• Bile leak
• Biliary obstruction
• Cholangitis
• Cholecystitis
• Emergency MR imaging
• MR cholangiopancreatography
• MRCP
• Pancreatitis

• Biliary Tract Diseases/diagnostic imaging
• Emergencies
• Humans
• Magnetic Resonance Imaging/methods
• Pancreatic Diseases/diagnostic imaging
• Pancreatitis/diagnostic imaging

• Nod-like receptor protein 3
• acute lung injury
• acute pancreatitis
• emodin
• neutrophil

• mortality
• pancreatitis
• risk factors
• serum phospahte

• acute respiratory distress syndrome (ARDS)
• extra corporeal life support (ECLS)
• extra corporeal membrane oxygenation (ECMO)
• pancreatitis

• Acute pancreatitis
• Complications
• Elderly patients
• Risk factors

• Acute pancreatitis
• Atlanta classification
• CT severity index
• severe pancreatitis

• Epidemiology
• Etiology
• Pancreatitis
• Severity
• South-America

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Chile/epidemiology
• Female
• Humans
• Male
• Middle Aged
• Pancreatitis/epidemiology
• Pancreatitis/etiology
• Pancreatitis/therapy
• Retrospective Studies
• Young Adult

• Acute pancreatitis
• Computed tomography
• Imaging
• Radiation dose

• Epidemiology
• acute pancreatitis
• gastroenterology
• pancreas
• pancreatitis

• Acute pancreatitis
• Bipolar affective disorder
• Schizoaffective disorder
• Schizophrenia

• Acute Disease
• Adult
• Bipolar Disorder/complications
• Bipolar Disorder/epidemiology
• Case-Control Studies
• Comorbidity
• Female
• Hospitalization
• Humans
• Male
• Mental Disorders/complications
• Mental Disorders/epidemiology
• Mental Disorders/psychology
• Middle Aged
• Pancreatitis/epidemiology
• Pancreatitis/etiology
• Psychotic Disorders/complications
• Psychotic Disorders/epidemiology
• Retrospective Studies
• Risk Factors
• Schizophrenia/complications
• Schizophrenia/epidemiology

• MC_PC_17214 Medical Research Council
• MR/T045302/1 Medical Research Council
• Department of Health

• Acute Disease
• Aged
• Aged, 80 and over
• Emergency Service, Hospital
• Hospital Mortality
• Humans
• Intensive Care Units
• Length of Stay
• Pancreatitis/diagnosis
• Pancreatitis/therapy
• Prognosis
• Retrospective Studies
• Tertiary Care Centers

• Acute necrotizing pancreatitis
• Age factor
• Magnetic resonance imaging
• Necrosis

• acute pancreatitis
• dynamic contrast-enhanced computed tomography
• pancreatic infection
• severe acute pancreatitis

• Acute pancreatitis
• Antibiotics
• Procalcitonin

• Algorithms
• Anti-Bacterial Agents/adverse effects
• Anti-Bacterial Agents/economics
• Anti-Bacterial Agents/therapeutic use
• Biomarkers/blood
• Clinical Decision-Making
• Clinical Trials, Phase III as Topic
• Cost Savings
• Cost-Benefit Analysis
• Decision Support Techniques
• Drug Costs
• Drug Monitoring/economics
• Drug Monitoring/methods
• England
• Humans
• Pancreatitis/blood
• Pancreatitis/diagnosis
• Pancreatitis/drug therapy
• Pancreatitis/economics
• Pragmatic Clinical Trials as Topic
• Predictive Value of Tests
• Procalcitonin/blood
• Single-Blind Method
• Time Factors
• Treatment Outcome

• Acute pancreatitis
• Charlson’s score
• elderly

Gallstones are the most common cause of acute biliary pancreatitis. Laboratory and imaging findings as well as age are important predictors for mortality. Hospitalization rate is also higher in elderly patients. In this study, we investigated clinical parameters and total mortality in patients with acute pancreatitis aged >65 years.

In this study, 852 patients who entered the Gastroenterology Clinic for acute biliary pancreatitis between April 2006 and October 2013 were included. Data were retrospectively collected from the electronic record system. The patients with elevated aspartate aminotransferase levels (i.e. three times higher than normal value), cholelithiasis, cholecystectomy history, or choledocholithiasis were accepted as the patients with acute biliary pancreatitis. Patients were divided into two groups based on their age, i.e., >65 and <65 years.

