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Khetpal N, Sharbatji M, Asfari MM, Ahmad S. Outcomes of Acute Pancreatitis Hospitalizations with Obesity. Dig Dis Sci 2025; 70:1350-1359. [PMID: 39946065 PMCID: PMC11972170 DOI: 10.1007/s10620-025-08880-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 01/17/2025] [Indexed: 04/06/2025]
Abstract
OBJECTIVE Assessing the relationship of body mass index (BMI) on acute pancreatitis (AP) hospitalization in the United States (US). METHODS The National Inpatient Sample utilized to capture normal weight, overweight, and obese AP hospitalization in the US during 2020 based on BMI. Patients, hospitalization characteristics, and outcomes were compared. RESULTS In 2020, there were 53,000 (20%) obese, 3980 (2.6%) overweight, and 210,000 (77.4%) normal weight AP hospitalizations. All-cause inpatient mortality was similar for obese, and overweight compared to normal weight AP hospitalizations, respectively (0.65% vs 0.63% vs 0.6%). Furthermore, obese AP hospitalization had a higher chance of developing systemic [odds ratio (OR): 1.7, confidence interval (CI) (1.35-2.12)], and needing intubation or vasopressor requirement OR: 1.75, CI (1.14-2.68), compared to normal AP patients. However, overweight AP hospitalizations had similar chance of developing systemic OR: 1.1, CI (0.83-1.38) and local complication OR: 1.14, CI (0.88-1.5), needing intubation or vasopressor requirements OR: 1.27, CI (0.73-2.23) except use of jejunostomy tube was higher OR: 1.74, CI (1.1-2.75) compared to normal weight AP hospitalizations. The mean length-of-stay and mean total healthcare costs were higher among obese by 2.14 days (CI 0.9-3.37), p = 0.001 and by US$ 21,626, CI (4379-38,872), p = 0.014 compared to normal weight AP hospitalizations. CONCLUSIONS Obese and overnight AP hospitalizations had similar inpatient mortality compared to normal weight hospitalizations. Obese AP hospitalizations have higher complications and healthcare utilization compared to normal weight hospitalizations.
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Affiliation(s)
- Neelam Khetpal
- Hartford HealthCare Medical Group at Hartford Hospital, Department of Hospital Medicine, Hartford, CT, 06102, USA
| | - Mohamad Sharbatji
- Department of Internal Medicine, AdventHealth Hospital and Loma Linda University Regional Campus, Orlando, FL, 32804, USA.
| | - Mohammad Maysara Asfari
- Department of Internal Medicine, AdventHealth Hospital and Loma Linda University Regional Campus, Orlando, FL, 32804, USA
| | - Sarfraz Ahmad
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL, 32804, USA
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Fu H, Li P, Sun S, Li L. Validation of the Global Leadership Initiative on Malnutrition Criteria for Predicting Adverse Outcomes in Acute Pancreatitis. Ther Clin Risk Manag 2024; 20:543-556. [PMID: 39220772 PMCID: PMC11365515 DOI: 10.2147/tcrm.s471127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024] Open
Abstract
Background and Aim The Global Leadership Initiative on Malnutrition (GLIM) has proposed criteria for the diagnosis of malnutrition. No studies validated the GLIM criteria in acute pancreatitis (AP). The present study aimed to validate the predictive capacity of GLIM criteria for adverse outcomes in AP patients. Patients and Methods Clinical data of 269 patients with AP were analyzed retrospectively. The Nutritional Risk Screening 2002 (NRS2002) was chosen as the screening tool. Multivariate logistic regression analyses evaluated the adverse clinical outcomes in malnourished patients. Results Overall, 160 patients (59.5%) were at nutritional risk and 38 (14.1%) were malnourished. Reduced muscle mass/ low body mass index + inflammation combinations contributed most to malnutrition overall and in each subgroup. The malnourished group had lower hemoglobin, neutrophils, albumin, total cholesterol, and triglycerides than the well-nourished group. The malnourished group had higher hospitalization costs (CNY, 11319.34 vs 9258.22, p <0.001) and more local complications (34.2% vs 14.7%, p =0.009) than the well-nourished group. There was an interaction between malnutrition and overweight/obesity on local complications (p for interaction = 0.023). Multivariate logistic regression showed malnutrition was significantly associated with local complications (OR 12.2, 95% CI: 2.51-59.37), infectious complications (OR 9.95, 95% CI: 1.25-79.44) and composite adverse outcome (OR 4.78, 95% CI: 1.05-21.73) in the overweight/obesity subgroup. There was no association between malnutrition and the rate of various adverse outcomes in the non-overweight/obesity subgroup. Additionally, we observed an association between malnutrition and composite adverse outcome (OR 6.75, 95% CI: 1.49-30.68) in patients <70 years only in females. Conclusion Malnourished AP patients were more likely to have adverse outcomes than well-nourished patients. Malnutrition was associated with various adverse outcomes only in the overweight/obesity subgroups.
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Affiliation(s)
- Hao Fu
- Nutrition Department, Affiliated Hospital of Chengde Medical University, Chengde, Heibei, People’s Republic of China
| | - Ping Li
- Gastroenterology, Affiliated Hospital of Chengde Medical University, Chengde, Heibei, People’s Republic of China
| | - Shuang Sun
- Nutrition Department, Affiliated Hospital of Chengde Medical University, Chengde, Heibei, People’s Republic of China
| | - Ling Li
- Nutrition Department, Affiliated Hospital of Chengde Medical University, Chengde, Heibei, People’s Republic of China
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Manrai M, Singh AK, Birda CL, Shah J, Dutta A, Bhadada SK, Kochhar R. Diabetes mellitus as a consequence of acute severe pancreatitis: Unraveling the mystery. World J Diabetes 2023; 14:1212-1225. [PMID: 37664472 PMCID: PMC10473947 DOI: 10.4239/wjd.v14.i8.1212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/19/2023] [Accepted: 07/06/2023] [Indexed: 08/11/2023] Open
Abstract
The occurrence of diabetes mellitus (DM) in pancreatitis is being increasingly recognized lately. Diabetes can develop not only with chronic pancreatitis but even after the first episode of acute pancreatitis (AP). The incidence of diabetes after AP varies from 18% to 23% in 3 years and reaches up to 40% over 5 years. The exact pathogenesis of diabetes after AP is poorly understood and various mechanisms proposed include loss of islet cell mass, AP-induced autoimmunity, and alterations in the insulin incretin axis. Risk factors associated with increased risk of diabetes includes male sex, recurrent attacks of pancreatitis, presence of pancreatic exocrine insufficiency and level of pancreatitic necrosis. Diagnosis of post-pancreatitis DM (PPDM) is often excluded. Treatment includes a trial of oral antidiabetic drugs in mild diabetes. Often, insulin is required in uncontrolled diabetes. Given the lack of awareness of this metabolic disorder after AP, this review will evaluate current information on epidemiology, risk factors, diagnosis and management of PPDM and identify the knowledge gaps.
