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Evaluation of hypertriglyceridemia-induced acute pancreatitis

Year 2017, Volume: 16 Issue: 3, 110 - 114, 20.11.2017
https://doi.org/10.17941/agd.351674

Abstract

Background and Aims: Hypertriglyceridemia is the third most common cause of acute pancreatitis. This study investigated the characteristics and outcomes (recurrence and mortality) of patients presenting with hypertriglyceridemia-induced acute pancreatitis. Materials and Methods: A total of 24 patients (average age: 38.8±6.5 years, 79% males) treated at our institution for severe hypertriglyceridemia-induced acute pancreatitis between January 2010 and August 2017 were included in this study. Complete fasting lipid profiles, amylase and lipase levels, and patient demographics were recorded for the evaluation of severe hypertriglyceridemia-induced acute pancreatitis. Results: A total of 615 patients were admitted with acute pancreatitis in our institution within the study period. Severe hypertriglyceridemia-induced acute pancreatitis was present in 24 patients (3.9%). All patients showed significant improvement in their triglyceride levels with medical treatment [therapeutic plasmapheresis with standard treatment (20 patients) or only standard treatment (4 patients)]. Of these patients 41.6% had type 2 diabetes mellitus, 16.6% had impaired glucose tolerance, 25% displayed excessive alcohol use, and 8.3% were pregnant. All these conditions are known to be associated with hypertriglyceridemia. Hospital mortality was 4.1%, and recurrent pancreatitis was detected in 29% of the patients. Conclusions: A high rate of recurrent pancreatitis was observed, which may be related to irregular drug use, lack of diet compliance, poor blood glucose regulation, and pregnancy. The low mortality rate of 4.1% in this cohort may partly be due to aggressive serum triglyceride lowering through a multidisciplinary team. Patients with severe hypertriglyceridemia-induced acute pancreatitis should be treated quickly. If therapeutic plasma exchange is available, triglyceride levels should be lowered to <500 mg/dl.