In the group with patients aged <65 years, serum alanine aminotransferase, albumin, hematocrit, and amylase, and in the group with patients aged >65 years, urea, leukocyte, and C-reactive protein levels were significantly different. Median hospital stay was similar in both the groups. The rate of detection of choledocholithiasis was significantly higher in elderly patients (p<0.001). Mortality rate was significantly higher in elderly patients for 28 day (0.21% and 2.95%, p<0.001) and 90 day (1.25% and 5.63%, p<0.001). In logistic regression multivariate analysis, age (OR 2.0, 95% CI 1.54–1.36; p=0.006), elevated urea levels (OR 1.12, 95% CI 1.05–1.19; p=0.001), elevated hematocrit levels (OR 1.42, 95% CI 1.13–1.77; p=0.002), and decreased albumin levels (OR 0.05, 95% CI 0.004–0.652; p=0.022) were found predictors for 90-day mortality.

Laboratory findings in elderly patients with acute pancreatitis may differ from those in younger patients. Although radiological findings are similar in both the groups, mortality is higher in the group with patients aged >65 years.

• Acute pancreatitis
• elderly
• mortality

Acute pancreatitis (AP) is one of the urgent diseases of gastroenterology. Due to the growth of the elderly population, the frequency of the disease in the elderly population is also increasing.

To evaluate the contributing factors of mortality in geriatric patients (age ≥ 65 years) and non-geriatric (age < 65 years) patients.

We retrospectively analyzed data of consecutive patients with AP, in the Adana Numune Education and Research Hospital between March 2013 and September 2015.

Of the 602 patients studied, 405 were female and 197 were male and their mean age was 55.2 ±19.5 years. The most common etiological factors were biliary stone, hyperlipidemia and alcohol, respectively. Two hundred and four patients were in the geriatric group and 394 patients were in the non-geriatric group. 84.4% of patients had mild AP, and 15.6% of patients had moderate to severe AP according to the revised Atlanta classification. 91.7% of non-geriatric patients had mild AP while 70.7% of geriatric patients had mild AP (p < 0.001). 29.4% of geriatric patients had moderate-to-severe AP while 8.4% of non-geriatric patients had moderate-severe AP. Duration of hospital stay was 6.2 ±3 days and 5.3 ±2.3 days in geriatric and non-geriatric groups respectively (p < 0.001). Mortality was higher in the geriatric group than the non-geriatric group (9.6% vs. 0.5%, respectively) (p < 0.001).

Acute pancreatitis in the geriatric population shows a more severe course than the non-geriatric population. Geriatric patients have longer duration of hospital stay and higher mortality than non-geriatric patients.

• acute pancreatitis
• geriatric population
• mortality
• prognosis

Introduction: The role of pre-, pro-, and synbiotics supplemented to standard enteral nutrition in severe acute pancreatitis (SAP) remains unclear. We performed this updated meta-analysis to determine the value of pre-, pro- and synbiotics supplemented to standard enteral nutrition in predicted SAP.

Methods: A systematic search in PubMed, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases was performed. Eligible studies were randomized controlled trials (RCTs) that compared the effects of pre-, pro-, and synbiotics supplemented to standard enteral nutrition with control regime in predicted SAP patients. Risk ratio (RR) and mean difference (MD) with 95% confidence interval (95% CI) were used to express the estimates of dichotomous and continuous data respectively.

Results: 13 RCTs comprising an aggregate total of 950 patients were eventually enrolled. Pooled results suggested that supplemented use of pre-, pro- and synbiotics effectively shorten the length of hospital stay in Chinese SAP cohorts (6 RCTs, MD = −5.57, 95% CI = −8.21 to −2.93, P < 0.001); however significant differences with regard to remaining clinical outcomes were not detected for all patients. Further analysis based on category of interventions including pre-, pro- and synbiotics also confirmed the findings to be reliable.

Conclusions: Supplemented use of pre-, pro and synbiotics reduced the length of hospital stay in Chinese SAP cohorts. And thus, we concluded that pre-, pro- and synbiotics supplemented to standard enteral nutrition may be a potential option for the treatment of SAP patients. However, we also suggest designing further studies with large-scale and rigorous methods of addressing data to establish the effects and safety of supplemented use of pre-, pro- and synbiotics for SAP patients due to the presence of limitations.

