Conservative Treatment

No abstract available.Image: Acute pancreatitis treatment

Risk Factors of Chronic Pancreatitis

Chronic pancreatitis (CP) still remains a challenging clinical problem with many controversial issues regarding pathogenesis, outcome, and treatment. The disease comprises a spectrum of disorders that culminate as a final step in the destruction of the pancreas. Complex interaction does exist between genetic, environmental and immunologic factors leading to development of the disease. Multiple risk factors interact in a multiple-step model; the pancreatic injury may occur through different mechanisms with transition between an acute pancreatitis condition to recurrent pancreatitis and, finally, to CP. Most patients have multiple risk factors and the overall risk is a product of all risk factors in additive or multiplicative fashion. Susceptibility to develop CP in alcoholics depends on the expression of single gene mutation or is derived from complex genetic polymorphism; in addition, smoking habit can influence the risk of pancreatic calcifications and severity in alcoholic and idiopathic CP. Alteration of the immune response induced by gene mutations and/or environmental factors represents the main determinant of pancreatic fibrosis, the end-stage histologic feature from all CP etiologies

Results of an International Multidisciplinary Consultation on a New Criteria to Assess Acute Pancreatitis Severity: the “Determinant-Based Classification”

Context The Atlanta definition of acute pancreatitis (AP) severity are based on empiric description of occurrences that are merely associated with severity, so resulting in a suboptimal assessment. Objective To develop a new classification of AP severity on the basis of a sound conceptual framework, comprehensive review of published evidence, and worldwide consultation. Methods Invitation to contribute to the development of a new classification of AP severity was sent to all surgeons, gastroenterologists, internists, intensivists, and radiologists who are currently active in the field of clinical AP. A global web-based survey was conducted and a dedicated international symposium was organized to bring contributors from different disciplines together and discuss the concept and definitions. Results The new classification of AP severity is based on the actual local and systemic determinants of severity. The “local determinants” relates to whether there is (peri)pancreatic necrosis or not, and if present whether it is sterile or infected. The “systemic determinants” relates to whether there is organ failure or not, and if present whether it is transient or persistent. The presence of a determinant can modify the effect of another such that the presence of both infected (peri)pancreatic necrosis and persistent organ failure has a greater effect on severity than either alone. The derivation of a classification based on the above principles results in four categories of severity: “mild”, “moderate”, “severe”, and “critical”. Conclusion This classification is the result of a consultative process amongst pancreatologists from 49 countries. It provides a set of concise up-to-date definitions of all the main entities pertinent to classifying the severity of AP in clinical practice and research. This ensures that the “Determinant-Based Classification” can be used in a uniform manner through the world

Individual patient data meta-analysis of organ failure in acute pancreatitis : protocol of the PANCREA II study

Context Organ failure is a major determinant of mortality in patients with acute pancreatitis. These patients usually requireadmission to high dependency or intensive care units and consume considerable health care resources. Given a low incidence rate of organ failure and a lack of large non-interventional studies in the field of acute pancreatitis, the characteristics of organ failure that influence outcomes of patients with acute pancreatitis remain largely unknown. Therefore, the Pancreatitis Across Nations Clinical Research and Education Alliance (PANCREA) aims to conduct a meta-analysis of individual patient data from prospective non-interventional studies to determine the influence of timing, duration, sequence, and combination of different organ failures on mortality in patients with acute pancreatitis. Methods Pancreatologists currently active with acute pancreatitis clinical research will be invited to contribute. To be eligible for inclusion patients will have to meet the criteria of acute pancreatitis, develop at least one organ failure during the first week of hospitalization, and not be enrolled into an intervention study. Raw data will then be collated and checked. Individual patient data analysis based on a logistic regression model with adjustment for confounding variables will be done. For all analyses, corresponding 95% confidence intervals and P values will be reported. Conclusion This collaborative individual patient data meta-analysis will answer important clinical questions regarding patients with acute pancreatitis that develop organ failure. Information derived from this study will be used to optimize routine clinical management and improve care strategies. It can also help validate outcome definitions, allow comparability of results and form a more accurate basis for patient allocation in further clinical studies

When Pathology Marries Clinics: the Honolulu Consensus Document and the Guidelines of the International Association of Pancreatology on Autoimmune Pancreatitis

No abstract available

Autoimmune Pancreatitis: An Autonomous Disease or a Single Entity in a Complex Puzzle of a Multi-Organ Disorder?

No abstract available