Smoking as a cofactor for causation of chronic pancreatitis: a meta-analysis.

OBJECTIVES: To assess the evidence for tobacco smoking as a risk factor for the causation of chronic pancreatitis. METHODS: We performed a meta-analysis with random-effects models to estimate pooled relative risks (RRs) of chronic pancreatitis for current, former, and ever smokers, in comparison to never smokers. We also performed dose-response, heterogeneity, publication bias, and sensitivity analyses. RESULTS: Ten case-control studies and 2 cohort studies that evaluated, overall, 1705 patients with chronic pancreatitis satisfied the inclusion criteria. When contrasted to never smokers, the pooled risk estimates for current smokers was 2.8 (95% confidence interval [CI], 1.8-4.2) overall and 2.5 (95% CI, 1.3-4.6) when data were adjusted for alcohol consumption. A dose-response effect of tobacco use on the risk was ascertained: the RR for subjects smoking less than 1 pack per day was 2.4 (95% CI, 0.9-6.6) and increased to 3.3 (95% CI, 1.4-7.9) in those smoking 1 or more packs per day. The risk diminished significantly after smoking cessation, as the RR estimate for former smokers dropped to a value of 1.4 (95% CI, 1.1-1.9). CONCLUSIONS: Tobacco smoking may enhance the risk of developing chronic pancreatitis. Recommendation for smoking cessation, besides alcohol abstinence, should be incorporated in the management of patients with chronic pancreatitis

Le malattie infiammatorie immuno-mediate (IMID) di interesse internistico: fisiopatologia, aspetti clinici e prospettive di terapia

Le IMID: inquadramento introduttivo A. Fontanella, G. Uomo Infiammazione e IMID T. d’Errico, M. Laccetti Malattia IgG4-relata C. Mastrobuoni, G. Uomo IMID in ematologia F. Rezzonico, A. Mazzone IMID in reumatologia A. Parisi, R. Buono, R. Russo, G. Uomo IMIDs in neurologia G.T. Maniscalco, C. Florio IMID in diabetologia R. Nicosia, C. Ricordi IMIDs in endocrinologia M.R. Poggiano, V. Nuzzo Malattie infiammatorie intestinali M. Salice, L. Calandrini, C. Praticò, M. Mazza, A. Calafiore, G. Carini, C. Calabrese, A. Belluzzi, F. Rizzello, P. Gionchetti, M. Campieri La malattia celiaca nel terzo millennio: nuove prospettive su patogenesi, clinica, diagnosi e terapia G. Caio, F. Giancola, R. De Giorgio, U. Volta Malattie epato-biliari autoimmuni M. Visconti, L. Fontanella, G. Marino Marsilia Pancreatiti autoimmuni P.G. Rabitti, R. Boni IMID e tumori F. Gallucci La sindrome infiammatoria da ricostruzione immune I. Ronga, G. Uomo Le malattie autoinfiammatorie M. Gattorno, A. Brucato Il rischio cardio-vascolare nelle IMIDs A. Fontanella, P. Gnerre, R. Nardi Quale ruolo degli inibitori delle PCSK9 in Medicina Interna nella prevenzione cardio-vascolare in alternativa alle terapie tradizionali? P. Gnerre, P. Zuccheri, M. Campanini, G. Pinna, R. Nardi Trombo-embolismo venoso e malattie autoimmuni sistemiche A. Fontanella, P. Gnerre, R. Nardi IMID nell’anziano: cenni sul trattamento M. Masina Farmaci biosimilari e farmaci innovativi in reumatologia: quale futuro? M. Todoerti, C. Montecucc

Patologia sistemica da virus dell'epatite C: la crioglobulinemia mista e altre manifestazioni extraepatiche

La malattia o sindrome da virus dell'epatite C 1M. Visconti, R. NardiIl virus C 5V. Iovinella, G. IovinellaCrioglobuline, crioglobulinemie e sindromi crioglobulinemiche 10M. Visconti, A. SalvioPatogenesi 14A. IlardiLa vasculite cutanea 19G. Monti, P. Novati, L. Castelnovo, F. SaccardoLe neuropatie periferiche 23R. BoniLa sindrome sicca 29G. ItalianoIl fenomeno di Raynaud 33F. Gallucci, A. Parisi, R. BuonoLa nefropatia crioglobulinemica 40F. SalvatiI linfomi 46M. LaccettiLa patologia articolare 52T. d'Errico, M. Varriale, C. Ambrosca, S. TassinarioSindrome da iperviscosità 56A. Fontanella, L. FontanellaDiagnosi 60G. Uomo, F. GallucciTerapia antivirale 65P.G. Rabitti, F. LampasiDiabete mellito 74A. Maffettone, M. RinaldiMalattie cardiovascolari 80R. Nardi, D. BorioniMalattie dermatologiche 86D. Galasso, D. D'AmicoMalattie neurologiche e psichiatriche 91M. ImparatoCorrelazioni tra patologia epatica e patologia tiroidea. Malattie tiroidee in corso di infezione da virus C 96M. Grandi, C. Sacchetti, S. PederzoliNeoplasie extraepatiche 101S. Fiorino, A. Domanico, E. Accogli, D. Borioni, P. LeandriSarcoidosi e malattie polmonari 109A. Zuccoli, N. Corcione, V. Nuzzo</p

Diagnosis and treatment of acute pancreatitis: The position statement of the Italian Association for the study of the pancreas

