MyMedR

Chronic pancreatitis: aetiology, epidemiology and clinical presentation

Goh KL

Med J Malaysia, 2005 Jul;60 Suppl B:94-8.

Chronic pancreatitis is a difficult disease to treat. Worldwide, alcohol is the most common aetiology but based on recent studies it is clear that genetic susceptibility plays an important role in determining disease. Several important genetic mutations have been identified. The prevalence of chronic pancreatitis appears to be lower in Asia although very high rates have been reported in parts of India. Severe intractable pain is the predominant presenting complaint of patients. The natural history of the disease and the onset of exocrine and endocrine insufficiency depend on the classification of disease as early onset, late-onset or alcohol associated. Complications of chronic pancreatitis are important and include pseudocyst formation, bile duct and duodenal strictures.

Matched MeSH terms: Pancreatitis/etiology

Fulltext Pancreatic tuberculosis presenting with recurrent acute pancreatitis

Redha S, Suresh RL, Subramaniam J, Merican I

Med J Malaysia, 2001 Mar;56(1):95-7.

PMID: 11503305

Tuberculosis, in its extrapulmonary form, though emerging as a common clinical problem, rarely affects the pancreas. Its indolent course, vague symptomatology along with its non-specific laboratory and radiographic findings call for greater vigilance. We report a case of pancreatic tuberculosis, previously managed as recurrent alcohol related pancreatitis which showed symptomatic improvement following commencement of antituberculosis drugs. The diagnosis of pancreatic tuberculosis in this case was based on the abdominal CT scan findings, response to anti-tubeculous chemotherapy and overall laboratory and radiological work-up.

Matched MeSH terms: Pancreatitis/etiology*

Fulltext Pancreatitis in primary hyperparathyroidism

Abdullah M

Med J Malaysia, 2003 Oct;58(4):600-3.

PMID: 15190638

The cause and effect relationship between acute pancreatitis and primary hyperparathyroidism (pHPT) still evokes controversy. Our paper reviews the debate in the medical literature. In this controversy we add a case of a 49-year old non-alcoholic man presenting with recurrent attacks of acute pancreatitis. His raised serum calcium was realized rather late. Eventually, high intact parathyroid hormone levels led to open neck exploration and finding of a solitary parathyroid adenoma. Post-surgery, serum calcium returned to normal and abdominal symptoms disappeared. The case report and the accompanying literature review support our belief, that acute pancreatitis is one of the symptoms of pHPT often caused by a parathyroid adenoma and curable by its excision.

Matched MeSH terms: Pancreatitis/etiology*

Fulltext Safe delivery of two parturient women in severe metabolic acidosis

Shariffuddin II, Rai V, Chan YK, Muniandy RK

BMJ Case Rep, 2014;2014.

PMID: 24862427 DOI: 10.1136/bcr-2014-205135

Care of an acutely ill parturient is particularly difficult when we have to balance the needs of both mother and the fetus to survive. The literature suggests there should be emphasis on stabilising the mother's condition. In dealing with metabolic acidosis, however, we believe delivering the baby early might not only relieve the threat of the acidosis on the mother, it may be the only way to deliver a live baby. We report two parturient women with severe metabolic acidosis which was considerably reduced very soon after the delivery and how our timely delivery resulted in the birth of two neurologically intact babies.

Matched MeSH terms: Pancreatitis/etiology

ERCP induced complications

Rupa B, Rao GV, Nageshwar DR

Med J Malaysia, 2005 Jul;60 Suppl B:140.

PMID: 16108197

Matched MeSH terms: Pancreatitis/etiology

Meta-Analysis of Early Endoscopic Retrograde Cholangiopancreatography (ERCP) ± Endoscopic Sphincterotomy (ES) Versus Conservative Management for Gallstone Pancreatitis (GSP)

Burstow MJ, Yunus RM, Hossain MB, Khan S, Memon B, Memon MA

Surg Laparosc Endosc Percutan Tech, 2015 Jun;25(3):185-203.