References

  • 1. Singla A, Csikesz NG, Simons JP, et al. National hospital volume in acute pancreatitis: analysis of the Nationwide In patient Sample 1998–2006. HPB (Oxford) 2009;11:391-7. 2. Fortson MR, Freedman SN, Webster PD 3rd. Clinical assessment of hyperlipidemic pankreatitis. Am J Gastroenterol 1995; 90:2134-9. 3. Searles GE, Ooi TC. Under recognition of chylomicronemia as a cause of acute pancreatitis. CMAJ 1992;147:1806-8. 4. Berglund L, Brunzell JD, Goldberg AC, et al; Endocrine society. Evaluation and treatment of hypertrglyceridemia: an Endocrine Society clinical practice guidline. J Clin Endocrinal Metab 2012;97:2969-89. 5. Sing VK, Bollen TL, Wu BU, et al. An assesment of the severity of intestitial pancreatitis. Clin Gastroenterol Hepatol 2011; 9:1098-103. 6. Van Santvoort HC, Bakker OJ, Bollen TL, et al; Dutch Pancreatitis Study Group. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology 2011;141:1254-63. 7. Brunzell JD, Schrott HG. The interaction of familial and secondary causes of hypertriglyceridemia: role in pancreatitis. J Clin Lipidol 2012;6:409-12. 8. Yadav D, Pitchumoni CS. Issues in hyperlipidemic pancreatitis. J Clin Gastroenterol 2003;36:54-62. 9. Halangk W, Lerch MM, Brandt-Nedelev B, et al. Role of cathepsin B in intracellular trypsinogen activation and the on set of acute pancreatitis. J Clin Invest. 2000;106:773-81. 10. Zeng Y, Wang X, Zhang W, et al. Hypertriglyceridemia aggravates ER stress and pathogenesis of acute pancreatitis. Hepatogastroenterology 2012;59:2318-26. 11. Banks PA, Bollen TL, Dervenis C, et al; Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis. 2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013;62:102-11. 12. Sekimoto M, Takada T, Kawarada Y, et al. JPN Guidelines for the management of acute pancreatitis: epidemiology, etiology, natural history, and outcome predictors in acute pancreatitis. J Hepatobiliary Pancreat Surg 2006;13:10-24. 13. Baranyai T, Terzin V, Vajda A, et al. Acute pancreatitis caused by hypertriglyceridemia. Orv Hetil 2010;151:1869-74. 14. Lloret Linares C, Pelletier AL, Czernichow S, et al. Acute pancreatitis in a cohort of 129 patients referred for severe hypertriglyceridemia. Pancreas 2008;37:13-2. 15. Deng LH, Xue P, Xia Q, et al. Effect of admission hypertriglyceridemia on the episodes of severe acute pancreatitis. World J Gastroenterol 2008;14:4558-61. 16. Toskes PP. Hyperlipidemic pancreatitis. Gastroenterol Clin North Am 1990;19:783-91. 17. O’Brien T, Dinneen SF, O’Brien PC, et al. Hyperlipidemia in patients with primary and secondary hypothyroidism. Mayo Clin Proc 1993;68:860-6. 18. Chang CC, Hsieh YY, Tsai HD, et al. Acute pancreatitis in pregnancy. Zhonghua Yi Xue Za Zhi (Taipei) 1998;61:85-92. 19. Havel RJ. Familial dysbetalipoproteinemia. New aspects of pathogenesis and diagnosis. Med Clin North Am 1982;66:441-54. 20. Nair S, Yadav D, Pitchumoni CS. Association of diabetic ketoacidosis and acute pancreatitis: observations in 100 consecutive episodes of DKA. Am J Gastroenterol 2000; 95:2795-800. 21. Tsuang W, Navaneethan U, Ruiz L, et al. Hypertriglyceridemic pancreatitis: presentation and management. Am J Gastroenterol 2009;104:984-91. 22. Henzen C, Röck M, Schnieper C, Heer K.Heparin and insulin in the treatment of acute hypertriglyceridemia-induced pancreatitis. Schweiz Med Wochenschr 1999;129:1242-8. 23. Betteridge DJ, Bakowski M, Taylor KG, et al. Treatment of severe diabetic hypertriglyceridaemia by plasma exchange. Lancet 1978;311:1368. 24. Gubensek J, Buturovic-Ponikvar J, Marn-Pernat A, et al. Treatment of hyperlipidemic acute pancreatitis with plasma exchange: a single- enter experience. Ther Apher Dial 2009;13:314-7. 25. Schwartz J, Winters JL, Padmanabhan A, et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the writing committee of the American Society for Apheresis: the sixth special issue. J Clin Apher 2013;28:145-284. 26. Chen JH, Yeh JH, Lai HW, Liao CS. Therapeutic plasma exchange in patients with hyperlipidemic pancreatitis. World J Gastroenterol 2004;10:2272-4. 27. Yeh JH, Chen JH, Chiu HC. Plasmapheresis for hyperlipidemic pancreatitis. J Clin Apher 2003;18:181-5. 28. Lennertz A, Parhofer KG, Samtleben W, Bosch T. Therapeutic plasma exchange in patients with chylomicronemia syndrome complicated by acute pancreatitis. Ther Apher 1999;3:227-33. 29. Kadikoylu G, Yavasoglu I, Bolaman Z. Plasma exchange in severe hypertriglyceridemia a clinical study. Transfus Apher Sci 2006;34:253-7.

Hipertrigliseridemi ilişkili akut pankreatit hastalarının değerlendirilmesi

Year 2017, Volume: 16 Issue: 3, 110 - 114, 20.11.2017
https://doi.org/10.17941/agd.351674