BACKGROUND AND AIM: Till now, no Italian studies providing information on acute pancreatitis have been published. The aim of this study was to evaluate the epidemiological and clinical characteristics of acute pancreatitis in Italy. MATERIALS AND METHODS: The study involved 37 Italian centres distributed homogeneously throughout the entire national territory and prospectively collected epidemiological, anamnestic, laboratory, radiological, therapeutic (pharmacological, endoscopic and surgical) data, relevant to each individual case of acute pancreatitis consecutively observed during the period from September 1996 to June 2000. RESULTS: One thousand two hundred and six case report forms were collected, but 201 patients (16.6%) were subsequently eliminated from the final analysis. We therefore studied 1005 patients, 533 (53%) males and 472 (47%) females, mean age 59.6 +/- 20 years. On the basis of the Atlanta classification of acute pancreatitis, 753 patients of the 1005 cases analysed (75%) were mild and 252 patients (25%) severe. The aetiology was biliary in 60% of the patients, related to alcohol abuse in 8.5%, while in 21% of the cases it could not be identified. Over 80% of the patients (83%) were admitted to hospital within 24 h from the onset of clinical symptoms, while only 6% were admitted after 48 h. In particular, 65% of the patients were admitted to hospital within the first 12 h. Antibiotics were used in 85% of the severe and 75% of mild forms. Endoscopic therapy was carried out in 65% of the severe cases, but only in 40% it was carried out prior to 72 h. Eighty-five patients (8.5% of the total, 34% of the severe forms) underwent surgical intervention: 20% on the first day, 38.5% within the fourth day, and the remaining (41.5% of the cases) later on for infected necrosis. The mean duration of hospitalisation for patients with mild pancreatitis was 13 +/- 8 days, while for the severe disease it was of 30 +/- 14 days. The overall mortality rate was 5%, 17% in severe and 1.5% in mild pancreatitis. CONCLUSIONS: Acute pancreatitis in Italy is more commonly a mild disease with a biliary aetiology. The treatment of the disease is not optimal and, on the basis of these data, needs to be standardised. Despite this, the overall mortality rate is low (5%BACKGROUND AND AIM: Till now, no Italian studies providing information on acute pancreatitis have been published. The aim of this study was to evaluate the epidemiological and clinical characteristics of acute pancreatitis in Italy. MATERIALS AND METHODS: The study involved 37 Italian centres distributed homogeneously throughout the entire national territory and prospectively collected epidemiological, anamnestic, laboratory, radiological, therapeutic (pharmacological, endoscopic and surgical) data, relevant to each individual case of acute pancreatitis consecutively observed during the period from September 1996 to June 2000. RESULTS: One thousand two hundred and six case report forms were collected, but 201 patients (16.6%) were subsequently eliminated from the final analysis. We therefore studied 1005 patients, 533 (53%) males and 472 (47%) females, mean age 59.6 +/- 20 years. On the basis of the Atlanta classification of acute pancreatitis, 753 patients of the 10

Parenteral nutrition support for patients with pancreatic cancer. Results of a phase II study

<p>Abstract</p> <p>Background</p> <p>Cachexia is a common problem in patients (pts) suffering from upper gastrointestinal cancer. In addition, most of these patients suffer from malabsorption and stenosis of the gastrointestinal tract due to their illness. Various methods of supplementary nutrition (enteral, parenteral) are practised. In patients with advanced pancreatic cancer (APC), phase angle, determined by bio-electrical impedance analysis (BIA), seems to be a survival predictor. The positive influence of BIA determinate predictors by additional nutrition is currently under discussion.</p> <p>Methods</p> <p>To examine the impact of additional parenteral nutrition (APN) we assessed outpatients suffering from APC and progressive cachexia. The assessment based on the BIA method. Assessment parameters were phase angle, ECM/BCM index (ratio of extracellular mass to body cell mass), and BMI (body mass index). Patients suffering from progressive weight loss in spite of additional enteral nutritional support were eligible for the study.</p> <p>Results</p> <p>Median treatment duration in 32 pts was 18 [8-35] weeks. Response evaluation showed a benefit in 27 pts (84%) in at least one parameter. 14 pts (43.7%) improved or stabilised in all three parameters. The median ECM/BCM index was 1.7 [1.11-3.14] at start of APN and improved down to 1.5 [1.12-3.36] during therapy. The median BMI increased from 19.7 [14.4-25.9] to 20.5 [15.4-25.0]. The median phase angle improved by 10% from 3.6 [2.3-5.1] to 3.9 [2.2-5.1].</p> <p>Conclusions</p> <p>We demonstrated the positive impact of APN on the assessed parameters, first of all the phase angle, and we observed at least a temporary benefit or stabilisation of the nutritional status in the majority of the investigated patients. Based on these findings we are currently investigating the impact of APN on survival in a larger patient cohort.</p> <p>Trial registration</p> <p>ClinicalTrials.gov Identifier: NCT00919659</p

JPN Guidelines for the management of acute pancreatitis: treatment of gallstone-induced acute pancreatitis

Gallstones, along with alcohol, are one of the primary etiological factors of acute pancreatitis, and knowledge of the etiology as well as the diagnosis and management of gallstones, is crucial for managing acute pancreatitis. Because of this, evidence regarding the management of gallstone-induced pancreatitis in Japan was collected, and recommendation levels were established by comparing current clinical practices with optimal clinical practices. The JPN Guidelines for managing gallstone-induced acute pancreatitis recommend two procedures: (1) an urgent endoscopic procedure should be performed in patients in whom biliary duct obstruction is suspected and in patients complicated by cholangitis (Recommendation A); and (2) after the attack of gallstone pancreatitis has subsided, a laparoscopic cholecystectomy should be performed during the same hospital stay (Recommendation B)