiliver. Nearly every reported case was managed with an intervention, most with a single intervention, but some required up to three interventions. Percutaneous treatment with either simple aspiration or with an indwelling drain were the most common interventions, frequently performed along with stenting of the pancreatic duct. The size of the IHPP correlated significantly with both the duration of treatment (P = 0.006) and with the number of interventions required (P = 0.031). The duration of therapy also correlated with the initial white blood cell (WBC) count (P = 0.048).CONCLUSIONDiagnosis of IHPP is difficult and often missed. Initial size and WBC are predictive of the treatment required. With appropriate intervention, most patients achieve resolution.

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Comparison of clinical course and outcome of acute pancreatitis according to the two main etiologies: alcohol and gallstone

Cited by 58 publications

References 27 publications

Comparative study of the outcome between alcohol and gallstone pancreatitis in a high‐volume tertiary care center

Comparative study of the outcome between alcohol and gallstone pancreatitis in a high‐volume tertiary care center

Index admission cholecystectomy for acute biliary pancreatitis favorably impacts outcomes of hospitalization in cirrhosis

Intrahepatic pancreatic pseudocyst: A review of the world literature

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