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Affiliation(s)
- Manish Manrai
- Department of Internal Medicine, Armed Forces Medical College, Pune 411040, Maharashtra, India
| | - Anupam K Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Chhagan Lal Birda
- Department of Gastroenterology, All India Institutes of Medical Sciences, Jodhpur 342001, India
| | - Jimil Shah
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Aditya Dutta
- Department of Endocrinology, Max Hospital, New Delhi 110017, India
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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García-Compeán D, Jiménez-Rodríguez AR, Muñoz-Ayala JM, González-González JA, Maldonado-Garza HJ, Villarreal-Pérez JZ. Post-acute pancreatitis diabetes: A complication waiting for more recognition and understanding. World J Gastroenterol 2023; 29:4405-4415. [PMID: 37576704 PMCID: PMC10415972 DOI: 10.3748/wjg.v29.i28.4405] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/22/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023] Open
Abstract
Post-acute pancreatitis diabetes (PAPD) is the second most common type of diabetes below type 2 diabetes mellitus. Due to the boom in research on this entity carried out during the last decade, its recognition has increased. However, much of the medical community still does not recognize it as a medium and long-term complication of acute pancreatitis (AP). Recent prospective cohort studies show that its incidence is about 23% globally and 34.5% in patients with severe AP. With the overall increase in the incidence of AP this complication will be certainly seen more frequently. Due to its high morbidity, mortality and difficult control, early detection and treatment are essential. However, its risk factors and pathophysiological mechanisms are not clearly defined. Its diagnosis should be made excluding pre-existing diabetes and applying the criteria of the American Diabetes Association after 90 d of resolution of one or more AP episodes. This review will show the evidence published so far on the incidence and prevalence, risk factors, possible pathophysiological mechanisms, clinical outcomes, clinical characteristics and preventive and corrective management of PAPD. Some important gaps needing to be clarified in forthcoming studies will also be discussed.
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Affiliation(s)
- Diego García-Compeán
- Department of Gastroenterology, Autonomous University of Nuevo León, Monterrey 64700, Nuevo León, Mexico
| | - Alan R Jiménez-Rodríguez
- Department of Gastroenterology, Autonomous University of Nuevo León, Monterrey 64700, Nuevo León, Mexico
| | - Juan M Muñoz-Ayala
- Department of Gastroenterology, Autonomous University of Nuevo León, Monterrey 64700, Nuevo León, Mexico
| | - José A González-González
- Department of Gastroenterology, Autonomous University of Nuevo León, Monterrey 64700, Nuevo León, Mexico
| | - Héctor J Maldonado-Garza
- Department of Gastroenterology, Autonomous University of Nuevo León, Monterrey 64700, Nuevo León, Mexico
| | - Jesús Z Villarreal-Pérez
- Department of Endocrinology, Autonomous University of Nuevo León, Monterrey 64700, Nuevo León, Mexico
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Bischoff SC, Ockenga J, Eshraghian A, Barazzoni R, Busetto L, Campmans-Kuijpers M, Cardinale V, Chermesh I, Kani HT, Khannoussi W, Lacaze L, Léon-Sanz M, Mendive JM, Müller MW, Tacke F, Thorell A, Vranesic Bender D, Weimann A, Cuerda C. Practical guideline on obesity care in patients with gastrointestinal and liver diseases - Joint ESPEN/UEG guideline. Clin Nutr 2023; 42:987-1024. [PMID: 37146466 DOI: 10.1016/j.clnu.2023.03.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Patients with chronic gastrointestinal disease such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), celiac disease, gastroesophageal reflux disease (GERD), pancreatitis, and chronic liver disease (CLD) often suffer from obesity because of coincidence (IBD, IBS, celiac disease) or related pathophysiology (GERD, pancreatitis and CLD). It is unclear if such patients need a particular diagnostic and treatment that differs from the needs of lean gastrointestinal patients. The present guideline addresses this question according to current knowledge and evidence. OBJECTIVE The present practical guideline is intended for clinicians and practitioners in general medicine, gastroenterology, surgery and other obesity management, including dietitians and focuses on obesity care in patients with chronic gastrointestinal diseases. METHODS The present practical guideline is the shortened version of a previously published scientific guideline developed according to the standard operating procedure for ESPEN guidelines. The content has been re-structured and transformed into flow-charts that allow a quick navigation through the text. RESULTS In 100 recommendations (3× A, 33× B, 24 × 0, 40× GPP, all with a consensus grade of 90% or more) care of gastrointestinal patients with obesity - including sarcopenic obesity - is addressed in a multidisciplinary way. A particular emphasis is on CLD, especially metabolic associated liver disease, since such diseases are closely related to obesity, whereas liver cirrhosis is rather associated with sarcopenic obesity. A special chapter is dedicated to obesity care in patients undergoing bariatric surgery. The guideline focuses on adults, not on children, for whom data are scarce. Whether some of the recommendations apply to children must be left to the judgment of the experienced pediatrician. CONCLUSION The present practical guideline offers in a condensed way evidence-based advice how to care for patients with chronic gastrointestinal diseases and concomitant obesity, an increasingly frequent constellation in clinical practice.
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Affiliation(s)
- Stephan C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany.
| | - Johann Ockenga
- Medizinische Klinik II, Klinikum Bremen-Mitte, Bremen FRG, Bremen, Germany.
| | - Ahad Eshraghian
- Department of Gastroenterology and Hepatology, Avicenna Hospital, Shiraz, Iran.
| | - Rocco Barazzoni
- Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy.
| | - Luca Busetto
- Department of Medicine, University of Padova, Padova, Italy.
| | - Marjo Campmans-Kuijpers
- Department of Gastroenterology and Hepatology, University Medical Centre Groningen, Groningen, the Netherlands.
| | - Vincenzo Cardinale
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.
| | - Irit Chermesh
- Department of Gastroenterology, Rambam Health Care Campus, Affiliated with Technion-Israel Institute of Technology, Haifa, Israel.
| | - Haluk Tarik Kani
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey.
| | - Wafaa Khannoussi
- Hepato-Gastroenterology Department, Mohammed VI University Hospital, Oujda, Morocco; and Laboratoire de Recherche des Maladies Digestives (LARMAD), Mohammed the First University, Oujda, Morocco.
| | - Laurence Lacaze
- Department of General Surgery, Mantes-la-Jolie Hospital, Mantes-la-Jolie, France.
| | - Miguel Léon-Sanz
- Department of Endocrinology and Nutrition, University Hospital Doce de Octubre, Medical School, University Complutense, Madrid, Spain.
| | - Juan M Mendive
- La Mina Primary Care Academic Health Centre, Catalan Institute of Health (ICS), University of Barcelona, Barcelona, Spain.
| | - Michael W Müller
- Department of General and Visceral Surgery, Regionale Kliniken Holding, Kliniken Ludwigsburg-Bietigheim gGmbH, Krankenhaus Bietigheim, Bietigheim-Bissingen, Germany.
| | - Frank Tacke
- Department of Hepatology & Gastroenterology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany.
| | - Anders Thorell
- Department of Clinical Science, Danderyds Hospital, Karolinska Institutet & Department of Surgery, Ersta Hospital, Stockholm, Sweden.
| | - Darija Vranesic Bender
- Unit of Clinical Nutrition, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.
| | - Arved Weimann
- Department of General, Visceral and Oncological Surgery, St. George Hospital, Leipzig, Germany.