Abstract

Giriş ve Amaç: Hipertrigliseridemi, akut pankreatitin en yaygın üçüncü sebebidir. Bu çalışmanın amacı, hipertrigliseridemi ilişkili akut pankreatit tanısı konulan hastaların karakteristiklerini, tekrar ortaya çıkma sıklığı ve mortalitesini araştırmaktır. Gereç ve Yöntem: Ocak 2010 - Ağustos 2017 tarihleri arasında şiddetli hipertrigliseridemi ilişkili akut pankreatit tanısı ile kurumumuzda 24 hasta (yaş ortalaması:38,8±6,5 yıl, %79 erkek) tedavi edildi. Şiddetli hipertrigliseridemi ilişkili akut pankreatiti değerlendirmek için açlık lipid profili, amilaz, lipaz değerleri ve hasta demografik verileri kaydedildi. Bulgular: Çalışma periyodu sırasında kurumumuza akut pankreatit tanısı ile 615 hasta kabul edildi. Şiddetli hipertrigliseridemi ilişkili akut pankreatiti olan hasta sayısı 24 (%3,9) idi. Tüm hastalarda, medikal tedavi sonrası [standart tedavi ile terapötik plazma aferezi (20 hasta) veya sadece standart tedavi (4 hasta)] trigliserid düzeylerinde anlamlı iyileşme oldu. Bizim hastaların hipertrigliseridemi ile ilişkili olarak bilinen durumlardan, %41,6’sında diyabetes mellitus, %16,6’sında bozulmuş glukoz toleransı, %25’inde aşırı alkol alımı, %8,3’ünde hamilelik vardı. Hastane mortalitesi %4,1, rekürren pankreatit ise %29 idi. Sonuç: Rekürren pankreatit oranı yüksek saptandı. Bu, düzensiz fibrat kullanımı, diyet uyumumun zayıf olması, kötü kan şekeri regülasyonu, hamilelik ile ilişkili olabilir. Mortalite oranı %4,1 idi. Bu kısmen bizim multidisipliner takım çalışması sayesinde, serum trigliserid düzeyinin agresif düzeltilmesinden dolayı olabilir. Şiddetli hipertrigliseridemi ilişkili akut pankreatit hızlıca tedavi edilmelidir. Eğer terapötik plazma afarezine ulaşılabiliyor ise trigilserid düzeyi < 500 mg/dl olana kadar yapılmalıdır.


