Influence of Etiology on the Course and Outcome of Acute Pancreatitis

Uhl, Waldemar; Isenmann, Rainer; Curti, Gaudenz; Vogel, Rainer; Beger, H. G.; Büchler, Markus W.

doi:10.1097/00006676-199611000-00002

Cited by 121 publications

(63 citation statements)

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“…[6][7][8] In 6 of 16 possible scenarios, mortality during 10 years' follow-up proved to be reduced, but only in 4 of 16 possible scenarios life-years were gained by prophylactic cholecystectomy, because surgical death occurs early, whereas gained lives occur later. Further data on incidence and subsequent mortality of pancreatitis (as well as other complications) in asymptomatic gallstone carriers are clearly needed, and further cost-benefit analyses with full-scale economic evaluations are required to determine total costs and potential benefits of prophylactic cholecystectomy versus "wait and see" strategy in the different scenarios.…”

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confidence: 99%

Intrahepatic cholestasis of pregnancy and bile acid levels

et al. 2005

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life-years than treatment according to "wait and see" strategy, depending on overall pancreatitis incidence (assumed to be 0.05%, 0.1%, 0.15%, or 0.2%/year) 3-5 and pancreatitis mortality (assumed to be 2.5%, 5%, 7.5%, or 10%). [6][7][8] In 6 of 16 possible scenarios, mortality during 10 years' follow-up proved to be reduced, but only in 4 of 16 possible scenarios life-years were gained by prophylactic cholecystectomy, because surgical death occurs early, whereas gained lives occur later. Further data on incidence and subsequent mortality of pancreatitis (as well as other complications) in asymptomatic gallstone carriers are clearly needed, and further cost-benefit analyses with full-scale economic evaluations are required to determine total costs and potential benefits of prophylactic cholecystectomy versus "wait and see" strategy in the different scenarios.NIELS G. VENNEMAN KAREL J. VAN Intrahepatic Cholestasis of Pregnancy and Bile Acid LevelsTo the Editor:We read with great interest the study reported by Glantz et al. 1 Although the authors should be congratulated on the data collected, we would nevertheless like to comment on their conclusions. Because these researchers had prospectively detected no increase of fetal risk in intrahepatic cholestasis of pregnancy (ICP) patients with bile acid levels less than 40 mol/L, they proposed to manage these women expectantly to reduce the costs of medical care. 1 We offer two reasons why this approach should be treated with caution.First, the pathogenesis of intrauterine fetal death (IUFD) in ICP remains unclear. 2 It has only been speculated, and never demonstrated, that bile acids may be the cause of IUFD in ICP. Moreover, it has never been demonstrated that they are solely responsible for IUFD in ICP and that other parameters do not play a role. 3 Second, among the three IUFDs that were reported by Glantz et al. during the observation period, one occurred while bile acid levels were less than 40 mol/L (27 mol/L). 1 Moreover, there was a slight increase in meconium staining of amniotic fluid, placenta, and membranes when bile acid levels were between 10 and 39 mol/L compared with normal controls. Although not statistically significant, these facts may be clinically significant.As the authors themselves report, "the low incidence of IUFD (0.4%) was due to increased attention devoted to ICP and its symptoms during the study which had led to high rates of induction of labor and planned cesarean section" (25% distributed as follows: 21% when bile acid levels were less than 10 mol/L, 24% when bile acid levels were between 10 and 39 mol/L, and 32% when bile acid levels were greater than 40 mol/L). 1 Therefore, why should obstetricians abandon active management, which is currently the only method that could reduce IUFD? 4 The policy of active management usefulness has been reinforced recently by the findings of Williamson et al. 5 These authors assessed the clinical outcome of 227 ICP patients. Among singleton pregnancies, 20 IUFDs were found. The median gestation...

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confidence: 99%

Intrahepatic cholestasis of pregnancy and bile acid levels

et al. 2005

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“…The similar incidence of the severe form of AP in the different etiologies established in the literature [16,17] supports the thesis that the magnitude of the pancreatic insult can be pre-established at the start of the clinical manifestations, and the course of the initiated ABP episode may not be influenced by ERC or ES [12][13][14][15][16][17][18] . Thus, the theory that the migration of small gallstones can trigger the onset of ABP and that their repeated passage, the impaction of the ampulla of Vater with larger stones [3,4] or the persistence of biliopancreatic obstruction may induce progression to the severe form of ABP [11] is still a matter of speculation.…”

Section: Introductionmentioning

confidence: 61%

Conservative management of cholestasis with and without fever in acute biliary pancreatitis

Santos¹

2012

WJGS

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“…In this study, 21 patients (13%) were classified as severe AP, and two (10%) of these patients died during hospitalization. Some studies have reported that the cause of AP was not related to disease severity [15][16][17] . However, in this study, among the etiologies of AP, alcohol showed a significant association with patients with severe AP (P = 0.030).…”

Section: Discussionmentioning

confidence: 99%