• acute pancreatitis
• extrapancreatic infection
• gram-negative bacteria
• infected pancreatic necrosis
• microbiological profile in pancreatitis
• multi-drug resistance
• organ failure

• FAERS
• acute pancreatitis
• adverse events
• gender
• pharmacovigilance

Pancreatitis is a common disease of the digestive system. Acute pancreatitis is one of the most common reasons for gastrointestinal hospital admission, and chronic pancreatitis significantly reduces quality of life. However, national epidemiological data on pancreatitis in China are lacking. This study aimed to quantify the disease burden of pancreatitis in China from 1990 to 2019.

This study was based on the Global Burden of Disease Study 2019 dataset. Age-standardized rates of incidence (ASIR), prevalence (ASPR), mortality (ASMR), and disability-adjusted life years (DALYs) were used to describe the disease burden of pancreatitis, and estimated annual percentage change (EAPC) was used to indicate the average change in age-standardized rates. We also described the trend of pancreatitis-related mortality and DALYs, which are attributable to alcohol use by age and sex.

From 1990 to 2019, the ASIR, ASPR, ASMR, and age-standardized DALYs of pancreatitis in China decreased by 10.90, 1.50, 0.49, and 15.54 per 100,000, respectively, with EAPCs of −1.35 (95% uncertainty interval [UI]: −1.67, −1.02) and −0.37 (95% UI: −0.43, −0.31), −2.01 (95% UI: −2.07, −1.94) and −2.32 (95% UI: −2.37, −2.28), respectively. Recently, the numbers of incident and prevalent cases have risen, with estimates of 380,018 (95% UI: 308,669–462,767) and 493,765 (95% UI: 416,705–578,675), respectively, in 2019. Among men, the disease burden of pancreatitis was more severe than among women, and with variances in the distribution among different age groups. Age-standardized DALYs caused by alcohol-related pancreatitis have gradually worsened in the past decade, accounting for 34.09% of the total in 2019.

The disease burden of pancreatitis in China has declined in the past 30 years, but the exacerbation of population aging poses a challenge to prevention and control of pancreatitis. Alcohol use has gradually become an important factor in the disease burden of pancreatitis in recent years.

In Thailand, most primary care hospitals cannot measure serum lipase and amylase; no 24 hours computed tomography and magnetic resonance imaging available, and no on-call gastroenterologists. Thus, acute pancreatitis cannot be diagnosed based on the established diagnostic criteria that require this information. The resultant delayed management increases morbidity and mortality. This study was performed to create a clinical prediction score for early diagnosis of acute pancreatitis in emergency departments without requiring a computed tomography scan or laboratory measurement to assist in the initial diagnosis, treatment, or referral.

Patients with suspected acute pancreatitis who had available data regarding lipase and amylase measurements and visited the emergency department from June 2019 to August 2020 were retrospectively analyzed. The baseline predictive factors were compared between patients with and without acute pancreatitis according to the 2012 revised Atlanta classification. Multivariable logistic regression was used to explore potential predictive factors and develop a clinical prediction score for the diagnosis of acute pancreatitis.

A total of 506 eligible patients, 84 (16%) had acute pancreatitis. The PRE-PAN score [area under the receiver operating characteristics curve, 0.88; 95% confidence interval (CI), 0.84–0.93] included six factors: alcohol drinking, epigastric pain, pain radiating to the back, persistent pain, nausea or vomiting, and the pain score. A score of >7.5 points suggested a high probability of acute pancreatitis [positive likelihood ratio, 6.80 (95% CI, 4.75–9.34; p < 0.001); sensitivity, 66.7% (95% CI, 54.6–77.3); specificity, 90.2% (95% CI, 86.6–93.1); positive predictive value, 58.5% (95% CI, 47.1–69.3);, 92.9% (95% CI, 89.6–95.4)].

A PRE-PAN risk score is a screening tool for predicting acute pancreatitis without using the lipase concentration or radiological findings. A high predictive score, especially >7.5, suggests a high probability of acute pancreatitis.

