Pancreatitis: TIGAR-O Version 2 Risk/Etiology Checklist With Topic Reviews, Updates, and Use Primers

Abstract

The Toxic-metabolic, Idiopathic, Genetic, Autoimmune, Recurrent and severe acute pancreatitis and Obstructive (TIGAR-O) Pancreatitis Risk/Etiology Checklist (TIGAR-O_V1) is a broad classification system that lists the major risk factors and etiologies of recurrent acute pancreatitis, chronic pancreatitis, and overlapping pancreatic disorders with or without genetic, immunologic, metabolic, nutritional, neurologic, metaplastic, or other features. New discoveries and progressive concepts since the 2001 TIGAR-O list relevant to understanding and managing complex pancreatic disorders require an update to TIGAR-O_V2 with both a short (S) and long (L) form. The revised system is designed as a hierarchical checklist for health care workers to quickly document and track specific factors that, alone or in combinations, may contribute to progressive pancreatic disease in individual patients or groups of patients and to assist in treatment selection. The rationale and key clinical considerations are summarized for each updated classification item. Familiarity with the structured format speeds up the completion process and supports thoroughness and consideration of complex or alternative diagnoses during evaluation and serves as a framework for communication. The structured approach also facilitates the new health information technologies that required high-quality data for accurate precision medicine. A use primer accompanies the TIGAR-O_V2 checklist with rationale and comments for health care workers and industries caring for patients with pancreatic diseases.

Severe Pain in Chronic Pancreatitis Patients: Considering Mental Health and Associated Genetic Factors

“…Understanding CP requires the transition from a traditional monolithic view of disease (eg WHO pain step-up model of pain management) to a more holistic view 81 where each case is an independent combination of multiple risk factors 82 that act in a pathogenic way to cause disease. [83][84][85] While the science of the new approach is beyond the scope of this review, the importance of genetics cannot be underestimated.…”

Sex-Related Differences of Acute and Chronic Pancreatitis in Adults

“…Hypercalcemia is a well-known risk factor for pancreatitis when total ionized calcium levels are ≥12.0 mg/dL or 3 mmol/L (typical upper limit of normal = 10.2 mg/dL). Over 90.0% of cases of hypercalcemia are due to primary hyperparathyroidism (PHPT) or hypercalcemia of malignancy, though less than 7.0% of patients with PHPT develop AP [ 42 ].…”

Descripción clínica y epidemiológica de pacientes con pancreatitis crónica en un hospital de alta complejidad en Cali, 2011 a 2017

“…Esto es esperable, puesto que en pacientes con PC y especialmente con IPE, se ha demostrado mayor riesgo de enfermedades cardiovasculares como insuficiencia cardíaca (29), infarto agudo de miocardio (30) y HTA (31). Otros antecedentes médicos como la hipertrigliceridemia se han relacionado con PC (7,20,32). El NASP group de Estados Unidos identificó la hipertrigliceridemia como un factor de riesgo en el 13 % de pacientes (33), lo que puede explicar la frecuencia encontrada en la población.…”

“…El NASP group de Estados Unidos identificó la hipertrigliceridemia como un factor de riesgo en el 13 % de pacientes (33), lo que puede explicar la frecuencia encontrada en la población. A pesar de reconocer antecedentes familiares de enfermedad pancreática como factores de riesgo para PC (20,34), en nuestra población fueron poco prevalentes, probablemente por desconocimiento de los pacientes y por falta de estudios genéticos disponibles.…”

“…El abordaje de un paciente con manifestaciones de PC como dolor abdominal crónico, diarrea o déficit nutricional es reconocer la posibilidad de esta enfermedad, realizar una historia clínica y examen físico dirigidos a condiciones asociadas y aplicar escalas de riesgo, con el fin de buscar cambios sugestivos en laboratorios e imágenes (7,18). Existen condiciones que pueden llevar al desarrollo de PC en lugar de ser provocada por una sola etiología, como el consumo crónico de alcohol, tabaquismo, medicamentos, enfermedades metabólicas tipo hipercalcemia e hipertrigliceridemia, predisposición genética y antecedentes familiares o personales de patología anatómica, litiásica y pancreatitis aguda recurrente (7,19,20).…”