| | - Cristina Cuerda
- Departamento de Medicina, Universidad Complutense de Madrid, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Váncsa S, Sipos Z, Váradi A, Nagy R, Ocskay K, Juhász FM, Márta K, Teutsch B, Mikó A, Hegyi PJ, Vincze Á, Izbéki F, Czakó L, Papp M, Hamvas J, Varga M, Török I, Mickevicius A, Erőss B, Párniczky A, Szentesi A, Pár G, Hegyi P. Metabolic-associated fatty liver disease is associated with acute pancreatitis with more severe course: Post hoc analysis of a prospectively collected international registry. United European Gastroenterol J 2023; 11:371-382. [PMID: 37062947 PMCID: PMC10165320 DOI: 10.1002/ueg2.12389] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/21/2023] [Indexed: 04/18/2023] Open
Abstract
INTRODUCTION Non-alcoholic fatty liver disease (NAFLD) is a proven risk factor for acute pancreatitis (AP). However, NAFLD has recently been redefined as metabolic-associated fatty liver disease (MAFLD). In this post hoc analysis, we quantified the effect of MAFLD on the outcomes of AP. METHODS We identified our patients from the multicentric, prospective International Acute Pancreatitis Registry of the Hungarian Pancreatic Study Group. Next, we compared AP patients with and without MAFLD and the individual components of MAFLD regarding in-hospital mortality and AP severity based on the revised Atlanta classification. Lastly, we calculated odds ratios (ORs) with 95% confidence intervals (CIs) using multivariate logistic regression analysis. RESULTS MAFLD had a high prevalence in AP, 39% (801/2053). MAFLD increased the odds of moderate-to-severe AP (OR = 1.43, CI: 1.09-1.89). However, the odds of in-hospital mortality (OR = 0.89, CI: 0.42-1.89) and severe AP (OR = 1.70, CI: 0.97-3.01) were not higher in the MAFLD group. Out of the three diagnostic criteria of MAFLD, the highest odds of severe AP was in the group based on metabolic risk abnormalities (OR = 2.68, CI: 1.39-5.09). In addition, the presence of one, two, and three diagnostic criteria dose-dependently increased the odds of moderate-to-severe AP (OR = 1.23, CI: 0.88-1.70, OR = 1.38, CI: 0.93-2.04, and OR = 3.04, CI: 1.63-5.70, respectively) and severe AP (OR = 1.13, CI: 0.54-2.27, OR = 2.08, CI: 0.97-4.35, and OR = 4.76, CI: 1.50-15.4, respectively). Furthermore, in patients with alcohol abuse and aged ≥60 years, the effect of MAFLD became insignificant. CONCLUSIONS MAFLD is associated with AP severity, which varies based on the components of its diagnostic criteria. Furthermore, MAFLD shows a dose-dependent effect on the outcomes of AP.
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Chaigneau T, Morello R, Vannier E, Musikas M, Piquet MA, Dupont B. Impact of sarcopenic obesity on predicting the severity of acute pancreatitis. Dig Liver Dis 2023:S1590-8658(23)00217-7. [PMID: 36849286 DOI: 10.1016/j.dld.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 02/04/2023] [Accepted: 02/09/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND AND AIMS This work aimed to evaluate the impact of sarcopenia and sarcopenic obesity on the occurrence of severe pancreatitis and to study the performance of anthropometric indices to predict severe forms. METHODS We conducted a single-center retrospective study at Caen University Hospital between 2014 and 2017. Sarcopenia was assessed by measuring the psoas area on an abdominal scan. The psoas area /body mass index ratio reflected sarcopenic obesity. By normalizing the value to the body surface, we obtained an index called sarcopancreatic index, avoiding sex differences in measurements. RESULTS Among 467 included patients, 65 (13.9%) developed severe pancreatitis. The sarcopancreatic index was independently associated with the occurrence of severe pancreatitis (1.455 95% CI [1.028-2.061]; p = 0.035), as was the Visual Analog Scale, creatinine or albumin. The complication rate was not different depending on sarcopancreatic index value. Based on variables independently associated with the occurrence of severe pancreatitis, we constructed a score called Sarcopenia Severity Index. This score presented an area under the receiver operating characteristics curve of 0.84, comparable to the Ranson score (0.87) and superior to body mass index or the sarcopancreatic index to predict a severe form of acute pancreatitis. CONCLUSIONS Sarcopenic obesity seems to be associated with severe acute pancreatitis.
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Affiliation(s)
- Thomas Chaigneau
- Département d'Hepato-Gastroenterologie et Nutrition, Normandie Univ, UNICAEN, CHU de Caen Normandie, Avenue Côte de Nacre, 14033 CAEN, France
| | - Remy Morello
- Plateforme de Méthodologie, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000 CAEN, France
| | - Elise Vannier
- Département d'Hepato-Gastroenterologie et Nutrition, Normandie Univ, UNICAEN, CHU de Caen Normandie, Avenue Côte de Nacre, 14033 CAEN, France
| | - Marietta Musikas
- Département d'Hepato-Gastroenterologie et Nutrition, Normandie Univ, UNICAEN, CHU de Caen Normandie, Avenue Côte de Nacre, 14033 CAEN, France
| | - Marie-Astrid Piquet
- Département d'Hepato-Gastroenterologie et Nutrition, Normandie Univ, UNICAEN, CHU de Caen Normandie, Avenue Côte de Nacre, 14033 CAEN, France
| | - Benoît Dupont
- Département d'Hepato-Gastroenterologie et Nutrition, Normandie Univ, UNICAEN, CHU de Caen Normandie, Avenue Côte de Nacre, 14033 CAEN, France.
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8
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Bischoff SC, Barazzoni R, Busetto L, Campmans-Kuijpers M, Cardinale V, Chermesh I, Eshraghian A, Kani HT, Khannoussi W, Lacaze L, Léon-Sanz M, Mendive JM, Müller MW, Ockenga J, Tacke F, Thorell A, Vranesic Bender D, Weimann A, Cuerda C. European guideline on obesity care in patients with gastrointestinal and liver diseases - Joint ESPEN/UEG guideline. Clin Nutr 2022; 41:2364-2405. [PMID: 35970666 DOI: 10.1016/j.clnu.2022.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/03/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with chronic gastrointestinal (GI) disease such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), celiac disease, gastroesophageal reflux disease (GERD), pancreatitis, and chronic liver disease (CLD) often suffer from obesity because of coincidence (IBD, IBS, celiac disease) or related pathophysiology (GERD, pancreatitis and CLD). It is unclear if such patients need a particular diagnostic and treatment that differs from the needs of lean GI patients. The present guideline addresses this question according to current knowledge and evidence. OBJECTIVE The objective of the guideline is to give advice to all professionals working in the field of gastroenterology care including physicians, surgeons, dietitians and others how to handle patients with GI disease and obesity. METHODS The present guideline was developed according to the standard operating procedure for ESPEN guidelines, following the Scottish Intercollegiate Guidelines Network (SIGN) grading system (A, B, 0, and good practice point (GPP)). The procedure included an online voting (Delphi) and a final consensus conference. RESULTS In 100 recommendations (3x A, 33x B, 24x 0, 40x GPP, all with a consensus grade of 90% or more) care of GI patients with obesity - including sarcopenic obesity - is addressed in a multidisciplinary way. A particular emphasis is on CLD, especially fatty liver disease, since such diseases are closely related to obesity, whereas liver cirrhosis is rather associated with sarcopenic obesity. A special chapter is dedicated to obesity care in patients undergoing bariatric surgery. The guideline focuses on adults, not on children, for whom data are scarce. Whether some of the recommendations apply to children must be left to the judgment of the experienced pediatrician. CONCLUSION The present guideline offers for the first time evidence-based advice how to care for patients with chronic GI diseases and concomitant obesity, an increasingly frequent constellation in clinical practice.