References

  • 1. Singla A, Csikesz NG, Simons JP, et al. National hospital volume in acute pancreatitis: analysis of the Nationwide In patient Sample 1998–2006. HPB (Oxford) 2009;11:391-7. 2. Fortson MR, Freedman SN, Webster PD 3rd. Clinical assessment of hyperlipidemic pankreatitis. Am J Gastroenterol 1995; 90:2134-9. 3. Searles GE, Ooi TC. Under recognition of chylomicronemia as a cause of acute pancreatitis. CMAJ 1992;147:1806-8. 4. Berglund L, Brunzell JD, Goldberg AC, et al; Endocrine society. Evaluation and treatment of hypertrglyceridemia: an Endocrine Society clinical practice guidline. J Clin Endocrinal Metab 2012;97:2969-89. 5. Sing VK, Bollen TL, Wu BU, et al. An assesment of the severity of intestitial pancreatitis. Clin Gastroenterol Hepatol 2011; 9:1098-103. 6. Van Santvoort HC, Bakker OJ, Bollen TL, et al; Dutch Pancreatitis Study Group. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology 2011;141:1254-63. 7. Brunzell JD, Schrott HG. The interaction of familial and secondary causes of hypertriglyceridemia: role in pancreatitis. J Clin Lipidol 2012;6:409-12. 8. Yadav D, Pitchumoni CS. Issues in hyperlipidemic pancreatitis. J Clin Gastroenterol 2003;36:54-62. 9. Halangk W, Lerch MM, Brandt-Nedelev B, et al. Role of cathepsin B in intracellular trypsinogen activation and the on set of acute pancreatitis. J Clin Invest. 2000;106:773-81. 10. Zeng Y, Wang X, Zhang W, et al. Hypertriglyceridemia aggravates ER stress and pathogenesis of acute pancreatitis. Hepatogastroenterology 2012;59:2318-26. 11. Banks PA, Bollen TL, Dervenis C, et al; Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis. 2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013;62:102-11. 12. Sekimoto M, Takada T, Kawarada Y, et al. JPN Guidelines for the management of acute pancreatitis: epidemiology, etiology, natural history, and outcome predictors in acute pancreatitis. J Hepatobiliary Pancreat Surg 2006;13:10-24. 13. Baranyai T, Terzin V, Vajda A, et al. Acute pancreatitis caused by hypertriglyceridemia. Orv Hetil 2010;151:1869-74. 14. Lloret Linares C, Pelletier AL, Czernichow S, et al. Acute pancreatitis in a cohort of 129 patients referred for severe hypertriglyceridemia. Pancreas 2008;37:13-2. 15. Deng LH, Xue P, Xia Q, et al. Effect of admission hypertriglyceridemia on the episodes of severe acute pancreatitis. World J Gastroenterol 2008;14:4558-61. 16. Toskes PP. Hyperlipidemic pancreatitis. Gastroenterol Clin North Am 1990;19:783-91. 17. O’Brien T, Dinneen SF, O’Brien PC, et al. Hyperlipidemia in patients with primary and secondary hypothyroidism. Mayo Clin Proc 1993;68:860-6. 18. Chang CC, Hsieh YY, Tsai HD, et al. Acute pancreatitis in pregnancy. Zhonghua Yi Xue Za Zhi (Taipei) 1998;61:85-92. 19. Havel RJ. Familial dysbetalipoproteinemia. New aspects of pathogenesis and diagnosis. Med Clin North Am 1982;66:441-54. 20. Nair S, Yadav D, Pitchumoni CS. Association of diabetic ketoacidosis and acute pancreatitis: observations in 100 consecutive episodes of DKA. Am J Gastroenterol 2000; 95:2795-800. 21. Tsuang W, Navaneethan U, Ruiz L, et al. Hypertriglyceridemic pancreatitis: presentation and management. Am J Gastroenterol 2009;104:984-91. 22. Henzen C, Röck M, Schnieper C, Heer K.Heparin and insulin in the treatment of acute hypertriglyceridemia-induced pancreatitis. Schweiz Med Wochenschr 1999;129:1242-8. 23. Betteridge DJ, Bakowski M, Taylor KG, et al. Treatment of severe diabetic hypertriglyceridaemia by plasma exchange. Lancet 1978;311:1368. 24. Gubensek J, Buturovic-Ponikvar J, Marn-Pernat A, et al. Treatment of hyperlipidemic acute pancreatitis with plasma exchange: a single- enter experience. Ther Apher Dial 2009;13:314-7. 25. Schwartz J, Winters JL, Padmanabhan A, et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the writing committee of the American Society for Apheresis: the sixth special issue. J Clin Apher 2013;28:145-284. 26. Chen JH, Yeh JH, Lai HW, Liao CS. Therapeutic plasma exchange in patients with hyperlipidemic pancreatitis. World J Gastroenterol 2004;10:2272-4. 27. Yeh JH, Chen JH, Chiu HC. Plasmapheresis for hyperlipidemic pancreatitis. J Clin Apher 2003;18:181-5. 28. Lennertz A, Parhofer KG, Samtleben W, Bosch T. Therapeutic plasma exchange in patients with chylomicronemia syndrome complicated by acute pancreatitis. Ther Apher 1999;3:227-33. 29. Kadikoylu G, Yavasoglu I, Bolaman Z. Plasma exchange in severe hypertriglyceridemia a clinical study. Transfus Apher Sci 2006;34:253-7.
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Details

Journal Section Articles
Authors

Altay Kandemir 0000-0002-2918-3811

Adil Coşkun 0000-0002-1549-5451

Publication Date November 20, 2017
Published in Issue Year 2017 Volume: 16 Issue: 3

Cite

APA Kandemir, A., & Coşkun, A. (2017). Hipertrigliseridemi ilişkili akut pankreatit hastalarının değerlendirilmesi. Akademik Gastroenteroloji Dergisi, 16(3), 110-114. https://doi.org/10.17941/agd.351674

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