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Changing Demography of Pancreatitis Patients in India -A Hospital Based Study
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Changing Demography of Pancreatitis Patients in India
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... Despite its potential utility, the clinical validity and prognostic accuracy of MCTSI in AP remain to be fully elucidated. Acute pancreatitis has long been recognized for its diverse range of manifestations, spanning from mild, nonspecific symptoms to the development of organ failure [3]. Over the course of time, numerous investigations have been utilized to evaluate the extent and customize the management [4]. ...
Introduction: Acute pancreatitis (AP) is a potentially life-threatening inflammatory condition characterized by pancreatic parenchymal and peripancreatic tissue injury. Objectives: The main objective of the study is to find the comparison of modified computed tomography severity index (MCTSI) and computed tomography severity index (CTSI) in predicting severity and clinical outcomes in acute pancreatitis. Methodology of the study: This retrospective study was conducted at Shaikh Zayed Hospital, Lahore Pakistan in a year of 2023. Data were collected from 120 patients. Patients were identified through electronic medical records, and data were collected regarding demographics, clinical characteristics, laboratory parameters, imaging findings, and clinical outcomes. The severity of acute pancreatitis was assessed using both the Computed Tomography Severity Index (CTSI) and the Modified Computed Tomography Severity Index (MCTSI) scoring systems based on the initial CT images obtained. Results: Data were collected from 120 AP patients according to methodology of the study. The results reveal that both the Computed Tomography Severity Index (CTSI) and the Modified Computed Tomography Severity Index (MCTSI) demonstrate robust sensitivity, with CTSI exhibiting a slightly higher sensitivity of 80% compared to MCTSI's 78%. Conversely, MCTSI displays superior specificity, reaching 82% compared to CTSI's 75%. Conclusion: It is concluded that both the Computed Tomography Severity Index (CTSI) and the Modified Computed Tomography Severity Index (MCTSI) are effective tools for predicting severity and clinical outcomes in acute pancreatitis. MCTSI demonstrates slightly higher specificity in identifying severe cases and exhibits improved discriminatory power compared to CTSI.
... The disease should be understood well to reduce their burden on individuals and their families. 2 The alcoholic abuse identified as a cause of acute pancreatitis at a median age of around 40 years compared with median age of biliary etiology around 53 years. 7 Alcohol is considered the most common cause of pancreatitis followed by genetic or environmental factors. ...
The pancreas has important endocrine and exocrine function and diseases of it causes significant morbidity and mortality. Diseases of the pancreas thus remain a continuing source of frustration in modern medicine. Clinical parameters have their limitations in diagnosing such lesions. Radiological evaluation also helps in diagnosing these lesions but to a certain extent. A good tumor marker is the answer to these problems. There are two tumor markers CA 242 and CA 19.9 which will not only help in early diagnosis of various pancreatic lesions, but also in differentiating them into neoplastic & non-neoplastic lesions.
100 patients of various pancreatic lesions were evaluated prospectively having USG confirmed pancreatic lesions, unexplained pancreatitis, pancreatic mass or pancreatic cystic lesion or worrisome clinical, imaging (CECT/USG) or laboratory findings.
Serum tumor marker CA 242 is more specific (100%) than CA 19.9(75%) and CA 19.9(71.9%) is more sensitive than CA 242(70.1%) in patients of various pancreatic lesions. While combined serum tumor marker CA 19.9 and CA 242 was more sensitive (70.5%) and specific (100%) than CA 19.9 and CA 242 alone.
For detection of various pancreatic lesions by serum tumor marker CA 19.9 and CA 242, the sensitivity, specificity and positive predictive value increases if markers are used in combination (serum tumor marker CA 19.9 and CA 242).
... 2 Southern states of India have the highest incidences of pancreatitis (114 to 200 per 100,000 population). 3 Global incidence is 30 to 40 cases per 100,000 population per year. 4 Most patients present with mild pancreatitis, usually self-limiting within a week and rarely fatal. ...