• enteral nutrition
• meta-analysis
• prebiotics
• probiotics
• severe acute pancreatitis
• synbiotics

• health care cost
• pancreatitis
• pediatric

Gastrin-releasing peptide (GRP) is a pluripotent peptide that has been implicated in both gastrointestinal inflammatory states and classical chronic metabolic diseases such as diabetes. Abnormal glucose metabolism (AGM) after pancreatitis, an exemplar inflammatory disease involving the gastrointestinal tract, is associated with persistent low-grade inflammation and altered secretion of pancreatic and gut hormones as well as cytokines. While GRP is involved in secretion of many of them, it is not known whether GRP has a role in AGM. Therefore, we aimed to investigate the association between GRP and AGM following pancreatitis.

Fasting blood samples were collected to measure GRP, blood glucose, insulin, amylin, glucagon, pancreatic polypeptide (PP), somatostatin, cholecystokinin, gastric-inhibitory peptide (GIP), gastrin, ghrelin, glicentin, glucagon-like peptide-1 and 2, oxyntomodulin, peptide YY (PYY), secretin, vasoactive intestinal peptide, tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein (MCP)-1, and interleukin-6. Modified Poisson regression analysis and linear regression analyses were conducted. Four statistical models were used to adjust for demographic, metabolic, and pancreatitis-related risk factors.

A total of 83 individuals after an episode of pancreatitis were recruited. GRP was significantly associated with AGM, consistently in all four models (P -trend < 0.05), and fasting blood glucose contributed 17% to the variance of GRP. Further, GRP was significantly associated with glucagon (P < 0.003), MCP-1 (P < 0.025), and TNF-α (P < 0.025) - consistently in all four models. GRP was also significantly associated with PP and PYY in three models (P < 0.030 for both), and with GIP and glicentin in one model (P = 0.001 and 0.024, respectively). Associations between GRP and other pancreatic and gut hormones were not significant.

GRP is significantly increased in patients with AGM after pancreatitis and is associated with increased levels of pro-inflammatory cytokines, as well as certain pancreatic and gut hormones. Detailed mechanistic studies are now warranted to investigate the exact role of GRP in derangements of glucose homeostasis following pancreatitis.

• Cytokines
• Gastrin-releasing peptide
• Gut hormones
• Pancreatic hormones
• Post-pancreatitis diabetes mellitus

• Acute pancreatitis
• Aetiology
• Europe
• Incidence

We have established a multicenter international consortium to better understand the natural history of acute pancreatitis (AP) worldwide and to develop a platform for future randomized clinical trials.

The AP patient registry to examine novel therapies in clinical experience (APPRENTICE) was formed in July 2014. Detailed web-based questionnaires were then developed to prospectively capture information on demographics, etiology, pancreatitis history, comorbidities, risk factors, severity biomarkers, severity indices, health-care utilization, management strategies, and outcomes of AP patients.

Between November 2015 and September 2016, a total of 20 sites (8 in the United States, 5 in Europe, 3 in South America, 2 in Mexico and 2 in India) prospectively enrolled 509 AP patients. All data were entered into the REDCap (Research Electronic Data Capture) database by participating centers and systematically reviewed by the coordinating site (University of Pittsburgh). The approaches and methodology are described in detail, along with an interim report on the demographic results.

APPRENTICE, an international collaboration of tertiary AP centers throughout the world, has demonstrated the feasibility of building a large, prospective, multicenter patient registry to study AP. Analysis of the collected data may provide a greater understanding of AP and APPRENTICE will serve as a future platform for randomized clinical trials.