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Affiliation(s)
- Stephan C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany.
| | - Rocco Barazzoni
- Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy.
| | - Luca Busetto
- Department of Medicine, University of Padova, Padova, Italy.
| | - Marjo Campmans-Kuijpers
- Department of Gastroenterology and Hepatology, University Medical Centre Groningen, Groningen, the Netherlands.
| | - Vincenzo Cardinale
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.
| | - Irit Chermesh
- Department of Gastroenterology, Rambam Health Care Campus, Affiliated with Technion-Israel Institute of Technology, Haifa, Israel.
| | - Ahad Eshraghian
- Department of Gastroenterology and Hepatology, Avicenna Hospital, Shiraz, Iran.
| | - Haluk Tarik Kani
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey.
| | - Wafaa Khannoussi
- Hepato-Gastroenterology Department, Mohammed VI University Hospital, Oujda, Morocco; Laboratoire de Recherche des Maladies Digestives (LARMAD), Mohammed the First University, Oujda, Morocco.
| | - Laurence Lacaze
- Department of General Surgery, Mantes-la-Jolie Hospital, Mantes-la-Jolie, France; Department of Clinical Nutrition, Paul-Brousse-Hospital, Villejuif, France.
| | - Miguel Léon-Sanz
- Department of Endocrinology and Nutrition, University Hospital Doce de Octubre, Medical School, University Complutense, Madrid, Spain.
| | - Juan M Mendive
- La Mina Primary Care Academic Health Centre, Catalan Institute of Health (ICS), University of Barcelona, Barcelona, Spain.
| | - Michael W Müller
- Department of General and Visceral Surgery, Regionale Kliniken Holding, Kliniken Ludwigsburg-Bietigheim GGmbH, Krankenhaus Bietigheim, Bietigheim-Bissingen, Germany.
| | - Johann Ockenga
- Medizinische Klinik II, Klinikum Bremen-Mitte, Bremen FRG, Bremen, Germany.
| | - Frank Tacke
- Department of Hepatology & Gastroenterology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany.
| | - Anders Thorell
- Department of Clinical Science, Danderyds Hospital, Karolinska Institutet & Department of Surgery, Ersta Hospital, Stockholm, Sweden.
| | - Darija Vranesic Bender
- Unit of Clinical Nutrition, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.
| | - Arved Weimann
- Department of General, Visceral and Oncological Surgery, St. George Hospital, Leipzig, Germany.
| | - Cristina Cuerda
- Departamento de Medicina, Universidad Complutense de Madrid, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Sardana O, Kumari P, Singh R, Chopra H, Emran TB. Health-related quality of life among acute pancreatitis patients correlates with metabolic variables and associated factors. Ann Med Surg (Lond) 2022; 82:104504. [PMID: 36268403 PMCID: PMC9577452 DOI: 10.1016/j.amsu.2022.104504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/19/2022] [Accepted: 08/21/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Acute pancreatitis (AP) and associated metabolic abnormalities constitute prevalent medical disorders that have disastrous implications and expensive cost of care. However, the connection with metabolic abnormalities and their influence on wellbeing i.e., health-related quality of life (HRQoL) remains unclear. As a result, we investigated the influence of MetS components on HRQoL in AP patients. Methods In a tertiary care hospital in North India, comprehensive observational research was undertaken with enrollment of subjects having AP along metabolic syndrome (MetS) or without was included. MetS was diagnosed for subjects using the National Cholesterol Education Program–Adult Treatment Panel III (NCEP-ATP III) guidelines. Various socio-demographic variables were also taken into consideration for the calculation of statistical significance (P ≤ 0.05) in AP patients. Student's t-test and Short Form-36 (SF-36) along with the association between AP and MetS, as well as their impact on HRQoL, was investigated finally with, Pearson Correlation Analysis Factor. Results The study comprised 100 subjects or patients diseased of AP associated with MetS and 100 patients with AP associated without MetS. Gender, Age, Educational Status, Tobacco uses along with the metabolic variables were found to be statistically significant (P ≤ 0.05) and comparatively increased in patients with AP with MetSthan AP without MetS except HDL levels. Finally, a negative association between all metabolic variables with the exception of HDL, and AP was found to be producing deterioration in Health compartment scores. Conclusion AP with MetS patients had a worse aggregate HRQOL than AP without MetS patients.
Acute pancreatitis (AP) and associated metabolic abnormalities constitute prevalent medical disorders. We investigated the influence of MetS components on HRQoL in AP patients. The focus of this study is to figure out the relationship between MetS with quality of life among AP patients. AP with MetS patients had a worse aggregate HRQOL than AP without MetS patients.
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Affiliation(s)
- Ojus Sardana
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Pratima Kumari
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Ravinder Singh
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
- Corresponding author. Department of Pharmacy Practice, Chitkara College of Pharmacy, Chitkara University, Patiala, 140401, Punjab, India.
| | - Hitesh Chopra
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Talha Bin Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, 4381, Bangladesh
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, 1207, Bangladesh
- Corresponding author. Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, 4381, Bangladesh.
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10
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Bischoff SC, Barazzoni R, Busetto L, Campmans‐Kuijpers M, Cardinale V, Chermesh I, Eshraghian A, Kani HT, Khannoussi W, Lacaze L, Léon‐Sanz M, Mendive JM, Müller MW, Ockenga J, Tacke F, Thorell A, Vranesic Bender D, Weimann A, Cuerda C. European guideline on obesity care in patients with gastrointestinal and liver diseases - Joint European Society for Clinical Nutrition and Metabolism / United European Gastroenterology guideline. United European Gastroenterol J 2022; 10:663-720. [PMID: 35959597 PMCID: PMC9486502 DOI: 10.1002/ueg2.12280] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patients with chronic gastrointestinal (GI) disease such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), celiac disease, gastroesophageal reflux disease (GERD), pancreatitis, and chronic liver disease (CLD) often suffer from obesity because of coincidence (IBD, IBS, celiac disease) or related pathophysiology (GERD, pancreatitis and CLD). It is unclear if such patients need a particular diagnostic and treatment that differs from the needs of lean GI patients. The present guideline addresses this question according to current knowledge and evidence. OBJECTIVE The objective of the guideline is to give advice to all professionals working in the field of gastroenterology care including physicians, surgeons, dietitians and others how to handle patients with GI disease and obesity. METHODS The present guideline was developed according to the standard operating procedure for European Society for Clinical Nutrition and Metabolism guidelines, following the Scottish Intercollegiate Guidelines Network grading system (A, B, 0, and good practice point [GPP]). The procedure included an online voting (Delphi) and a final consensus conference. RESULTS In 100 recommendations (3x A, 33x B, 24x 0, 40x GPP, all with a consensus grade of 90% or more) care of GI patients with obesity - including sarcopenic obesity - is addressed in a multidisciplinary way. A particular emphasis is on CLD, especially fatty liver disease, since such diseases are closely related to obesity, whereas liver cirrhosis is rather associated with sarcopenic obesity. A special chapter is dedicated to obesity care in patients undergoing bariatric surgery. The guideline focuses on adults, not on children, for whom data are scarce. Whether some of the recommendations apply to children must be left to the judgment of the experienced pediatrician. CONCLUSION The present guideline offers for the first time evidence-based advice how to care for patients with chronic GI diseases and concomitant obesity, an increasingly frequent constellation in clinical practice.
