Chronic use of statins and risk of post-ERCP acute pancreatitis (STARK) : Study protocol for an international multicenter prospective cohort study

Background: Acute pancreatitis (AP) is the most common complication after endoscopic retrograde cholangiopancreatography (ERCP). Statins have been traditionally associated to an increased risk of AP, however, recent evidence suggests that statins may have a protective role against this disease. Aims: Our primary aim is to investigate whether the use of statins has a protective effect against post-ERCP pancreatitis (PEP). Secondary outcomes are: to evaluate the effect of other drugs on the incidence of PEP; to ascertain the relationship between the use of statins and the severity of PEP; and to evaluate the effect of other risk and protective factors on the incidence of PEP. Methods: STARK is an international multicenter prospective cohort study. Centers from Spain, Italy, Croatia, Finland and Sweden joined this study. The total sample size will include about 1016 patients, which was based on assuming a 5% incidence of PEP among non-statin (NSt) users, a 1-3 ratio of statin (St) and NSt consumers respectively, a 70% decrease in PEP among St consumers, an alpha-error of 0.05 and beta-error of 0.20. All patients aged >18 years scheduled for ERCP will be offered to enter the study. Discussion: STARK study will ascertain whether statins, a safe, widely used and inexpensive drug, can modify the incidence of PEP. (C) 2018 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.Peer reviewe

Le malattie autoimmuni

Aspetti patologici, criteri diagnostici, epidemiologia e manifestazioni cliniche; imaging e terapia della pancreatite autoimmun

Dieulafoy's lesion | La lesione di Dieulafoy

Dieulafoy's lesion is a rare but important cause of acute gastrointestinal bleeding supported by a vascular anomaly located more frequently in the proximal stomach. The endoscopic diagnosis is often difficult and may require more endoscopic investigations. Endoscopic methods are the treatment of choice with a high success rate. Angiographic and surgical interventions are kept for failure of endoscopic treatment or for lesions not accessible by endoscopy

Steroid-Responsive Chronic Pancreatitides: Autoimmune Pancreatitis and Idiopathic Duct-Centric Chronic Pancreatitis

Two different forms of steroid-responsive pancreatitides are recognized, with both being referred to as “autoimmune pancreatitis.” They differ significantly in their clinical, histological, and epidemiological features. It has recently been suggested that the term “AIP” be reserved for the disease associated with elevated serum and tissue IgG4, while the term idiopathic duct centric chronic pancreatitis (IDCP) be used for pancreas-specific form. Clinically the most frequent presentation is painless obstructive jaundice with a mass/enlargement of the pancreas at imaging, and the differential diagnosis with cancer is frequently difficult. AIP is part of a multiorgan disorder called IgG4-related disease and any organ may be involved. Therefore, more than 50 % of the patients suffering from AIP present an inflammatory involvement of other organs (particularly bile ducts, kidneys, and salivary glands). Serum IgG4 elevation is not pathognomonic of AIP and serum IgG4 should be used in combination with other features to make a diagnosis of AIP. Both AIP and IDCP respond to steroids. In relapses of AIP the use of immunosuppressive drugs or of biologic agents may be considered

Chest pain, dysphagia and hematemesis in a new mother

Caso di ematoma intramurale esofageo in gravid

What to do for a patient complaining of recurrent non biliary acute pacreatitis? | Che fare se il paziente presenta episodi ricorrenti di pancreatite acuta non biliare?

The cause of relapsing non biliary pancreatitis is difficult to recognise and, generally, several instrumental investigations are performed, often inappropriately. In this review, the main causes of non biliary recurrent pancreatitis are described. The complexity and the high costs for the etiological diagnosis implie that, these patients should be followed in a highly specialized centers

What if the esophageal varices bleed after the first endoscopic treatment | Che fare se le varici esofagee risanguinano dopo il primo trattamento endoscopico

L'emorragia da varici esofagee è una delle maggiori complicanze della cirrosi epatica ed ancora oggi è gravata da una mortalità del 15-20%. I pazienti in cui viene ottenuta un‘emostasi efficace del primo episodio emorragico presentano un elevato rischio di risanguinamento (60% entro 1 anno), soprattutto precoce (20% entro le prime sei settimane dall’evento acuto), in particolare se non viene impostata quanto prima un'adeguata terapia di profilassi secondaria

Secondary analysis of large databases for hepatology research

Secondary analysis of large datasets involves the utilization of existing data that has typically been collected for other purposes to advance scientific knowledge. This is an established methodology applied in health services research with the unique advantage of efficiently identifying relationships between predictor and outcome variables but which has been underutilized for hepatology research. Our review of 1431 abstracts published in the 2013 European Association for the Study of Liver (EASL) abstract book showed that less than 0.5% of published abstracts utilized secondary analysis of large database methodologies.This review paper describes existing large datasets that can be exploited for secondary analyses in liver disease research. It also suggests potential questions that could be addressed using these data warehouses and highlights the strengths and limitations of each dataset as described by authors that have previously used them. The overall goal is to bring these datasets to the attention of readers and ultimately encourage the consideration of secondary analysis of large database methodologies for the advancement of hepatology. (C) 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved

The features and clinical outcomes of inflammatory bowel disease associated with autoimmune pancreatitis: A greater awareness is needed

: The prevalence of inflammatory bowel disease (IBD) has been described in 5% to 40% of autoimmune pancreatitis (AIP) patients. The aim of our study was to evaluate the prevalence, endoscopic features, and outcome of IBD in association with AIP.A retrospective analysis including all consecutive patients with AIP and a histological diagnosis of IBD from 2010 to 2020 was performed. Demographical data, AIP, and IBD features, as well as clinical course, were recorded.Among 267 AIP patients, 45 were diagnosed with ulcerative colitis (UC) (27 men, mean age 31.6), all with a diagnosis of type 2 AIP. The most frequent presentation of AIP was acute pancreatitis (55.5%). Both diffuse (51.1%) and focal (48.9%) pancreatic involvement were observed. The AIP relapse rate was 11.1% over a mean follow-up of 55 months. In 69% of patients, the interval time between the diagnosis of AIP and UC was <1 year. When UC was present at AIP onset, UC was in clinical remission in 50% of patients. Fecal calprotectin levels, when available, were elevated in 86.6% of these patients. Mostly, mild-moderate pancolitis was initially diagnosed (55.5%). During follow-up, escalation therapy for UC was required in 40% of patients after a mean time of 45 months. Two patients (4.4%) underwent colectomy.The prevalence of UC in AIP patients was 17%. Mild pancolitis with a low rate of colectomy was found. Greater awareness is needed to avoid a delayed diagnosis of UC, and the dosage of fecal calprotectin levels could have a role in this setting

Clinical and Morphological Features of Paraduodenal Pancreatitis: An Italian Experience With 120 Patients

This study aimed to evaluate the clinical and radiological features and clinical outcomes of paraduodenal pancreatitis (PP)