Sudden unexpected deaths pose a challenge for the forensic pathologists. Usually relates to cardiovascular cause and such deaths due to gastrointestinal related pathology are uncommon. Acute pancreatitis is a major etiology of gastrointestinal sudden deaths. It is mainly associated with gallbladder stones and alcoholism. We report a case of a 48-year-old man, chronic alcoholic, who was brought dead to hospital after complaints of abdominal pain and vomiting. The postmortem examination revealed the death due to acute hemorrhagic pancreatitis. Literature shows pancreatitis to be significantly associated with alcoholic liver disease. The present case reemphasizes the importance of examination of retroperitoneal space during autopsy and how ancillary investigations such as histopathology, chemical analysis, measuring serum amylase, lipase and vitreous glucose levels help in arriving at final diagnosis.
Keywords: Sudden death, Pancreatic haemorrhage, Pancreatic necrosis, Alcoholic liver disease, Acute hemorrhagic pancreatitis
... The sample size was estimated using 6% as the prevalence of AP as per previous studies. 9 Taking into consideration 95% as the confidence interval (CI) and 5% as the relative error, the sample size was calculated to be 90 using the formula. ...
Background: The mortality and morbidity associated with acute pancreatitis (AP) demands timely management and prediction of disease progression and clinical outcome. Multifactorial scoring systems shall facilitate risk stratification and prognostic assessment in AP. Aims and Objectives: The aim of the study was (i) to assess C-reactive protein (CRP) levels and modified computed tomography severity index (mCTSI) in AP patients and their association with the clinical outcome and (ii) to determine the correlation between CRP levels and mCTSI scores in AP. Materials and Methods: This cross-sectional, hospital-based study comprised 90 patients diagnosed with AP. Data collection included sociodemographic information, clinical presentation, and CRP estimation. The mCTSI score was estimated by axial slices contrast-enhanced computed tomography of abdomen and was used to assess the severity of AP. Categorical data were analyzed by Chi-square test and Pearson’s coefficient was estimated to determine the correlation between CRP levels and mCTSI score. P<0.05 was adopted as level of significance. Results: The study comprised 81 males (90%) and 9 females (10%). The mean age of the patients was 36.94±9.19 years, with majority in age group of 31–40 years (40%). Alcohol consumption (>50 g/day) was the commonest risk factor in 82.22% (n=74) patients, followed by hypertriglyceridemia in 13.33% (n=12) patients. Pain in abdomen was the most common presentation in 96.67% (n=87) patients, followed by vomiting 57.78% (n=52) patients. Majority of patients [82.22% (n=74)] had CRP levels of 10–21 mg/dL. Mild, moderate, and severe mCTSI scores were obtained in 17.78%, 66.67%, and 15.55% patients, respectively. There is a significant positive correlation between CRP values and mCTSI scores with r=0.3008 (P=0.003). Conclusion: CRP level had significant positive correlation with mCTSI scores in AP. Higher values of CRP and severe mCTSI scores had worse clinical outcome in AP.
... Acute pancreatitis (AP) a common abdominal pathology having a wide clinical spectrum with its prevalence increasing every year in India .Current prevalence stands at 7.9 per 100,000 with men and women having prevalence of 8.6 and 8.0 per 100,000 respectively in India. Few southern states of India have reported an incidence rate of 125-200/100,000 population [1]. The common risk factors leading to acute pancreatitis include alcohol intake, gall stones, trauma, drugs, and infections. ...