PMID: 25799261 DOI: 10.1097/SLE.0000000000000142

The utility of early endoscopic retrograde cholangiopancreatography (ERCP) ± endoscopic sphincterotomy (ES) in the treatment of gallstone pancreatitis (GSP) is still contentious.

Matched MeSH terms: Pancreatitis/etiology

Fulltext Life threatening pancreatitis following varicella vaccination: cause, association or co-incidence?

Chan PWK, Goh AYT

Med J Malaysia, 2000 Dec;55(4):527-8.

PMID: 11221171

Matched MeSH terms: Pancreatitis/etiology*

Fulltext Tropical calcific pancreatitis

Tan CT, Kannan P, Sng KH

Med J Malaysia, 1980 Dec;35(2):150-4.

PMID: 7266409

Matched MeSH terms: Pancreatitis/etiology

Fulltext International consensus recommendations for difficult biliary access

Liao WC, Angsuwatcharakon P, Isayama H, Dhir V, Devereaux B, Khor CJ, et al.

Gastrointest Endosc, 2017 Feb;85(2):295-304.

PMID: 27720741 DOI: 10.1016/j.gie.2016.09.037

Matched MeSH terms: Pancreatitis/etiology

Fulltext Acute pancreatitis in north-eastern peninsular Malaysia: an unusual demographic and aetiological pattern

Raj SM, Lopez D, Thambidorai CR, Kandasamy P, Toufeeq Khan TF, Mohamad H, et al.

Singapore Med J, 1995 Aug;36(4):371-4.

PMID: 8919148

A survey of 142 cases of acute pancreatitis was undertaken in two major hospitals serving the state of Kelantan in Malaysia. Females outnumbered males by a ratio of more than 3:1. The incidence among females peaked in the third decade of life. Twenty-one percent (23/109) of the females were pregnant. Ultrasonography revealed gallstones in only 9.4% (13/138). However, abnormalities of serum transaminases were found in 35% (35/100), suggesting that occult gallstones or microlithiasis may be the cause in a significant proportion of patients. Alcohol was virtually absent as an aetiological factor. There was a higher frequency of Ascaris infection in this group than a control hospital population (11/35 vs 33/242; p < 0.02) suggesting that ascariasis may be an important cause of acute pancreatitis in Kelantan. Only 8.4% fell into the category of severe pancreatitis. The overall mortality rate was 2.1%.

Matched MeSH terms: Pancreatitis/etiology*

Fulltext Acute pancreatitis in a multi-ethnic population

Kandasami P, Harunarashid H, Kaur H

Singapore Med J, 2002 Jun;43(6):284-8.

PMID: 12380724

There is very little information in literature describing ethnic variations in etiologic and clinical outcome of acute pancreatitis in the Asian population. This study describes the demographic, etiologic and clinical course of acute pancreatitis among the three main races in Malaysia namely, the Malays, Chinese and Indians. One hundred and thirty-three consecutive patients were admitted for acute pancreatitis for the period January 1994 to July 1999 and they consisted of 77 males and 56 females with a mean age of 43.5 years (SD+/- 14.7). The racial breakdown of acute pancreatitis was: Malays 38 (28.6%), Chinese 19 (14.3%), Indians 75 (56.4%) and 1 (0.8%) patient was an orang asli. The incidence of alcohol association with acute pancreatitis was significantly increased in the males, while gallstone pancreatitis was principally a disease of the female. Alcohol was identified as the predominant factor associated with acute pancreatitis among the Indians (73.3%) and in contrast, gallstone was the commonest associated etiologic factor for the Malays and Chinese. No etiologic factor could be identified in a substantial proportion of the Malay patients (60.5%) when compared to the Chinese (36.8%) and Indians (35%). Severe disease developed in 25% of the cases reviewed but there was no difference in of the rate of severe pancreatitis in terms of ethnic groupings or etiologic factors. The overall mortality rate was 7.5% and the commonest cause of death was multi-organ failure. The study recognises that there are differences in the characteristics of acute pancreatitis among the three major races in the country and this divergence is primarily due to sociocultural habits.