• APPRENTICE
• Acute pancreatitis
• international multicenter consortium
• methodology

• acute pancreatitis
• critical care
• multiple organ dysfunction syndrome
• organ failure
• record linkage analysis
• safe haven

• Acute Disease
• Adult
• Aged
• Aged, 80 and over
• Critical Care/statistics & numerical data
• Databases, Factual
• Diabetes Mellitus, Type 2/complications
• Disease Progression
• Female
• Hospital Mortality
• Humans
• Logistic Models
• Male
• Medical Records
• Middle Aged
• Pancreatitis/mortality
• Patient Admission/statistics & numerical data
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Scotland/epidemiology

• G0901697 Medical Research Council
• MC_PC_15049 Medical Research Council
• MR/K007017/1 Medical Research Council
• MR/M501633/1 Medical Research Council

• Acute pancreatitis
• Co-morbidity
• Elderly patients
• Frailty
• Predictive factors
• Ransom score

• Acute Disease
• Adult
• Aged
• Aged, 80 and over
• Comorbidity
• Databases, Factual
• Female
• Hospitalization
• Humans
• Italy
• Leukocyte Count
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Necrosis/epidemiology
• Pancreatitis/complications
• Pancreatitis/diagnosis
• Retrospective Studies
• Severity of Illness Index
• Young Adult

• Acute pancreatitis
• Clinical update
• Fluid sequestration
• Fluid therapy
• Mortality
• Nutritional support

Acute pancreatitis is a potentially life threatening disease. The spectrum of severity of the illness ranges from mild self-limiting disease to a highly fatal severe necrotizing pancreatitis. Despite intensive research and improved patient care, overall mortality still remains high, reaching up to 30–40% in cases with infected pancreatic necrosis. Although little is known about the exact pathogenesis, it has been widely accepted that premature activation of digestive enzymes within the pancreatic acinar cell is the trigger that leads to autodigestion of pancreatic tissue which is followed by infiltration and activation of leukocytes. Extensive research has been done over the past few decades regarding their role in diagnosis and prognostic evaluation of severe acute pancreatitis. Although many standalone biochemical markers have been studied for early assessment of severity, C-reactive protein still remains the most frequently used along with Interleukin-6. In this review we have discussed briefly the pathogenesis and the role of different biochemical markers in the diagnosis and severity evaluation in acute pancreatitis.

• Acute pancreatitis
• Alcohol
• Calcium overload
• Carboxylester lipase
• Fatty acid ethyl esters
• Mitochondrial dysfunction

• Drainage/adverse effects
• Drainage/methods
• Endoscopy, Digestive System
• Endosonography
• Humans
• Pancreatic Pseudocyst/complications
• Pancreatic Pseudocyst/diagnosis
• Pancreatic Pseudocyst/surgery
• Time Factors
• Tomography, X-Ray Computed
• Ultrasonography, Interventional

• Acute Disease
• Dietary Fiber/therapeutic use
• Dietary Supplements
• Enteral Nutrition/methods
• Enteral Nutrition/mortality
• Female
• Humans
• Immunotherapy/methods
• Immunotherapy/mortality
• Male
• Pancreatitis/mortality
• Pancreatitis/therapy
• Probiotics/therapeutic use
• Randomized Controlled Trials as Topic

Very little is known about whether mortality following acute pancreatitis may be influenced by the following five factors: social deprivation, week day of admission, recruitment of junior doctors in August each year, European Working Time Directives (EWTDs) for junior doctors’ working hours and hospital size. The aim of this study was to establish how mortality following acute pancreatitis may be influenced by these five factors in a large cohort study.

Systematic record linkage of inpatient, mortality and primary care data for 10 589 cases of acute pancreatitis in Wales, UK (population 3.0 million), from 1999 to 2010. The main study outcome measure was mortality at 60 days following the date of admission.

Mortality was 6.4% at 60 days. There was no significant variation in mortality according to social deprivation or the week day of admission. There was also no significant variation according to calendar month for acute pancreatitis overall or for gallstone aetiology, but for alcoholic acute pancreatitis, mortality was increased significantly by 93% for admissions during the months of August and September and 102% from August to October when compared with all other calendar months. Mortality was increased significantly for alcoholic aetiology in August 2004, the official month that the first EWTD was implemented, but there were no other increases following the first or second EWTDs. There were also indications of increased mortality in large hospitals when compared with small hospitals, for acute pancreatitis overall and for gallstone aetiology but not for alcoholic acute pancreatitis, although these increases in mortality were of quite marginal significance.

Although we found some evidence of increased mortality for patients admitted with alcoholic acute pancreatitis during August to October, in August 2004, and in large hospitals for acute pancreatitis overall and for gallstone aetiology, the study factors had limited impact on mortality following acute pancreatitis and no significant impact when adjusted for multiple comparisons.