Acute pancreatitis is one of the most common abdominal pathologies having variable outcome ranging from self limiting abdominal pain to high mortality and morbidity due to organ failure, over the past five decades, various classification systems have emerged to classify pancreatitis according to its severity , and the associated complications have emerged to classify acute pancreatitis and its various complications, such as Apache Scoring , Ct Severity , Modified Ct Severity ,Ransen and Atlanta Classification. Objectives: We in our study will be classifying patients suffering from acute pancreatitis according to the revised Atlanta classification to divide them into interstitial edematous pancreatitis and necrotizing pancreatitis. The local complications will be classified according to CT imaging findings into acute necrotic collection, psuedocyst, acute necrotic collection and walled of necrosis. Organ failure will be assessed according to modified marshal scoring system into transient or persistent organ failure. Methodology: We will be carrying forward our study on Siemens 16 slice computer tomography machine over a sample of 140 patients coming to the outpatient department of our hospital which will be followed by a routine clinical follow up of the patient to find out their prognosis. Study Protocol Singh et al.; JPRI, 33(31B): 61-68, 2021; Article no.JPRI.68602 62 Results: Will be tabulated at the end of the study using SPSS version 26 software. Conclusion: The revised Atlanta classification for acute pancreatitis, in conjunction with the Modified Marshall Scoring System for organ failure, if found useful, in our series in improving the prognosis of the patients, then it can be incorporated in management.
Acute pancreatitis (AP) is one of the most common acute abdominal pathologies, having varying grades of severity and presentation ranging from mild self-limiting pain in the abdomen and vomiting to severe category which consists of multiple organ failure, sepsis, fever, and severe abdominal pain and vomiting making the patient hospital-bound. Over the years, many radiological and clinical classification systems have emerged to categorize the patient severity and associated local complications to assess their prognosis and help the clinicians decide the treatment plan. Patients suffering from mild pancreatitis are treated with conservative management, whereas those with moderate-to-severe pancreatitis are dealt with minimally invasive or surgical procedures hence making it necessary to classify the patients according to their severity which further helps the clinicians and surgeons decide on treatment plans. The revised Atlanta’s (2012) classification has made a milestone change in the way we classify AP and its complications by including the presence of organ failure and local fluid collections as an essential component of severity grading. In this review article, we will be reviewing past literature and discussing the efficacy of the revised Atlanta classification (2012) in evaluating the type of pancreatitis, the presence or absence of organ failure, local complications, and its role in assessing the prognosis of the patient.
Acute pancreatitis (AP) presents a substantial burden in India, characterized by evolving disease patterns and life‐threatening complications. Globally, the increasing incidence of AP underscores the urgent need for effective therapeutic interventions. Key proteins such as ERR‐γ, Keap‐1, and NF‐κB play pivotal roles in the pathophysiology of AP, contributing to dysregulated molecular pathways and cellular interactions. Targeting these proteins offers a promising avenue to modulate these dysregulated pathways and improve AP outcomes. Smilax perfoliata, widely recognized for its diverse medicinal properties, presents a promising opportunity for the exploration of novel antipancreatitis agents, although data on its efficacy remains limited. In this study, we employed molecular docking simulations to evaluate the binding interactions between 23 identified phytocompounds from Smilax perfoliata and the target proteins ERR‐γ, Keap‐1, and NF‐κB. Among the compounds tested, silychrystin exhibited the highest binding affinity with Keap‐1 (−11.2 kcal/mol), followed by ERR‐γ (−10.2 kcal/mol) and NF‐κB (−8.5 kcal/mol). Additionally, a 200‐ns molecular dynamics simulation using GROMACS (GROningen MAchine for Chemical Simulations) confirmed the stability of the silychrystin‐target protein complex, revealing consistent interaction stability and minimal structural fluctuations. These findings suggest that silychrystin could serve as a promising therapeutic candidate for AP, warranting further research to evaluate its efficacy in preclinical and clinical settings.
Introduction:
Acute pancreatitis (AP) is one of the most common yet, the most complex and challenging abdominal emergencies encountered by clinicians globally. It runs an unpredictable course. One-fifth of all AP patients develop complications. Many prognostic predictive scoring systems are used for AP. The aim of our study was to evaluate the usefulness of modified computed tomography severity index (MCTSI) scores to predict the need for intensive care unit (ICU) stay, complications, and mortality in patients of AP.