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Affiliation(s)
| | - Rocco Barazzoni
- Department of Medical, Technological and Translational SciencesUniversity of TriesteTriesteItaly
| | - Luca Busetto
- Department of MedicineUniversity of PadovaPadovaItaly
| | - Marjo Campmans‐Kuijpers
- Department of Gastroenterology and HepatologyUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Vincenzo Cardinale
- Department of Medico‐Surgical Sciences and BiotechnologiesSapienza University of RomeRomeItaly
| | - Irit Chermesh
- Department of GastroenterologyRambam Health Care CampusAffiliated with Technion‐Israel Institute of TechnologyHaifaIsrael
| | - Ahad Eshraghian
- Department of Gastroenterology and HepatologyAvicenna HospitalShirazIran
| | - Haluk Tarik Kani
- Department of GastroenterologyMarmara UniversitySchool of MedicineIstanbulTurkey
| | - Wafaa Khannoussi
- Hepato‐Gastroenterology DepartmentMohammed VI University HospitalOujdaMorocco
- Laboratoire de Recherche des Maladies Digestives (LARMAD)Mohammed the First UniversityOujdaMorocco
| | - Laurence Lacaze
- Department of NutritionRennes HospitalRennesFrance
- Department of general surgeryMantes‐la‐Jolie HospitalFrance
- Department of clinical nutritionPaul Brousse‐Hospital, VillejuifFrance
| | - Miguel Léon‐Sanz
- Department of Endocrinology and NutritionUniversity Hospital Doce de OctubreMedical SchoolUniversity ComplutenseMadridSpain
| | - Juan M. Mendive
- La Mina Primary Care Academic Health Centre. Catalan Institute of Health (ICS)University of BarcelonaBarcelonaSpain
| | - Michael W. Müller
- Department of General and Visceral SurgeryRegionale Kliniken HoldingKliniken Ludwigsburg‐Bietigheim gGmbHBietigheim‐BissingenGermany
| | - Johann Ockenga
- Medizinische Klinik IIKlinikum Bremen‐MitteBremenGermany
| | - Frank Tacke
- Department of Hepatology & GastroenterologyCharité Universitätsmedizin BerlinCampus Virchow‐Klinikum and Campus Charité MitteBerlinGermany
| | - Anders Thorell
- Department of Clinical ScienceDanderyds HospitalKarolinska InstitutetStockholmSweden
- Department of SurgeryErsta HospitalStockholmSweden
| | - Darija Vranesic Bender
- Department of Internal MedicineUnit of Clinical NutritionUniversity Hospital Centre ZagrebZagrebCroatia
| | - Arved Weimann
- Department of General, Visceral and Oncological SurgerySt. George HospitalLeipzigGermany
| | - Cristina Cuerda
- Departamento de MedicinaUniversidad Complutense de MadridNutrition UnitHospital General Universitario Gregorio MarañónMadridSpain
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11
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van Erpecum KJ, Didden P, Verdonk RC. High risk of complications and mortality in cirrhotic patients with acute pancreatitis. Eur J Intern Med 2022; 102:45-46. [PMID: 35718647 DOI: 10.1016/j.ejim.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Karel J van Erpecum
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, the Netherlands.
| | - Paul Didden
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, the Netherlands
| | - Robert C Verdonk
- Department Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, the Netherlands
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12
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Jin X, Hu R, Guo H, Ding C, Pi G, Tian M. Pretreatment Body Mass Index (BMI) as an Independent Prognostic Factor in Nasopharyngeal Carcinoma Survival: A Systematic Review and Meta-Analysis. Nutr Cancer 2022; 74:3457-3467. [PMID: 35658769 DOI: 10.1080/01635581.2022.2084557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We performed a meta-analysis to investigate the association between pretreatment body mass index (BMI) and prognosis of nasopharyngeal carcinoma (NPC). Case-control and cohort studies were searched from PubMed, Web of Science, EMBASE, and CNKI databases. Pooled hazard ratios (HR) with 95% confidence intervals (CI) for overall survival (OS) or distant metastasis-free survival (DMSF) were used to estimate the prognostic value. Bias in the included studies was evaluated using funnel plots. The results showed that compared with normal weight patients, the estimated HR of OS was 1.54 (95% CI: 1.25-1.90; P < 0.05) for underweight, 0.63 (95% CI: 0.48-0.83; P < 0.05) for overweight, and 0.67 (95% CI: 0.41-1.08; P = 0.102) obese patients. We also found that compared with normal-weight patients, the estimated HR of DMFS was 1.63 (95% CI: 1.38-1.92; P < 0.05) for underweight, 0.83 (95% CI: 0.61-1.13; P = 0.244) for overweight, and 0.60 (95% CI: 0.39-0.92; P < 0.05) for patients with obesity. BMI is an independent prognostic factor for NPC survival. Being underweight before treatment was associated with poorer OS and DMFS in patients with NPC. Neither overweight nor obesity before treatment has an unfavorable effect on NPC survival.
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Affiliation(s)
- Xin Jin
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Renchong Hu
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Huan Guo
- Department of Cancer Prevention Center, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chenchen Ding
- Department of Cancer Prevention Center, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Guoliang Pi
- Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Mengxing Tian
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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13
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Maatman TK, Westfall-Snyder JA, Ceppa EP, House MG, Nakeeb A, Nguyen TK, Schmidt CM, Zyromski NJ. Necrotizing Pancreatitis from Hypertriglyceridemia: More Severe Disease? Dig Dis Sci 2021; 66:4485-4491. [PMID: 33464454 DOI: 10.1007/s10620-020-06766-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 12/06/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Necrotizing pancreatitis (NP) is caused by hypertriglyceridemia (HTG) in up to 10% of patients. Clinical experience suggests that HTG-NP is associated with increased clinical severity; objective evidence is limited and has not been specifically studied in NP. AIM The aim of this study was to critically evaluate outcomes in HTG-NP. We hypothesized that patients with HTG-NP had significantly increased severity, morbidity, and mortality compared to patients with NP from other etiologies. METHODS A case-control study of all NP patients treated at a single institution between 2005 and 2018 was performed. Diagnostic criteria of HTG-NP included a serum triglyceride level > 1000 mg/dL and the absence of another specific pancreatitis etiology. To control for differences in age, sex, and comorbidities, non-HTG and HTG patients were matched at a 4:1 ratio using propensity scores. Outcomes were compared between non-HTG and HTG patients. RESULTS A total of 676 NP patients were treated during the study period. The incidence of HTG-NP was 5.8% (n = 39). The mean peak triglyceride level at diagnosis was 2923 mg/dL (SEM, 417 mg/dL). After propensity matching, no differences were found between non-HTG and HTG patients in CT severity index, degree of glandular necrosis, organ failure, infected necrosis, necrosis intervention, index admission LOS, readmission, total hospital LOS, or disease duration (P = NS). Mortality was similar in non-HTG-NP (7.1%) and HTG-NP (7.7%), P = 1.0. CONCLUSION In this large, single-institution series, necrotizing pancreatitis caused by hypertriglyceridemia had similar disease severity, morbidity, and mortality as necrotizing pancreatitis caused by other etiologies.
