Pancreatitis Associated with Viral Hepatitis: Systematic Review

Panić, Nikola; Mihajlovic, Sladjana; Vujasinović, Miroslav; Bulajić, Milutin; Löhr, Matthias

doi:10.3390/jcm9103309

Cited by 12 publications

(15 citation statements)

References 57 publications

(66 reference statements)

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“…Regarding the indirect mechanism, SARS-CoV2 causes microthrombi formation due to its ability to invade endothelial cells via the ACE2 protein. This phenomenon is also observed in other virus infections, such as viral hepatitis[ 85 ]. Microthrombus in vasculature triggers hypoperfusion of the pancreas, resulting in ischemic pancreatitis.…”

Section: Discussionmentioning

confidence: 61%

Occam’s razor or Hickam’s dictum-COVID-19 is not a textbook aetiology of acute pancreatitis: A modified Naranjo Score appraisal

Teng¹,

Chua²,

Lim³

et al. 2023

World J Gastroenterol

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BACKGROUND Acute pancreatitis (AP) is a disease spectrum ranging from mild to severe disease. During the coronavirus disease 2019 (COVID-19) pandemic, numerous reports of AP have been published, with most authors concluding a causal relationship between COVID-19 and AP. Retrospective case reports or small case series are unable to accurately determine the cause-effect relationship between COVID-19 and AP. AIM To establish whether COVID-19 is a cause of AP using the modified Naranjo scoring system. METHODS A systematic review was conducted on PubMed, World of Science and Embase for articles reporting COVID-19 and AP from inception to August 2021. Exclusion criteria were cases of AP which were not reported to be due to COVID-19 infection, age < 18 years old, review articles and retrospective cohort studies. The original 10-item Naranjo scoring system (total score 13) was devised to approximate the likelihood of a clinical presentation to be secondary to an adverse drug reaction. We modified the original scoring system into a 8-item modified Naranjo scoring system (total score 9) to determine the cause-effect relationship between COVID-19 and AP. A cumulative score was decided for each case presented in the included articles. Interpretation of the modified Naranjo scoring system is as follows: ≤ 3: Doubtful, 4-6: Possible, ≥ 7: Probable cause. RESULTS The initial search resulted in 909 articles, with 740 articles after removal of duplicates. A total of 67 articles were included in the final analysis, with 76 patients which had AP reported to be due to COVID-19. The mean age was 47.8 (range 18-94) years. Majority of patients (73.3%) had ≤ 7 d between onset of COVID-19 infection and diagnosis of AP. There were only 45 (59.2%) patients who had adequate investigations to rule out common aetiologies (gallstones, choledocholithiasis, alcohol, hypertriglyceridemia, hypercalcemia and trauma) of AP. Immunoglobulin G4 testing was conducted in 9 (13.5%) patients to rule out autoimmune AP. Only 5 (6.6%) patients underwent endoscopic ultrasound and/or magnetic resonance cholangiopancreatogram to rule out occult microlithiasis, pancreatic malignancy and pancreas divisum. None of the patients had other recently diagnosed viral infections apart from COVID-19 infection, or underwent genetic testing to rule out hereditary AP. There were 32 (42.1%), 39 (51.3%) and 5 (6.6%) patients with doubtful, possible, and probable cause-effect relationship respectively between COVID-19 and AP. CONCLUSION Current evidence is weak to establish a strong link between COVID-19 and AP. Investigations should be performed to rule out other causes of AP before establishing COVID-19 as an aetiology.

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Section: Discussionmentioning

confidence: 61%

Occam’s razor or Hickam’s dictum-COVID-19 is not a textbook aetiology of acute pancreatitis: A modified Naranjo Score appraisal

Teng¹,

Chua²,

Lim³

et al. 2023

World J Gastroenterol

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“…The most common cause was hepatitis E (4 patients), with hepatitis B confirmed in only 1 case [ 27 ]. In a recent systematic review, Panic et al reported 73 published cases of AP in patients with viral hepatitis, 6 of whom (8.2%) had HBV [ 28 ]. Interestingly, the only reported case of chronic pancreatitis associated with viral hepatitis was due to HBV.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, the only reported case of chronic pancreatitis associated with viral hepatitis was due to HBV. Since both HBsAg and HCV antigens were detected in pancreatic tissue, the authors hypothesized that chronic infection with HBV or HCV viruses might also affect the pancreas [ 28 ]. In 1988, Alexander et al compared HBsAg+ and HBsAg− liver transplantation patients.…”

Section: Discussionmentioning

confidence: 99%

Acute Pancreatitis in Patients After Liver Transplantation

et al. 2022

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Background Acute pancreatitis (AP) is a relatively rare but serious complication that can occur after organ transplantation. Material/Methods The aim of this study was to evaluate the incidence, potential risk factors, and course of AP in patients following liver transplantation at a single large-volume transplant center. Results Out of a total of 1850 transplanted patients, 49 (2.8%) were diagnosed with AP. Of this group, 37 (75.5%) had a mild form of AP and 12 (24.5%) had a severe form of AP. The mortality rate was 10% overall and 42% in the group of patients with severe AP. An early form of AP (<30 days from transplantation) occurred in 13 patients (26.5%), most of whom presented with severe AP (10 patients, 76.9%); 4 patients died (40%). A late form of AP was diagnosed in 36 patients (73.5%), most of whom had mild AP (34 patients, 94.4%); 1 of 2 patients with severe AP died. The most common AP etiologies were post-ERCP (38.8%), idiopathic (34.7%), and postoperative (18.4%). Chronic HBV infection was a risk factor for development of AP ( P =0.01). Conclusions AP in liver transplant recipients was more frequent and more severe than in the general population. This unfavorable course was associated with the occurrence of AP in the early post-transplant period. Liver transplantation due to complications of HBV infection was a risk factor for the development of AP.