Methodology:
An observational, prospective study was conducted for 1 year. Fifty cases diagnosed as AP were included in this study. Contrast-enhanced computed tomography of the abdomen and pelvis was carried out in all patients. MCTSI was calculated according to CT findings. Patients' demographic details, clinical findings, duration of hospital stay, complications, and interventions were recorded. SPSS version 26.0 was used for statistical analysis.
Results:
A.
Unlabelled:
total of 50 patients were enrolled in the study. The mean age was 43.34 years. Total hospital stay was 9.02 ± 6.47 days, mean ward stay was 6.08 ± 2.73, and mean ICU stay was 2.94 ± 4.7 days. Five deaths were reported. There was a significant correlation between the necessity of ICU admission and grade of pancreatitis. There is significant correlation with age and ICU stay (r = 0.344, P = 0.014), age and ward stay (r = -0.340, P = 0.016), total duration of hospital stay and MCTSI score (r = 0.742, P = 0.000), duration of ward stay and MCTSI score (r = -0.442, P = 0.001), and strong correlation with duration of ICU stay and MCTSI score (r = 0.869, P = 0.000). A higher MCTSI score was significantly associated with the presence of local as well as systemic complications and with death (P = 0.0001).
Conclusion:
Grading by modified CT severity index has a significant direct correlation with the necessity of ICU admission, duration of ICU stay, and total duration of hospital stay. A modified CT severity index can be used to predict the possibility of developing local and systemic complications as well as the need for interventions. Modified CTSI is a reliable predictor of clinical course and outcome in cases of acute pancreatitis.
This paper reviews the current status of our understanding of the epidemiology, diagnosis, and management of the continuum of pancreatic diseases from acute and recurrent acute pancreatitis to chronic pancreatitis and the diseases that are often linked with pancreatitis including diabetes mellitus and pancreatic cancer. In addition to reviewing the current state of the field, we identify gaps in knowledge that are necessary to address to improve patient outcomes in these conditions.
Ayurveda is considered as one of the oldest of the traditional systems of medicine (TSMs) accepted worldwide. The ancient wisdom in this traditional system of medicine is still not exhaustively explored. The junction of the rich knowledge from different traditional systems of medicine can lead to new avenues in herbal drug discovery process. The lack of the understanding of the differences and similarities between the theoretical doctrines of these systems is the major hurdle towards their convergence apart from the other impediments in the discovery of plant based medicines. This review aims to bring into limelight the age old history and the basic principles of Ayurveda. This would help the budding scholars, researchers and practitioners gain deeper perspicuity of traditional systems of medicine, facilitate strengthening of the commonalities and overcome the challenges towards their global acceptance and harmonization of such medicinal systems. © 2016 Center for Food and Biomolecules, National Taiwan University.
The incidence of acute pancreatitis has increased sharply in many European countries and the USA in recent years.
To establish trends in incidence and mortality for acute pancreatitis in Wales, UK, and to assess how incidence may be linked to factors including social deprivation, seasonal effects and alcohol consumption.
Use of record linked inpatient, mortality and primary care data for 10 589 hospitalised cases of acute pancreatitis between 1999 and 2010.
The incidence of acute pancreatitis was 30.0 per 100 000 population overall, mortality was 6.4% at 60 days. Incidence increased significantly from 27.6 per 100 000 in 1999 to 36.4 in 2010 (average annual increase = 2.7% per year), there was little trend in mortality (0.2% average annual reduction). The largest increases in incidence were among women aged <35 years (7.9% per year) and men aged 35-44 (5.7%) and 45-54 (5.3%). Incidence was 1.9 times higher among the most deprived quintile of patients compared with the most affluent (3.9 times higher for alcoholic acute pancreatitis and 1.5 for gallstone acute pancreatitis). Acute pancreatitis was increased significantly during the Christmas and New Year weeks by 48% (95% CI = 24-77%) for alcoholic aetiology, but not for gallstone aetiology (9%). Alcoholic admissions were increased with higher consumption of spirits and beer, but not wine.
