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11/21/2019 Abstracts of Papers Submitted to the Joint 50th Anniversary... : Pancreas
https://journals.lww.com/pancreasjournal/Fulltext/2019/11000/Abstracts_of_Papers_Submitted_to_the_Joint_50th.29.aspx/?cid=eTOC Issue…
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Gastroenterology, Hospital Nacional "Profesor Alejandro Posadas", Buenos Aires, Argentina;
Department of Surgery, University of Medicine and Pharmacy, Bucharest, Romania;
Department of Gastroenterology, San Raffaele Scientific Institute, Milan, Italy; Department of
Gastroenterology, Indiana University School of Medicine, Indianapolis, IN; Department of
Gastroenterology, Attikon University General Hospital, Athens, Greece; Department of
Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán-
Universidad Autónoma d Mexico, Mexico City, Mexico; Department of Gastroenterology,
Allegheny General Hospital, Pittsburgh, PA; Department of Surgery, Hospital General de
Argudos "Dr. Cosme Argerich", Buenos Aires, Argentina; Department of Gastroenterology,
Investigación Sanitaria y Biomédica de Alicante (ISABIAL – Fundación FISABIO), Alicante,
Spain; Department of Gastroenterology, Kaiser Permanente, Pasadena, CA; Department of
Gastroenterology, Medical University of South Carolina, Charleston, SC; Department of
Gastroenterology, Eastern Maine Medical Center, Bangor, ME.
Background: Oral feeding intolerance (OFI) is a well-known complication of acute pancreatitis
(AP) and results in slow recovery and increased health care resource utilization. The decision to
start oral refeeding is empiric and there is lack of validated criteria to assist in clinical decision
making. We aim to determine simple clinical factors associated with OFI.
Methods: Acute Pancreatitis Patient Registry to Examine Novel Therapies in Clinical Experience
(APPRENTICE) is an international, prospective cohort including 22 centers. Patients who had
initial feeding attempt by mouth were included in the study. OFI was defined based on worsening
epigastric pain, nausea/emesis and increased opioid requirement following a feeding attempt. The
timing of initial feeding attempt was stratified based on day of hospitalization.
Pearson’s chi-square test was used for categorical variables, while Wilcoxon’s rank-sum, Kruskal-
Wallis, and Fisher’s exact tests were used for continuous variables.
Results: A total of 1233 patients were included; of which, 160 (12.9%) met criteria for OFI. The
incidence of OFI was similar irrespective of timing of initial feeding attempt (range, 85%–90%; P =
0.41). Younger age (45 vs 50 years; P = 0.018), male sex (61% vs 49%; P = 0.004), transfers (38% vs
29%; P = 0.02), alcohol use (44% vs 36%; P = 0.034), smoking (29% vs 21%; P = 0.022), non-biliary
etiology (69% vs 51%; P < 0.001), presence of SIRS on admission (49% vs 35%; P < 0.001) and at 48
h (50% vs 26%; P < 0.001), elevated BUN (20 vs 15; P < 0.001) and Hct on admission (41.7 vs 40.5;
P = 0.017) were associated with OFI. On multivariable analysis, SIRS positive status at 48h (OR,
2.85; P < 0.001) and non-biliary AP etiology (OR, 1.77; P = 0.01) were independently associated
with OFI.
Conclusions: Based on our findings, only presence of SIRS at 48 h and non-biliary etiology were
independently associated with OFI. SIRS at 48 h is an independent risk, whereas biliary etiology is a
protective factor for OFI.
Clinical Intervention of Ayurvedic Treatment
in the Patients of Recurrent Acute/Chronic
Pancreatitis
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11/21/2019 Abstracts of Papers Submitted to the Joint 50th Anniversary... : Pancreas
https://journals.lww.com/pancreasjournal/Fulltext/2019/11000/Abstracts_of_Papers_Submitted_to_the_Joint_50th.29.aspx/?cid=eTOC Issue…
358/534
V.B. Prakash, S. Prakashm, S. Tiwari, S. Sharma, P. Jaryal, Department of Clinical Research,
VCPC Research Foundation, Uttarakhand, India; Department of Medicine, Padaav – Speciality
Ayurvedic Treatment Centre, Uttarakhand, India.
Background: Recurrent Acute/Chronic Pancreatitis (RA/CP) is a progressive disease that
significantly affects the physical and psychological well-being of its patients. In recent years, there is
an upsurge in the incidences of pancreatitis in India. The limitations of conventional treatment,
along with the psychological fear and financial burden associated with it, compel patients to look for
alternative treatment options. It is more so in India, where complementary and alternative
medicines (CAM) are recognized as independent medical systems in conjunction with conventional
medicine. A North India based Ayurvedic clinic has been treating patients of RA/CP using a Metal
Based Ayurvedic Formulation (MBAF) with a balanced diet and regulated lifestyle. The said MBAF
has shown pancreatitis protective properties against L-Arginine induced Pancreatitis in two
consequent studies in rats. The formulation has also passed acute, sub-acute and chronic toxicity
studies following OECD guidelines.
Methodology: The clinic has enrolled 777 well diagnosed cases of RA/CP till date, starting from
January 1997. Out of these, about 70% were non-alcoholics, 80% were non-tobacco users and 95%
had no family history of the disease. Majority of the patients were of the age group of 19 to 45 years
with more males than females (5:1). 400 patients of RA/CP have undergone one year long
therapeutic intervention using MBAF. None of the patients received pancreatic enzymes after the
start of Ayurvedic treatment.
Results: Significant reduction in number of attacks, emergency hospitalizations and weight loss
was observed in nearly 70% cases. Significant weight gain was seen in about 50% cases. The
formulation did not cause any Grade II toxicity and has brought down the mortality rate from 55%
to 1.2%. Ayurvedic treatment has shown sustainable effect with longest ongoing remission of more
than 20 years.
Conclusions: MBAF could be further explored in the management of RA/CP.
Activation of Pancreatic Stellate Cells and
Progression of Fibrosis in Experimental
Models of Early Chronic Pancreatitis
K. Priyam, M.K. Sharma, S. Argrawal, P.K. Garg, T.S. Roy, T.G. Jacob, Department of
Anatomy and Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Background: Activated pancreatic stellate cells (PSCs) are responsible for fibrosis in chronic
pancreatitis (CP). Acinar cell injury activate PSCs through TGF-β signaling. Here, we found the
earliest time-point of evidence of PSC-activation in experimental CP.
Methods: CP was induced in 36 male, Swiss albino mice (25 g body-weight) by intraperitoneal
injections of cerulein (Group-1, G1: 50 μg/kg, two days per week for 6-weeks). Six mice were
sacrificed in a CO -chamber every week, until week 7. Controls (G2) were treated with equivalent
doses of normal saline. Pancreata were dissected out, some fixed in buffered paraformaldehyde or
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