Acute pancreatitis (AP) poses a worldwide challenge due to the growing incidence and its potentially life-threatening course and complications. Specific targeted therapies are not available, prompting the identification of new pathways and novel therapeutic approaches. Flavonoids comprise several groups of biologically active compounds with wide-ranging effects. The flavone compound, tricetin (TCT), has not yet been investigated in detail but sporadic reports indicate diverse biological activities. In the current study, we evaluated the potential protective effects of TCT in AP. TCT (30 μM) protected isolated primary murine acinar cells from the cytotoxic effects of cerulein, a cholecystokinin analog peptide. The protective effects of TCT were observed in a general viability assay (calcein ester hydrolysis), in an apoptosis assay (caspase activity), and in necrosis assays (propidium iodide uptake and lactate dehydrogenase release). The effects of TCT were not related to its potential antioxidant effects, as TCT did not protect against H₂O₂-induced acinar cell death despite possessing radical scavenging activity. Cerulein-induced expression of IL1β, IL6, and matrix metalloproteinase 2 and activation of nuclear factor-κB (NFκB) were reduced by 30 μM TCT. In vivo experiments confirmed the protective effect of TCT in a mouse model of cerulein-induced AP. TCT suppressed edema formation and apoptosis in the pancreas and reduced lipase and amylase levels in the serum. Moreover, TCT inhibited interleukin-1β (IL1β), interleukin-6 (IL6), and tumor necrosis factor-α (TNFα) expression in the pancreas and reduced the activation of the oxidative DNA damage sensor enzyme poly(ADP-ribose) polymerase-1 (PARP-1). Our data indicate that TCT can be a potential treatment option for AP.

• Pancreatitis bundles
• endoscopic intervention
• local pancreatic complications
• severity assessment
• step-up approach

• Acute Disease
• Humans
• Pancreatitis/complications
• Pancreatitis/diagnosis
• Retrospective Studies
• Risk Factors
• Sepsis/diagnosis

• Acute pancreatitis
• Early assessment
• Mortality
• Organ failure
• Prognostic score

• Acute Disease
• Cohort Studies
• Emergency Service, Hospital
• Hospital Mortality
• Humans
• Intensive Care Units
• Organ Dysfunction Scores
• Pancreatitis/diagnosis
• Pancreatitis/therapy
• Prognosis
• ROC Curve
• Retrospective Studies
• Sepsis

• Technische Universität München (1025)

• Acute pancreatitis
• Diabetes mellitus
• Gastrointestinal symptoms
• Metabolic syndrome
• Obesity
• Patient-reported outcomes

• mortality
• pancreatitis
• risk factors
• serum phospahte

• Acute pancreatitis
• Acute renal failure
• Acute respiratory distress syndrome
• Mortality
• Predict
• Retrospective
• Scoring system
• Severity

• Alcohol
• ERCP
• Endoscopic drainage
• Endoscopic necrosectomy
• Walled-off necrosis

• Adult
• Aged
• Aged, 80 and over
• Female
• Humans
• Incidence
• Japan/epidemiology
• Male
• Middle Aged
• Pancreatitis/epidemiology
• Pancreatitis/etiology
• Pancreatitis/mortality
• Pancreatitis/therapy
• Risk Factors
• Young Adult

Acute pancreatitis (AP) is a disease with significant morbidity and mortality. The aim of this study was to evaluate the predictive role of inflammatory markers, particularly interleukins (ILs), in the course of AP and to determine the frequency of etiologic factors of AP. We included patients with AP who were treated at our institution from May 1, 2012 to January 31, 2015. Different laboratory parameters, including ILs, and the severity scoring systems Ranson’s criteria and Bedside Index of Severity in Acute Pancreatitis (BISAP) were analyzed. AP was classified into mild and severe, and independent parameters were compared between these groups. The predictive performance of each parameter was evaluated using receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC). A binomial logistic regression was performed to evaluate Ranson’s criteria and IL6, IL8, and IL10 (at admission and after 48 hours) in the course of AP. Overall, 96 patients were treated, 59 (61.5%) males and 37 (38.5%) females, average age 62.5 ± 16.8 years (range 22–91 years). The best predictor for the severity of AP was IL6, measured 48 hours after admission (AUC = 0.84). Other useful predictors of the severity of AP were lactate dehydrogenase (p < 0.001), serum glucose (p < 0.006), and difference in the platelet count (p < 0.001) between admission and after 48 hours (p < 0.001), hemoglobin (p < 0.027) and erythrocytes (p < 0.029). The major causes of AP were gallstones and alcohol consumption. According to our results, IL6 and Ranson score are important predictors of the severity of AP.

This study aimed to investigate the predictive value of long non‐coding RNA intersectin 1‐2 (lnc‐ITSN1‐2) for severe acute pancreatitis (SAP) risk, and its correlation with disease severity and in‐hospital mortality in SAP patients.