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“…Einzelne Fallkontrollstudien zeigen Assoziationen verschiedener Erkrankungen mit einer Risikoerhöhung für eine akute Pankreatitis, deren Kausalität jedoch unklar ist. Hierzu zählen eine Pneumokokken-Infektion, chronisch-entzündliche Darmerkrankungen sowie eine Hepatitis A (Evidenzlevel 3) [43][44][45][46]. Ebenfalls unklar ist die Datenlage hinsichtlich eines Zusammenhangs zwischen Ernährung und Pankreatitisrisiko: 2 populationsbasierte Kohortenstudien zeigen eine Risikoreduktion für eine akute, nicht biliär-bedingte Pankreatitis durch eine fischreiche Ernährung (2-3 Portionen/Woche) und eine gemüsereiche Ernährung, ein direk-ter kausaler Zusammenhang bzw.…”

Section: Weitere Seltene Ursachen Und Ernährungseinflüsseunclassified

S3-Leitlinie Pankreatitis – Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – September 2021 – AWMF Registernummer 021-003

et al. 2022

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Kapitel: Definition und Ätiologie der akuten Pankreatitis 427 2. Schweregradeinschätzung einer akuten Pankreatitis 431 3. Bildgebung bei akuter Pankreatitis 435 4. Volumen-und Schmerztherapie, Intensivmedizinische Therapie bei akuter Pankreatitis 438 5. Antibiotika, Probiotika und Ernährung bei akuter Pankreatitis (Prävention und Therapie infektiöser Komplikationen) 442 6. Akute biliäre Pankreatitis und Therapie biliärer Komplikationen 445 7. Indikation, Zeitpunkt und Therapieverfahren bei infizierter Nekrose 448 8. Verlaufskontrolle nach akuter Pankreatitis 452 9. Definition, Epidemiologie und Ätiologie der chronischen Pankreatitis 456 9.1. Definition 456 10. Diagnostik (Funktionstests, Bildgebung, Klassifikation) bei chronischer Pankreatitis 459 10.3. Funktionstests 459 10.4. Bildgebung 461 10.5. Klassifikation 462 11. Medikamentöse Therapie der chronischen Pankreatitis 464 11.1. Akuter Schub 464 11.2. Schmerztherapie 464 11.3. Enzymsubstitution bei chronischer Pankreatitis 467 11.4. Ernährung 470 Inhaltsverzeichnis Seite 12. Endoskopische und interventionelle Therapie 471 12.1. Indikationsstellung 471 12.2. Therapie von Pseudozysten 473 12.3. Therapie von Pseudoaneurysmen 476 12.4. Therapie von Pankreasgangveränderungen und Pankreasgangsteinen bei chronischer Pankreatitis 477 12.5. Endoskopische Therapie von Gallengangsstenosen bei chronischer Pankreatitis 479 13. Indikationsstellung und chirurgische Therapie bei chronischer Pankreatitis 480 14. Überwachung und Verlaufskontrolle 484 15. Diagnostik und Therapie der chronischen Pankreatitis im Kindesalter 486 15.2. Klinisches Bild der Pankreatitis bei Kindern und Jugendlichen 486 15.3. Ätiologie und Häufigkeitsverteilung der Pankreatitis im Kindes-und Jugendalter 486 15.4. Komplikationen der Pankreatitis bei Kindern und Jugendlichen 487 15.5. Labordiagnostik bei V. a. Pankreatitis im Kindesund Jugendalter 487 15.6. Bildgebende Diagnostik bei Pankreatitis im Kindes-und Jugendalter 488 15.7. Genetische Diagnostik bei Pankreatitis im Kindes-und Jugendalter 489 15.8. Spezifische Diagnostik zum Ausschluss einer zystischen Fibrose bei Kindern und Jugendlichen mit chronischer Pankreatitis 489 15.9. Supportive Therapiemaßnahmen bei Kindern und Jugendlichen im akuten Schub einer Pankreatitis 490 15.10. Endoskopisch-interventionelle Therapie bei Kindern und Jugendlichen mit Pankreatitis 490 15.11. Operative Therapie bei Kindern und Jugendlichen mit Pankreatitis 490 15.12. Schmerztherapie der chronischen Pankreatitis bei Kindern und Jugendlichen 490 15.13. Ernährung bei Kindern im akuten Schub einer Pankreatitis 491

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Pancreatitis Associated with Viral Hepatitis: Systematic Review

Cited by 12 publications

References 57 publications

Occam’s razor or Hickam’s dictum-COVID-19 is not a textbook aetiology of acute pancreatitis: A modified Naranjo Score appraisal

Occam’s razor or Hickam’s dictum-COVID-19 is not a textbook aetiology of acute pancreatitis: A modified Naranjo Score appraisal

Acute Pancreatitis in Patients After Liver Transplantation

S3-Leitlinie Pankreatitis – Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – September 2021 – AWMF Registernummer 021-003

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