The study shows an elevated rate of alcoholic acute pancreatitis during the Christmas and New Year period. Acute pancreatitis continues to rise, most rapidly for young women, while alcoholic acute pancreatitis is linked strongly with social deprivation.
Objectives:
The epidemiological trends contributing to increasing acute pancreatitis (AP) hospitalizations remain unknown. We sought to analyze etiological factors and outcomes of increasing AP hospitalizations.
Methods:
Utilizing the Nationwide Inpatient Sample, retrospective analyses of adult (≥18 years) inpatient admissions with a primary diagnosis of AP (N = 2,016,045) were performed. Patient hospitalizations from 2009 to 2012 were compared with those from 2002 to 2005.
Results:
Compared with 2002-2005, there was a 13.2% (P < 0.001) increase in AP admissions in 2009-2012. Multivariate analysis adjusted for "period," patient and hospital demographics, AP etiologies, and disease associations demonstrated an increase in the odds of associated chronic pancreatitis (CP) [2002-2005: odds ratio, (OR), 32.04; 95% confidence interval (CI), 30.51-33.64; 2009-2012: OR, 35.02; 95% CI, 33.94-36.14], whereas associated odds of gallstones (2002-2005: OR, 36.37; 95% CI, 35.32-37.46; 2009-2012: OR, 29.85; 95% CI, 29.09-30.64) decreased. Compared with 2002-2005, the AP-related mortality decreased in 2009-2012 (1.62%-0.79%, P < 0.001) and was lower in AP with associated CP (0.65%-0.26%; P < 0.001) compared with AP without CP.
Conclusion:
In the preceding decade, AP hospitalizations are increasing, but associated mortality is declining. Associated CP has emerged as a leading contributor for AP-related hospitalizations. Further research is needed to identify novel interventions to prevent disease progression of AP.
Background and Aims: A survey was conducted of chronic pancreatitis (CP) in different countries in the Asia-Pacific region. The main objective of the survey was to generate a database containing information regarding the prevalence, etiology, clinical presentation, diagnostic work-up, and management of CP in the Asia-Pacific region. Methods: Data were collected from seven countries using a structured questionnaire. Expert participants were asked to respond to the questionnaire based on the data of patients with CP studied in their centers. Results: The prevalence of CP was found to be very high in southern India (114-200/100 000 population), in contrast to the low reported rate of 4.2/100 000 population in Japan. Alcohol was the most common etiological factor in Australia (95%) and Japan (54%) while idiopathic pancreatitis was the most common type in India (tropical pancreatitis) and China, accounting for approximately 70% of all cases of CP. Pain was the most common clinical feature. Diabetes and steatorrhea were uncommon. With regard to the diagnosis of CP, all the experts believed that a patient could be diagnosed as having CP in the presence of any one or more of the following: ductal changes on endoscopic retrograde cholangiopancreatography, a positive secretin test, pancreatic calcification, and endosonographic abnormalities suggestive of CP. Most experts suggested pancreatic enzymes and analgesics as initial medical therapy for pain relief in CP. Endotherapy was suggested as the therapy of choice if medical therapy failed. Surgery was offered only after the failure of endotherapy. Most experts agreed that research should focus on genetic abnormalities in CP and the role of endotherapy for pain relief. Conclusion: The survey brought out the prevalent types and presentation of CP, common management practices, and also the shortcomings in the existing knowledge of CP in the Asia-Pacific region. These findings might help focus attention on the research priorities for CP in this region. (C) 2004 Blackwell Publishing Asia Pty Ltd.
Recent reports indicate a decline in prevalence of classical tropical chronic pancreatitis (TCP). We studied the etiologies and risk factors over a 14-year period at a tertiary care university hospital.
We compared the etiology in chronic pancreatitis (CP) patients presenting and followed-up in our Pancreas Clinic over two time periods (2000-06 and 2007-13).