Plasma samples from 60 SAP, 60 moderate‐severe acute pancreatitis (MSAP) and 60 mild acute pancreatitis (MAP) patients were collected within 24 hours, and plasma samples from 60 age and gender‐matched healthy controls (HCs) were collected when enrollment. Lnc‐ITSN1‐2 was detected by reverse transcription‐quantitative polymerase chain reaction. In AP patients, disease severity was evaluated and in‐hospital deaths were recorded.

Lnc‐ITSN1‐2 was increased in SAP patients compared with MSAP, MAP patients, and HCs, and it is well‐discriminated SAP patients from MSAP patients (area under curve (AUC): 0.699, 95% confidence interval (CI): 0.605‐0.792), MAP patients (AUC: 0.862, 95% CI: 0.798‐0.926), and HCs (AUC: 0.958, 95% CI: 0.925‐0.990). For disease severity, lnc‐ITSN1‐2 was positively correlated with Ranson's score, acute pathologic and chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score, and C‐reactive protein (CRP) in SAP patients, MSAP patients, and MAP patients; meanwhile, the correlation coefficients were highest in SAP patients. Furthermore, lnc‐ITSN1‐2 displayed a good predictive value for increased in‐hospital mortality in SAP (AUC: 0.803, 95% CI: 0.673‐0.933) and MSAP (AUC: 0.854, 95% CI: 0.752‐0.956) patients, which was similar with several common prognostic factors (including Ranson's score, APACHE II score, SOFA score, and CRP).

Lnc‐ITSN1‐2 might be a potential biomarker for discrimination of SAP to improve the prognosis of SAP patients.

• disease severity
• in-hospital mortality
• long non-coding RNA intersectin 1-2
• predictive factor
• severe acute pancreatitis

Supplemental Digital Content is available in the text

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

• LAMS
• acute pancreatitis
• low mortality and morbidity
• stent-in-stent procedure
• step-up approach

• Adult
• Aged
• Drainage/adverse effects
• Drainage/instrumentation
• Drainage/methods
• Endoscopy/adverse effects
• Endoscopy/methods
• Female
• Hemorrhage/etiology
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Necrosis/surgery
• Pancreatitis, Acute Necrotizing/complications
• Pancreatitis, Acute Necrotizing/mortality
• Pancreatitis, Acute Necrotizing/surgery
• Retrospective Studies
• Self Expandable Metallic Stents/adverse effects

• Pancreas
• alcohol
• cholecystectomy
• gallstones
• natural history

An AIE dual-reactive supramolecular probe has been devised to simultaneously measure endogenous lipase and α-amylase activity in a homogeneous system. Fluorescence quantitative analysis of lipase and α-amylase in real biological samples enables rapid and accurate diagnosis of diseases.

• Caffeine
• Coffee
• Meta-analysis
• Pancreatitis

• Candida
• Candidemia
• Necrosis
• Pancreatitis
• Risk factor

• Morphine
• PDX-1
• PTF-1
• hedgehog
• macrophages
• pancreatitis
• regeneration
• severity

• Chronic pancreatitis
• Epidemiology
• Recurrent acute pancreatitis

Treatment of acute pancreatitis (AP) is one of the critical challenges to the field of gastroenterology because of its high mortality rate and high medical costs associated with the treatment of severe cases. Early-phase treatments for AP have been optimized in Japan, and clinical guidelines have been provided. However, changes in early-phase treatments and the relationship between treatment strategy and clinical outcome remain unclear. Retrospective analysis of nationwide epidemiological data shows that time for AP diagnosis has shortened, and the amount of initial fluid resuscitation has increased over time, indicating the compliance with guidelines. In contrast, prophylactic use of broad-spectrum antibiotics has emerged. Despite the potential benefits of early enteral nutrition, its use is still limited. The roles of continuous regional arterial infusion in the improvement of prognosis and the prevention of late complications are uncertain. Furthermore, early-phase treatments have had little impact on late-phase complications, such as walled-off necrosis, surgery requirements and late (> 4 w) AP-related death. Based on these observations, early-phase treatments for AP in Japan have approached the optimal level, but late-phase complications have become concerning issues. Early-phase treatments and the therapeutic strategy for late-phase complications both need to be optimized based on firm clinical evidence and cost-effectiveness.