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Affiliation(s)
- T K Maatman
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive EH 519, Indianapolis, IN, 46202, USA
| | | | - E P Ceppa
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive EH 519, Indianapolis, IN, 46202, USA
| | - M G House
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive EH 519, Indianapolis, IN, 46202, USA
| | - A Nakeeb
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive EH 519, Indianapolis, IN, 46202, USA
| | - T K Nguyen
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive EH 519, Indianapolis, IN, 46202, USA
| | - C M Schmidt
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive EH 519, Indianapolis, IN, 46202, USA
| | - N J Zyromski
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive EH 519, Indianapolis, IN, 46202, USA.
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14
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Wiese ML, Aghdassi AA, Lerch MM, Steveling A. Excess Body Weight and Pancreatic Disease. Visc Med 2021; 37:281-286. [PMID: 34540944 DOI: 10.1159/000517147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/14/2021] [Indexed: 12/13/2022] Open
Abstract
Background Excess body weight (EBW) is a risk factor for various acute and chronic conditions. Conversely, the "obesity paradox" suggests a protective effect of higher body weight on some disease outcomes. This article discusses the role of EBW along the disease continuum of pancreatitis and pancreatic cancer (PC) in terms of incidence and outcome. Summary Comparison of findings is hampered by the use of different methods to assess EBW. Nevertheless, in acute pancreatitis (AP) and PC, EBW, especially visceral obesity, presents a distinct risk factor and predictor of a negative outcome. Findings of a protective effect likely result from nonconsideration of fat distribution or other confounders. Regarding chronic pancreatitis (CP), few studies indicate lower incidence and a better outcome with higher body mass. However, there is insufficient evidence to confirm the existence of an obesity paradox. The precise mechanisms of how EBW affects the disease continuum require further elucidation but both common and disease-specific effects seem involved. Key Messages EBW is associated with higher incidence and a negative outcome in AP and PC. The association with CP is less conclusive. Thus, maintaining normal weight is advisable at any stage of the disease continuum.
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Affiliation(s)
- Mats L Wiese
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Ali A Aghdassi
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Antje Steveling
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
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15
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Hart PA, Bradley D, Conwell DL, Dungan K, Krishna SG, Wyne K, Bellin MD, Yadav D, Andersen DK, Serrano J, Papachristou GI. Diabetes following acute pancreatitis. Lancet Gastroenterol Hepatol 2021; 6:668-675. [PMID: 34089654 PMCID: PMC8277724 DOI: 10.1016/s2468-1253(21)00019-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/26/2020] [Accepted: 01/12/2021] [Indexed: 02/07/2023]
Abstract
Diabetes represents a group of diseases involving persistent hyperglycaemia. Exocrine disorders of the pancreas are increasingly recognised to cause or precede the onset of diabetes, which in this context is referred to as pancreatogenic or type 3c diabetes. Diabetes, as a sequela of acute pancreatitis, is observed across the spectrum of severity in acute pancreatitis and can be associated with other clinical complications. The pathophysiology of acute pancreatitis-related diabetes is poorly understood, and observations suggest that it is probably multifactorial. In this Review, we discuss the epidemiology, pathophysiology, and management considerations of diabetes following acute pancreatitis, and highlight knowledge gaps in this topic.
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Affiliation(s)
- Phil A Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - David Bradley
- Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Darwin L Conwell
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kathleen Dungan
- Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Somashekar G Krishna
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kathleen Wyne
- Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Melena D Bellin
- Department of Pediatrics and Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Dhiraj Yadav
- Division of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Dana K Andersen
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jose Serrano
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Georgios I Papachristou
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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16
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Thavamani A, Umapathi KK, Sferra TJ, Sankararaman S. Undernutrition and Obesity Are Associated with Adverse Clinical Outcomes in Hospitalized Children and Adolescents with Acute Pancreatitis. Nutrients 2020; 13:43. [PMID: 33375612 PMCID: PMC7824217 DOI: 10.3390/nu13010043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/16/2020] [Accepted: 12/23/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Adult studies demonstrated that extremes of nutritional status adversely impact clinical outcomes in acute pancreatitis (AP). With rising prevalence of undernutrition/obesity in children, we analyzed the effect of nutritional status on the clinical outcomes in children and adolescents with acute pancreatitis. Methodology: We analyzed the Kids' Inpatient Database (KID) between 2003 and 2016 to include all patients with a primary diagnosis of AP using specific International Classification of Diseases (ICD) codes. We classified into (1) undernutrition, (2) obesity and (3) control groups, based on ICD codes, and we compared severe acute pancreatitis and healthcare utilization (length of stay and hospitalization costs). Results: Total number of AP admissions was 39,805. The prevalence of severe AP was higher in the undernutrition and obesity groups than the control group (15.7% vs. 5.8% vs. 3.5% respectively, p < 0.001). Multivariate analyses demonstrated that undernutrition and obesity were associated with 2.5 and 1.6 times increased risk of severe AP, p < 0.001. Undernutrition was associated with an additional six days of hospitalization and almost $16,000 in hospitalization costs. Obesity was associated with an additional 0.5 day and almost $2000 in hospitalization costs, p < 0.001. Conclusion: Undernutrition and obesity were associated with greater severity of AP, as well as prolonged hospitalization stay and costs. It is imperative for treating clinicians to be aware of these high-risk groups to tailor management and strive for improved outcomes.
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Affiliation(s)
- Aravind Thavamani
- Department of Pediatrics (Divison of Pediatric Gastroenterology), UH Rainbow Babies and Children’s Hospital, Cleveland, OH 44106, USA; (A.T.); (T.J.S.)
| | | | - Thomas J. Sferra
- Department of Pediatrics (Divison of Pediatric Gastroenterology), UH Rainbow Babies and Children’s Hospital, Cleveland, OH 44106, USA; (A.T.); (T.J.S.)
| | - Senthilkumar Sankararaman
- Department of Pediatrics (Divison of Pediatric Gastroenterology), UH Rainbow Babies and Children’s Hospital, Cleveland, OH 44106, USA; (A.T.); (T.J.S.)