Idiopathic chronic pancreatitis (ICP) was the predominant etiology seen over the two time periods. However an increase in prevalence of alcoholic chronic pancreatitis (ACP) during the latter time period suggests that it may be emerging as a dominant etiology over recent years. Hypertriglyceridemia and hyperparathyroidism were uncommon causes of non-alcoholic CP. Autoimmune pancreatitis was noted only during 2007-13, but remains a rare cause of CP. There are multiple risk factors for CP in our population.
The high prevalence of ICP indicates need closer examination of risk factors and ICP pathogenesis. ACP appears to be emerging as a dominant cause of CP which suggests a need to reorient preventive strategies.
Acute pancreatitis is one of the most frequent gastrointestinal causes of hospital admission in the United States. Chronic pancreatitis, although lower in incidence, significantly reduces patients' quality of life. Pancreatic cancer is associated with a high mortality rate and is one of the top 5 causes of death from cancer. The burden of pancreatic disorders is expected to increase over time. The risk and etiology of pancreatitis differ with age and sex, and all pancreatic disorders affect the black population more than any other race. Gallstones are the most common cause of acute pancreatitis, and early cholecystectomy eliminates the risk of future attacks. Alcohol continues to be the single most important risk factor for chronic pancreatitis. Smoking is an independent risk factor for acute and chronic pancreatitis, and its effects could synergize with those of alcohol. Significant risk factors for pancreatic cancer include smoking and non-O blood groups. Alcohol abstinence and smoking cessation can alter the progression of pancreatitis and reduce recurrence; smoking cessation is the most effective strategy to reduce the risk of pancreatic cancer.
Abstract Current knowledge about chronic pancreatitis (CP) is limited and there is a particular dearth of information about the entity known as tropical pancreatitis. A consensus working party was convened by the Trustees of the Journal of Gastroenterology and Hepatology Foundation to conduct a systematic investigation into available evidence about the epidemiology, etiopathogenesis, diagnosis and management of CP. A literature search and formal survey of international experts in the field were used to assemble reliable evidence about these issues. The present review summarizes the results of the working party’s findings and presents a series of practice guidelines to improve diagnosis, investigation and treatment of patients with CP, particularly those in the Asia–Pacific region. Areas for further research have also been identified.
© 2002 Blackwell Publishing Asia Pty Ltd
Population-based data on chronic pancreatitis (CP) in the United States are scarce. We determined incidence, prevalence, and survival of CP in Olmsted County, MN.
Using Mayo Clinic Rochester's Medical Diagnostic Index followed by a detailed chart review, we identified 106 incident CP cases from 1977 to 2006 (89 clinical cases, 17 diagnosed only at autopsy); CP was defined by previously published Mayo Clinic criteria. We calculated age- and sex-adjusted incidence (for each decade) and prevalence rate (1 January 2006) per 100,000 population (adjusted to 2000 US White population). We compared the observed survival rate for patients with expected survival for age- and sex-matched Minnesota White population.
Median age at diagnosis of CP was 58 years, 56% were male, and 51% had alcoholic CP. The overall (clinical cases or diagnosed only at autopsy) age- and sex-adjusted incidence was 4.05/100,000 person-years (95% confidence interval (CI) 3.27-4.83). The incidence rate for clinical cases increased significantly from 2.94/100,000 during 1977-1986 to 4.35/100,000 person-years during 1997-2006 (P<0.05) because of an increase in the incidence of alcoholic CP. There were 51 prevalent CP cases on 1 January 2006 (57% male, 53% alcoholic). The age- and sex-adjusted prevalence rate per 100,000 population was 41.76 (95% CI 30.21-53.32). At last follow-up, 50 patients were alive. Survival among CP patients was significantly lower than age- and sex-specific expected survival in Minnesota White population (P<0.001).
Incidence and prevalence of CP are low, and ∼50% are alcohol related. The incidence of CP cases diagnosed during life is increasing. Survival of CP patients is lower than in the Minnesota White population.