• Diagnostic time
• Fluid resuscitation
• Enteral nutrition
• Continuous regional arterial infusion
• Walled-off necrosis

• Acute Disease
• Gastroenterologists/trends
• Guideline Adherence/trends
• Health Care Surveys
• Humans
• Japan
• Pancreatitis/diagnosis
• Pancreatitis/mortality
• Pancreatitis/therapy
• Practice Guidelines as Topic
• Practice Patterns, Physicians'/trends
• Predictive Value of Tests
• Retrospective Studies
• Time Factors
• Treatment Outcome

Necrotising pancreatitis, and particularly infected necrosis, are still associated with high morbidity and mortality. Since 2011, a step-up approach with lower morbidity rates compared to initial open necrosectomy has been established. However, mortality and complication rates of this complex treatment are hardly studied thereafter.

The German Pancreatitis Study Group performed a multicenter, retrospective study including 220 patients with necrotising pancreatitis requiring intervention, treated at 10 hospitals in Germany between January 2008 and June 2014. Data were analysed for the primary endpoints "severe complications" and "mortality" as well as secondary endpoints including "length of hospital stay", "follow up", and predisposing or prognostic factors.

Of all patients 13.6% were treated primarily with surgery and 86.4% underwent a step-up approach. More men (71.8%) required intervention for necrotising pancreatitis. The most frequent etiology was biliary (41.4%) followed by alcohol (29.1%). Compared to open necrosectomy, the step-up approach was associated with a lower number of severe complications (primary composite endpoint including sepsis, persistent multiorgan dysfunction syndrome (MODS) and erosion bleeding: 44.7% vs. 73.3%), lower mortality (10.5% vs. 33.3%) and lower rates of diabetes mellitus type 3c (4.7% vs. 33.3%). Low hematocrit and low blood urea nitrogen at admission as well as a history of acute pancreatitis were prognostic for less complications in necrotising pancreatitis. A combination of drainage with endoscopic necrosectomy resulted in the lowest rate of severe complications.

A step-up approach starting with minimal invasive drainage techniques and endoscopic necrosectomy results in a significant reduction of morbidity and mortality in necrotising pancreatitis compared to a primarily surgical intervention.

Acute pancreatitis (AP) is an acute inflammatory disease of the exocrine pancreas. In Japan, nationwide epidemiological surveys have been conducted every 4 to 5 years by the Research Committee of Intractable Pancreatic Diseases, under the support of the Ministry of Health, Labour, and Welfare of Japan. We reviewed the results of the nationwide surveys focusing on the severity assessment and changes in the therapeutic strategy for walled-off necrosis. The severity assessment system currently used in Japan consists of 9 prognostic factors and the imaging grade on contrast-enhanced computed tomography. By univariate analysis, all of the 9 prognostic factors were associated with AP-related death. A multivariate analysis identified 4 out of the 9 prognostic factors (base excess or shock, renal failure, systemic inflammatory response syndrome criteria, and age) that were associated with AP-related death. Receiver-operating characteristics curve analysis showed that the area under the curve was 0.82 for these 4 prognostic factors and 0.84 for the 9 prognostic factors, suggesting the comparable utility of these 4 factors in the severity assessment. We also examined the temporal changes in treatment strategy for walled-off necrosis in Japan according to the 2003, 2007, and 2011 surveys. Step-up approaches and less-invasive endoscopic therapies were uncommon in 2003 and 2007, but became popular in 2011. Mortality has been decreasing in patients who require intervention for walled-off necrosis. In conclusion, the nationwide survey revealed the comparable utility of 4 prognostic factors in the severity assessment and the increased use of less-invasive, step-up approaches with improved clinical outcomes in the management of walled-off necrosis.

• Endoscopic necrosectomy
• Diagnostic criteria
• Epidemiology
• Pancreatic pseudocyst
• Systemic inflammatory response syndrome
• Step-up approach
• Walled-off necrosis

• Acute Disease
• Drainage
• Endoscopy, Digestive System
• Humans
• Japan/epidemiology
• Multivariate Analysis
• Pancreatic Pseudocyst/diagnostic imaging
• Pancreatic Pseudocyst/epidemiology
• Pancreatic Pseudocyst/therapy
• Pancreatitis/diagnostic imaging
• Pancreatitis/epidemiology
• Pancreatitis/therapy
• Prognosis
• ROC Curve
• Renal Insufficiency/epidemiology
• Severity of Illness Index
• Shock/epidemiology
• Surveys and Questionnaires
• Systemic Inflammatory Response Syndrome/epidemiology
• Tomography, X-Ray Computed