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17
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Increase in visceral adipose tissue and subcutaneous adipose tissue thickness in children with acute pancreatitis. A case-control study. Arch Pediatr 2020; 28:29-32. [PMID: 33309120 DOI: 10.1016/j.arcped.2020.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/18/2020] [Accepted: 10/02/2020] [Indexed: 12/14/2022]
Abstract
AIM The aim of this study was to investigate the relationship between the development of acute pancreatitis in children and their body mass index (BMI), waist circumference (WC), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) thickness. METHOD This was a case-control study carried out in a tertiary hospital between October and November 2019. The diagnosis of acute pancreatitis was based on the presence of at least two of three criteria of the International Study Group of Pediatric Pancreatitis (INSPPIRE) guidelines. AC, VAT, and SAT measurements of patients and controls were performed by using a three-dimensional workstation (Aquarius 3D Workstation, TeraRecon Inc., San Mateo, Calif., USA) through cross sections of the L2 vertebra level after examining previous abdominal computerized tomography (CT) records. RESULTS A total of 25 patients diagnosed with acute and acute recurrent pancreatitis who underwent abdominal CT were included in the study and 38 healthy, sex- and age-matched children formed the control group. There were no differences between the patients and healthy children in terms of age, sex and BMI-for-age z-scores. Besides, measurements of WC, SAT, and VAT thickness were found to be higher in the patient group (P=0.007, P=0.021, P=0.016, respectively). CONCLUSION In this study, WC, VAT, and SAT were found to be thicker in children with acute pancreatitis compared with healthy children without any difference in BMI. Further studies are needed to clarify whether adipose tissue thickness is an etiological cause or a secondary finding in patients with acute pancreatitis.
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18
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Singh AK, Dawra S, Rana S, Gupta P, Samanta J, Sinha SK, Gupta V, Yadav TD, Kochhar R. Can serum resistin predict severity of acute pancreatitis? Biomarkers 2020; 26:31-37. [PMID: 33089708 DOI: 10.1080/1354750x.2020.1841295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Acute pancreatitis (AP) is a common disorder with high mortality in severe cases. Several markers have been studied to predict development of severe AP (SAP) including serum resistin with conflicting results. This study aimed at assessing the role of baseline serum resistin levels in predicting SAP. METHODS This prospective study collected data from 130 AP patients from July 2017 to Nov 2018. Parameters measured included demographic profile, serum resistin at admission, severity scores, hospital stay, surgery, and mortality. Patients were divided into two groups, severe and non-severe AP. The two groups were compared for baseline characteristics, serum resistin levels, hospital stay, surgery and mortality. RESULTS Among 130 patients, 53 patients had SAP. SAP patients had higher BMI, baseline CRP, APACHE II and CTSI scores (p-value 0.045, <0.001, <0.001 and 0.001, respectively). Both groups had comparable serum resistin levels. Serum resistin levels were also not different for obese and non-obese patients (p-value = 0.62). On multivariate analysis, BMI and high APACHE II score and CRP levels were found to independently predict SAP. CONCLUSION We found that serum resistin is not a useful marker for predicting the severity of AP and does not correlate with increasing body weight.
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Affiliation(s)
- Anupam Kumar Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saurabh Dawra
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Satyavati Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Section of GI radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saroj K Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Thakur Deen Yadav
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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19
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Zhou J, Xue Y, Liu Y, Li X, Tong Z, Li W. The effect of immunonutrition in patients with acute pancreatitis: a systematic review and meta‐analysis. J Hum Nutr Diet 2020; 34:429-439. [PMID: 33001472 DOI: 10.1111/jhn.12816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/08/2020] [Accepted: 08/17/2020] [Indexed: 12/20/2022]
Affiliation(s)
- J. Zhou
- Surgical Intensive Care Unit (SICU) Department of General Surgery Jinling Hospital Medical School of Southeast University Nanjing China
- Department of Clinical Medicine School of Medicine Southeast University Nanjing China
| | - Y. Xue
- Department of Clinical Medicine School of Medicine Southeast University Nanjing China
| | - Y. Liu
- Surgical Intensive Care Unit (SICU) Department of General Surgery Jinling Hospital Medical School of Nanjing University Nanjing China
| | - X.K. Li
- Department of Clinical Medicine School of Medicine Southeast University Nanjing China
| | - Z.H. Tong
- Surgical Intensive Care Unit (SICU) Department of General Surgery Jinling Hospital Medical School of Nanjing University Nanjing China
| | - W.Q. Li
- Surgical Intensive Care Unit (SICU) Department of General Surgery Jinling Hospital Medical School of Southeast University Nanjing China
- Surgical Intensive Care Unit (SICU) Department of General Surgery Jinling Hospital Medical School of Nanjing University Nanjing China
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Ma BQ, Wang LF, Wu WY, Xing YJ. Serum glycoprotein 2 as a biomarker of severity of acute pancreatitis. Shijie Huaren Xiaohua Zazhi 2019; 27:1271-1277. [DOI: 10.11569/wcjd.v27.i20.1271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is a main cause of acute abdominal pain. Although the pathophysiology of AP is not fully understood, it is now widely acknowledged that the activation of enzymes in zymogen granules (ZGs) plays an important role in the progression of AP. In AP animal models, the up-regulation of serum ZG glycoprotein 2 (GP2) can be used as a potential biological marker for AP.
AIM To investigate whether serum GP2 can be used as an early biomarker of AP severity.
METHODS In a prospective single-center cohort study, plasma samples and baseline clinical data were collected from 9 healthy subjects and 59 patients with AP within 24 h of onset. Serum GP2 levels were detected by enzyme-linked immunosorbent assay, and their correlation with the severity of AP was analyzed.
RESULTS Of the 59 AP patients, 30 had mild AP, 16 had moderate AP, and 13 had severe AP. Serum GP2 levels were significantly increased in AP patients and positively correlated with AP severity. Using 2.3 ng/mL as the cut-off point, the sensitivity and specificity of serum GP2 to distinguish moderate AP were 96.6% and 90.0%, respectively, and the positive and negative predictive values were 90.3% and 96.4%, respectively. Using 5.1 ng/mL as the cut-off point, the sensitivity, specificity, positive predictive value, and negative predictive value to distinguish severe AP were all 100%. Serum GP2 was found to be a better prognostic marker than bedside index for severity in acute pancreatitis score, hematocrit, admission or persistent systemic inflammatory response score, and C-reactive protein.
CONCLUSION Serum GP2 increases in AP patients, and it positively correlates with the severity of AP, suggesting its potential to predict the severity of AP.
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Affiliation(s)
- Bai-Qiang Ma
- Department of Trauma, Acute Abdomen and Hernia Surgery, Lishui City People's Hospital, Lishui 323000, Zhejiang Province, China
| | - Li-Fu Wang
- Department of Trauma, Acute Abdomen and Hernia Surgery, Lishui City People's Hospital, Lishui 323000, Zhejiang Province, China
| | - Wen-Yuan Wu
- Department of Trauma, Acute Abdomen and Hernia Surgery, Lishui City People's Hospital, Lishui 323000, Zhejiang Province, China
| | - Yong-Jun Xing
- Department of Trauma, Acute Abdomen and Hernia Surgery, Lishui City People's Hospital, Lishui 323000, Zhejiang Province, China
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Sternby H, Mahle M, Linder N, Erichson-Kirst L, Verdonk RC, Dimova A, Ignatavicius P, Ilzarbe L, Koiva P, Penttilä A, Regnér S, Bollen TL, Brill R, Stangl F, Wohlgemuth WA, Singh V, Busse H, Michl P, Beer S, Rosendahl J. Mean muscle attenuation correlates with severe acute pancreatitis unlike visceral adipose tissue and subcutaneous adipose tissue. United European Gastroenterol J 2019; 7:1312-1320. [PMID: 31839956 DOI: 10.1177/2050640619882520] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 09/18/2019] [Indexed: 12/26/2022] Open
Abstract
Background Acute pancreatitis (AP) is a frequent disorder with considerable morbidity and mortality. Obesity has previously been reported to influence disease severity. Objective The aim of this study was to investigate the association of adipose and muscle parameters with the severity grade of AP. Methods In total 454 patients were recruited. The first contrast-enhanced computed tomography of each patient was reviewed for adipose and muscle tissue parameters at L3 level. Associations with disease severity were analysed through logistic regression analysis. The predictive capacity of the parameters was investigated using receiver operating characteristic (ROC) curves. Results No distinct variation was found between the AP severity groups in either adipose tissue parameters (visceral adipose tissue and subcutaneous adipose tissue) or visceral muscle ratio. However, muscle mass and mean muscle attenuation differed significantly with p-values of 0.037 and 0.003 respectively. In multivariate analysis, low muscle attenuation was associated with severe AP with an odds ratio of 4.09 (95% confidence intervals: 1.61-10.36, p-value 0.003). No body parameter presented sufficient predictive capability in ROC-curve analysis. Conclusions Our results demonstrate that a low muscle attenuation level is associated with an increased risk of severe AP. Future prospective studies will help identify the underlying mechanisms and characterise the influence of body composition parameters on AP.
