Management of acute pancreatitis (AP) – Polish Pancreatic Club recommendations

Rosołowski, Mariusz; Lipiński, Michał; Dobosz, Marek; Durlik, Marek; Głuszek, Stanisław; Kuśnierz, Katarzyna; Lampe, Paweł; Małecka‐Panas, Ewa; Nowakowska-Duława, Ewa; Nowak-Niezgoda, Magdalena; Radomańska, Barbara; Talar-Wojnarowska, Renata; Wereszczyńska-Siemiątkowska, Urszula; Rydzewska, Grażyna

doi:10.5114/pg.2016.60251

Cited by 14 publications

(47 citation statements)

References 52 publications

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“…Regarding AP etiology, gallstones and alcohol abuse are the two main phenomena considered to be the roots of the disease; whereas hypertriglyceridemia should be taken into account as the third plausible underlying factor. Other causes of acute pancreatitis include drug-induced, hereditary, and autoimmune AP [ 25 ]. In our study, the most common etiological factors of AP were alcohol abuse (47.7%), biliary stones (38.6%), hypertriglyceridaemia (4.5%), autoimmune pancreatitis (4.5%), groove pancreatitis (2.3%) and azathioprine treatment (2.3%).…”

Section: Discussionmentioning

confidence: 99%

Plasma Sphingolipids in Acute Pancreatitis

Konończuk

Łukaszuk

Żendzian-Piotrowska

et al. 2017

IJMS

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Acute pancreatitis (AP) is a prevalent gastrointestinal disorder associated with systemic inflammatory response syndrome and, in the case of severe AP, a mortality rate ranging from 36% to 50%. Standard clinical treatment of AP includes intensive hydration, analgesia, and management of complications. Unfortunately, the direct treatment of AP at the level of its molecular pathomechanism has not yet been established. Recent studies indicate that the sphingolipid signaling pathway may be one of the important factors contributing to the development of inflammation in pancreatic diseases. In the current study, we sought to investigate this promising route. We examined the plasma sphingolipid profile of 44 patients with acute pancreatitis, dividing them into three groups: mild, moderate and severe AP. Samples were collected from these groups at days 1, 3 and 7 following their hospital admission. We demonstrated significant changes in blood plasma sphingolipids in relation to the time course of AP. We also found an inhibition of de novo ceramide synthesis in mild and moderate AP. However, the most important and novel finding was a significant elevation in sphingosine-1-phosphate (S1P) (a downstream metabolite of ceramide) in mild AP, as well as a dramatic reduction in the lipid molecule content in the early stage (days 1 and 3) of severe AP. This strongly indicates that plasma S1P could serve as a prognostic marker of AP severity.

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Section: Discussionmentioning

confidence: 99%

Plasma Sphingolipids in Acute Pancreatitis

Konończuk

Łukaszuk

Żendzian-Piotrowska

et al. 2017

IJMS

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“…The patients were subsequently divided into three groups corresponding to the three grades of disease severity, based on the Revised Atlanta Classification for Acute Pancreatitis. Mild AP was diagnosed when there were no organ dysfunctions or local or systemic complications, moderately severe course was diagnosed when there was transient (< 48 h) organ dysfunction and/or the presence of local or systemic complications, and severe course was diagnosed when there was persistent dysfunction of one or more organs for > 48 h [17,18].…”

Section: Methodsmentioning

confidence: 99%

Clinical usefulness of pentraxin 3 (PTX3) as a biomarker of acute pancreatitis and pancreatic cancer