• 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

• Adverse effect
• Epidemiology
• NSAID
• Pancreatitis
• Risk
• Safety

• APACHE
• Adult
• Biomarkers/blood
• Creatinine/blood
• Decision Trees
• Female
• Humans
• L-Lactate Dehydrogenase/blood
• Male
• Middle Aged
• Models, Statistical
• Oxygen Consumption
• Pancreatitis, Acute Necrotizing/blood
• Pancreatitis, Acute Necrotizing/diagnosis
• Pancreatitis, Acute Necrotizing/pathology
• Prognosis
• Regression Analysis
• Retrospective Studies
• Risk Factors
• Sensitivity and Specificity
• Severity of Illness Index

• Database
• Mortality
• Observational study
• Outcomes
• Proton pump inhibitors
• Severe acute pancreatitis

Acute pancreatitis (AP) is an acute inflammatory disease of the exocrine pancreas. In spite of the pivotal role of the endocrine pancreas in glucose metabolism, the impact of impaired glucose tolerance on AP has not been fully elucidated. A meta-analysis of seven observational studies showed that type 2 diabetes mellitus (DM) was associated with an increased risk of AP. The increased risk of AP shown in the meta-analysis was independent of hyperlipidemia, alcohol use and gallstones. Anti-diabetic drugs including incretins might increase the risk of AP, but no intervention trials have confirmed this. Although a controversial finding, DM seems to be associated with severe attacks and organ failure in AP. We analyzed the results of a nationwide epidemiological survey of AP in Japan. We studied the impact of pre-existing DM on the clinical course of AP in 1954 cases for which information on DM status was available at the onset of AP. The prevalence of DM in AP patients (12.8%) was higher than that in the general population in Japan (10.5%). AP patients with DM had higher morbidity of cardiovascular and renal failure than those without DM. About 35% of the idiopathic AP patients with DM had renal failure. The mortality of AP patients with DM (4.0%) was higher than that of AP patients without DM (1.7%). If stratified by etiology, idiopathic, but not alcoholic or biliary, AP patients with DM were predisposed to increased mortality (9.7%). In conclusion, impaired glucose tolerance might have an impact on the development and clinical outcome of AP. However, the impact might depend on the cause of hyperglycemia, the condition of DM including severity, duration and treatment, and the characteristics of the AP patients including age, etiology and comorbidity.

• Alcohol
• Diabetes mellitus
• Epidemiology
• Gallstone
• Mortality
• Organ failure

• Acute Disease
• Biomarkers/blood
• Blood Glucose/metabolism
• Comorbidity
• Diabetes Mellitus/blood
• Diabetes Mellitus/diagnosis
• Diabetes Mellitus/drug therapy
• Diabetes Mellitus/epidemiology
• Disease Progression
• Glucose Intolerance/blood
• Glucose Intolerance/diagnosis
• Glucose Intolerance/drug therapy
• Glucose Intolerance/epidemiology
• Humans
• Hypoglycemic Agents/adverse effects
• Insulin/blood
• Japan/epidemiology
• Pancreas, Exocrine/metabolism
• Pancreatitis/blood
• Pancreatitis/diagnosis
• Pancreatitis/epidemiology
• Prognosis
• Risk Factors
• Severity of Illness Index

• Diabetes
• Etiology
• Hospitalization
• Mortality
• Pancreatitis
• Prevalence

• Labour and Welfare of Japan (JPN) scoring system
• Ministry of Health
• guideline
• pediatrics
• severe acute pancreatitis
• severity assessment

• Acute
• Diabetes
• Hospitalization
• Mortality
• Pancreatitis
• Trends

Acute pancreatitis (AP) is a potentially life-threatening disease with a wide spectrum of severity. The overall mortality of AP is approximately 5%. According to the revised Atlanta classification system, AP can be classified as mild, moderate, or severe. Severe AP often takes a clinical course with two phases, an early and a late phase, which should both be considered separately. In this review article, we first discuss general aspects of AP, including incidence, pathophysiology, etiology, and grading of severity, then focus on the assessment of patients with suspected AP, including diagnosis and risk stratification, followed by the management of AP during the early phase, with special emphasis on fluid therapy, pain management, nutrition, and antibiotic prophylaxis.

• Acute pancreatitis
• Incidence
• Pathophysiology
• Etiology
• Severity
• Risk stratification
• Fluid therapy
• Pain management
• Nutrition
• Antibiotic prophylaxis

• 8-Nitro-cGMP
• Acute pancreatitis
• Bile salts
• Exocrine pancreas
• Guanylyl cyclase