Matched MeSH terms: Pancreatitis/etiology

Can Rectal Diclofenac Prevent Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis?

Lua GW, Muthukaruppan R, Menon J

Dig Dis Sci, 2015 Oct;60(10):3118-23.

PMID: 25757446 DOI: 10.1007/s10620-015-3609-9

BACKGROUND: Non steroidal anti-inflammatory drugs (NSAIDs) have been shown to reduce the incidence of post endoscopic retrograde cholangiopancreatography pancreatitis (PEP). There were various trials using different routes and dosages of NSAIDs but meta-analysis revealed inconsistent results.

AIMS: The aims of this study were to determine the efficacy of rectal diclofenac in preventing PEP and to evaluate any adverse events.

METHODS: This was a randomized, open-label, two-arm, prospective clinical trial. Only patients at high risk of developing PEP were recruited. They received 100 mg rectal diclofenac or no intervention immediately after ERCP. The patients were reviewed 30 days after discharge to evaluate any adverse event.

RESULTS: Among 144 recruited patients, 69 (47.9%) received diclofenac and 75 (52.1%) had no intervention. Eleven patients (7.6%) developed PEP, in which seven were from the diclofenac group and four were in the control group. Eight cases of PEP (5.5%) were mild and three cases (2.1%) were moderate. The differences in pancreatitis incidence and severity between both groups were not statistically significant. There were 11 adverse events reported. Clinically significant bleeding happened in four patients (2.8%): one from the diclofenac group and three from the control group. Other events included cholangitis: two patients (2.9%) from the diclofenac group and four (5.3%) from the control group. One patient from the diclofenac group (1.4%) had a perforation which was treated conservatively.

CONCLUSIONS: In summary, prophylactic rectal diclofenac did not significantly decrease the incidence of PEP among patients at high risk for developing PEP. However, the administration of diclofenac was fairly safe with few clinical adverse events.

Matched MeSH terms: Pancreatitis/etiology

Fulltext Outcomes of early versus delayed cholecystectomy in patients with mild to moderate acute biliary pancreatitis: A randomized prospective study

Jee SL, Jarmin R, Lim KF, Raman K

Asian J Surg, 2018 Jan;41(1):47-54.

PMID: 27530927 DOI: 10.1016/j.asjsur.2016.07.010

BACKGROUND: In patients with acute biliary pancreatitis (ABP), cholecystectomy is mandatory to prevent further biliary events, but the precise timing of cholecystectomy for mild to moderate disease remain a subject of ongoing debate. The aim of this study is to assess the outcomes of early versus delayed cholecystectomy. We hypothesize that early cholecystectomy as compared to delayed cholecystectomy reduces recurrent biliary events without a higher peri-operative complication rate.

METHODS: Patients with mild to moderate ABP were prospectively randomized to either an early cholecystectomy versus a delayed cholecystectomy group. Recurrent biliary events, peri-operative complications, conversion rate, length of surgery and total hospital length of stay between the two groups were evaluated.

RESULTS: A total of 72 patients were enrolled at a single public hospital. Of them, 38 were randomized to the early group and 34 patients to the delayed group. There were no differences regarding peri-operative complications (7.78% vs 11.76%; p = 0.700), conversion rate to open surgery (10.53% vs 11.76%; p = 1.000) and duration of surgery performed (80 vs 85 minutes, p = 0.752). Nevertheless, a greater rate of recurrent biliary events was found in the delayed group (44.12% vs 0%; p ≤ 0.0001) and the hospital length of stay was longer in the delayed group (9 vs 8 days, p = 0.002).

CONCLUSION: In mild to moderate ABP, early laparoscopic cholecystectomy reduces the risk of recurrent biliary events without an increase in operative difficulty or perioperative morbidity.

Matched MeSH terms: Pancreatitis/etiology

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