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Affiliation(s)
- Hanna Sternby
- Department of Surgery, Institution of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Mariella Mahle
- Department of Internal Medicine I, Martin Luther University, Halle (Saale), Germany
| | - Nicolas Linder
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany.,IFB Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Laureen Erichson-Kirst
- Department of Internal Medicine, Neurology and Dermatology, Division of Gastroenterology, Leipzig, Germany
| | - Robert C Verdonk
- Department of Gastroenterology, St. Antonius Ziekenhuis, Nieuwegein, the Netherlands
| | - Alexandra Dimova
- Department of Surgery, University Hospital for Emergency Medicine "Pirogov", Sofia, Bulgaria
| | - Povilas Ignatavicius
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Lucas Ilzarbe
- Department of Gastroenterology, Hospital del Mar, Barcelona, Spain
| | - Peeter Koiva
- Department of Gastroenterology, East Tallinn Central Hospital, Tallinn, Estonia
| | - Anne Penttilä
- Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Sara Regnér
- Department of Surgery, Institution of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Thomas L Bollen
- Department of Radiology, St. Antonius Ziekenhuis, Nieuwegein, the Netherlands
| | - Richard Brill
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Franz Stangl
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Walter A Wohlgemuth
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Vijay Singh
- Department of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Harald Busse
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany.,IFB Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Patrick Michl
- Department of Internal Medicine I, Martin Luther University, Halle (Saale), Germany
| | - Sebastian Beer
- Department of Internal Medicine, Neurology and Dermatology, Division of Gastroenterology, Leipzig, Germany
| | - Jonas Rosendahl
- Department of Internal Medicine I, Martin Luther University, Halle (Saale), Germany
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Szentesi A, Párniczky A, Vincze Á, Bajor J, Gódi S, Sarlós P, Gede N, Izbéki F, Halász A, Márta K, Dobszai D, Török I, Farkas H, Papp M, Varga M, Hamvas J, Novák J, Mickevicius A, Maldonado ER, Sallinen V, Illés D, Kui B, Erőss B, Czakó L, Takács T, Hegyi P. Multiple Hits in Acute Pancreatitis: Components of Metabolic Syndrome Synergize Each Other's Deteriorating Effects. Front Physiol 2019; 10:1202. [PMID: 31620021 PMCID: PMC6763590 DOI: 10.3389/fphys.2019.01202] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 09/03/2019] [Indexed: 12/16/2022] Open
Abstract
Introduction The incidence of acute pancreatitis (AP) and the prevalence of metabolic syndrome (MetS) are growing worldwide. Several studies have confirmed that obesity (OB), hyperlipidemia (HL), or diabetes mellitus (DM) can increase severity, mortality, and complications in AP. However, there is no comprehensive information on the independent or joint effect of MetS components on the outcome of AP. Our aims were (1) to understand whether the components of MetS have an independent effect on the outcome of AP and (2) to examine the joint effect of their combinations. Methods From 2012 to 2017, 1435 AP cases from 28 centers were included in the prospective AP Registry. Patient groups were formed retrospectively based on the presence of OB, HL, DM, and hypertension (HT). The primary endpoints were mortality, severity, complications of AP, and length of hospital stay. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated. Results 1257 patients (55.7 ± 17.0 years) were included in the analysis. The presence of OB was an independent predictive factor for renal failure [OR: 2.98 (CI: 1.33–6.66)] and obese patients spent a longer time in hospital compared to non-obese patients (12.1 vs. 10.4 days, p = 0.008). HT increased the risk of severe AP [OR: 3.41 (CI: 1.39–8.37)], renal failure [OR: 7.46 (CI: 1.61–34.49)], and the length of hospitalization (11.8 vs. 10.5 days, p = 0.020). HL increased the risk of local complications [OR: 1.51 (CI: 1.10–2.07)], renal failure [OR: 6.4 (CI: 1.93–21.17)], and the incidence of newly diagnosed DM [OR: 2.55 (CI: 1.26–5.19)]. No relation was found between the presence of DM and the outcome of AP. 906 cases (mean age ± SD: 56.9 ± 16.7 years) had data on all four components of MetS available. The presence of two, three, or four MetS factors increased the incidence of an unfavorable outcome compared to patients with no MetS factors. Conclusion OB, HT, and HL are independent risk factors for a number of complications. HT is an independent risk factor for severity as well. Components of MetS strongly synergize each other’s detrimental effect. It is important to search for and follow up on the components of MetS in AP.
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Affiliation(s)
- Andrea Szentesi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,First Department of Medicine, University of Szeged, Szeged, Hungary.,Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Andrea Párniczky
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Heim Pál National Institute of Pediatrics, Budapest, Hungary
| | - Áron Vincze
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Judit Bajor
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Szilárd Gódi
- Division of Translational Medicine, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Patricia Sarlós
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Noémi Gede
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Ferenc Izbéki
- Szent György Teaching Hospital of Fejér County, Székesfehérvár, Hungary
| | - Adrienn Halász
- Szent György Teaching Hospital of Fejér County, Székesfehérvár, Hungary
| | - Katalin Márta
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Dalma Dobszai
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Imola Török
- County Emergency Clinical Hospital - Gastroenterology and University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureş, Romania
| | - Hunor Farkas
- County Emergency Clinical Hospital - Gastroenterology and University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureş, Romania
| | - Mária Papp
- Division of Gastroenterology, Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | - Márta Varga
- Dr. Réthy Pál Hospital of Békés County, Békéscsaba, Hungary
| | | | - János Novák
- Department of Gastroenterology, Pándy Kálmán Hospital of Békés County, Gyula, Hungary
| | - Artautas Mickevicius
- Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania.,Clinics of Abdominal Surgery, Nephrourology and Gastroenterology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Ville Sallinen
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Dóra Illés
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Balázs Kui
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - László Czakó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Takács
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,First Department of Medicine, University of Szeged, Szeged, Hungary.,Division of Translational Medicine, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary.,Hungarian Academy of Sciences - University of Szeged, Momentum Gastroenterology Multidisciplinary Research Group, Szeged, Hungary
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