Głuszek¹,

Matykiewicz²,

Grabowska³

et al. 2020

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Introduction: Increased concentrations of pentraxin 3 (PTX 3) were diagnosed in acute pancreatitis (AP) and in pancreatic ductal adenocarcinoma (PDAC). Aim of the research: To assess of the clinical usefulness of PTX3 in the early differentiation of AP from PDAC. Material and methods: The test group consisted of 125 patients with AP and 24 people with PDAC, as well as 52 healthy subjects. The following concentrations were tested in plasma: PTX3, C-reactive protein (CRP), interleukin-6 (IL-6), and CA-19.9. Results: The mean PTX3 concentration in the moderately-severe AP (MAP) or severe AP (SAP) equalled 16.53 ng/ml and was significantly higher in comparison with mild AP (9.60 ng/ml; p = 0.0007) and the control group (2.31 ng/ml). In the case of patients with PDAC, the mean concentration of PTX3 was 9.20 ng/ml and was significantly higher than in the control group (2.31 ng/ml); p < 0.0001. A significantly higher average CRP value of 100.37 mg/l and IL-6 91.65 pg/ml was also found in patients with PDAC compared to the control group (p < 0.0001). Tested pro-inflammatory cytokines were significantly higher in patients with MAP or SAP than in those with PDAC (p < 0.05). The ROC curve confirms the clear connection of PTX3 level and PDAC in comparison with the control group (p = 0.0001), relatively low sensitivity, and high specificity. However, the results were not significant enough to allow us to differentiate cancer from AP (p > 0.05). Conclusions: Pentraxin 3 can be a marker in the prediction of the severe course of AP, but its clinical usefulness for the differentiation of PDAC was not confirmed. Streszczenie Wprowadzenie: Podwyższone stężenie pentraksyny 3 (PTX3) stwierdzono zarówno w ostrym zapaleniu trzustki (AP), jak i raku trzustki (PDAC). Cel pracy: Ocena przydatności klinicznej PTX3 we wczesnym różnicowaniu AP i PDAC. Materiał i metody: Zbadano 125 chorych na AP i 24 chorych z potwierdzonym histopatologicznie lub cytologicznie PDAC oraz 52 osoby zdrowe jako grupę kontrolną. Próbkę krwi pobierano w pierwszym dniu hospitalizacji. Oznaczono stężenia w osoczu PTX3, białka C-reaktywnego (CRP), interleukiny (IL-6) i aktywność CA-19.9. Wyniki: Średnie stężenie PTX3 u pacjentów z umiarkowanie ciężkim AP (MAP) i ciężkim AP (SAP) wynosiło 16,53 ±15,73 ng/ml i było istotnie wyższe niż średnie stężenia u pacjentów z łagodnym AP (9,60 ±9,65 ng/ml; p = 0,0007) i z grupy kontrolnej (2,31 ±0,58 ng/ml). Średnie stężenie PTX3 u chorych z PDAC wynosiło 9,20 ng/ml i było znacząco większe niż stężenie w grupie kontrolnej (2,31 ng/ml); p < 0,0001. Stwierdzono również istotnie wyższą średnią wartość CRP 100,37 mg/l i IL-6 91,65 pg/ml u chorych z PDAC w porównaniu z grupą osób zdrowych (p < 0,0001). Stężenia cytokin prozapalnych były znamiennie wyższe u chorych z MAP i SAP niż z PDAC (p < 0,05). Krzywa ROC potwierdza istotną zależność między stężeniem PTX3 a rozpoznaniem PDAC w porównaniu z grupą kontrolną, ze stosunkowo niską czułością i wysoką specyficznością. Nie wykazano istotnej zdolności do różnicowania PDAC z AP (p > 0,05). ...

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“…Many guidelines for management have been proposed for the initial management of AP. Many of these recent recommendations come from guidelines issued by the American Gastroenterological Association, the International Association of Pancreatology, and other gastroenterological associations around the world [1,3,4].…”

Section: Introductionmentioning

confidence: 99%

Clinical practice guidelines in the diagnosis and management of acute pancreatitis

Kinoshita¹,

Zhang²,

Ponthisarn³

et al. 2019

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Acute pancreatitis (AP) continues to be a cause of significant morbidity and mortality and requires more research to identify the best clinical management practices. Many guidelines have been proposed for the initial management of AP. Although these guidelines have a significant overlap in the recommendations provided for diagnosing and managing AP, there is still some disagreement in aspects of the types and timing of interventions that should be used for the diagnosis and management of both mild and severe AP. A working group consisting of physicians, especially gastroenterologists from various hospitals and universities from the Asia-Pacific region, has led to the development of these evidence-based guidelines and recommendations. Early enteral feedings, performing a cholecystectomy in the case of gallstones if indicated during the initial hospitalisation, treatment of hypertriglyceridaemia-induced acute pancreatitis using intravenous regular insulin or plasmapheresis if severe, and providing counselling for alcohol avoidance are recommended. Streszczenie Ostre zapalenie trzustki nadal charakteryzuje się dużą zachorowalnością i śmiertelnością. Niezbędne są dalsze badania, które pozwolą na bardziej szczegółowe opracowanie optymalnej praktyki w zakresie postępowania u pacjentów z tym schorzeniem. Dotychczas przedstawiono wiele wytycznych dotyczących schematu początkowego postępowania w przypadku ostre go zapalenia trzustki. Chociaż pod względem zalecanej diagnostyki i postępowania wytyczne te w znacznym stopniu się pokrywają, nadal istnieje pewna rozbieżność poglądów na temat rodzaju oraz czasu interwencji, które powinny być podejmowane w diagnostyce i terapii łagodnych i ciężkich postaci ostrego zapalenia trzustki. W ramach grupy roboczej złożonej z lekarzy, głównie gastroenterologów, z różnych szpitali i uniwersytetów w regionie Azji i Pacyfiku opracowano niniejsze wytyczne i zalecenia oparte na dowodach naukowych. Zaleca się wczesne wdrażanie żywienia drogą dojelitową, cholecystektomię u chorych z kamicą żółciową, jeżeli istnieje takie wskazanie podczas wstępnej hospitalizacji, leczenie ostrego zapalenia trzustki wywołanego hipertriglicerydemią przy zastosowaniu standardowej, dożylnie podawanej insuliny lub (w ciężkich przypadkach) plazmaferezy, a także poradnictwo dotyczące unikania alkoholu.

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Management of acute pancreatitis (AP) – Polish Pancreatic Club recommendations

Cited by 14 publications

References 52 publications

Plasma Sphingolipids in Acute Pancreatitis

Plasma Sphingolipids in Acute Pancreatitis

Clinical usefulness of pentraxin 3 (PTX3) as a biomarker of acute pancreatitis and pancreatic cancer

Clinical practice guidelines in the diagnosis and management of acute pancreatitis

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