Abstract
Background and Aims:
Hypertriglyceridemia is an etiologic cause of acute pancreatitis, with a
frequency of 1%-5%. Insulin infusion, heparin infusion, and plasmapheresis can
be used for the treatment of acute pancreatitis related to
hypertriglyceridemia. The aim of our study was to share our experience with the
treatment, clinical course, and demographic features of patients with acute
pancreatitis related to hypertriglyceridemia and the effectiveness of
plasmapheresis. Material and Methods: Patients with
acute pancreatitis diagnosed and treated at Türkiye Yüksek İhtisas Training and
Research Hospital during 2014-2016 were screened. Those who had
hypertriglyceridemia with levels >900 mg/dl without any potential cause of
acute pancreatitis were included in the study as patients with
hypertriglyceridemia-induced acute pancreatitis. Medical data were collected
from patients’ files and the hospital computer automation system. Results: A total of 10
patients [male/female: 4/6, median age: 41.4 (26-51) years] were included in
the study. The frequency of acute pancreatitis was 1.4. The Bedside Index of
Severity in Acute Pancreatitis scoring system was used to establish the
severity of acute pancreatitis. Patients with a high Bedside Index of Severity
in Acute Pancreatitis score were treated with plasmapheresis (n=4). In this
group, three patients developed walled off necrosis and pseudocysts.
Percutaneous drainage was applied in one patient with walled off necrosis. No
mortality was observed in our patients. Conclusion:
Hypertriglyceridemia is a rare cause of acute pancreatitis. Early diagnosis and
appropriate treatment are important in this group for decreasing the
disease-related morbidity and mortality. Plasmapheresis is an effective
treatment modality, especially in patients with severe
hypertriglyceridemia-induced acute pancreatitis.
References
- 1. Frossard JL, Steer ML, Pastor CM. Acute pancreatitis. Lancet 2008;371:143-52. 2. Hamada S, Masamune A, Kikuta K, et al; Research Committee of Intractable Diseases of the Pancreas. Nationwide epidemiological survey of acute pancreatitis in Japan. Pancreas 2014;43:1244-8. 3. Yeh JH, Chen JH, Chiu HC. Plasmapheresis for hyperlipidemic pancreatitis. J Clin Apher 2003;18:181-5. 4. Henzen C, Rock M, Schnieper C, Heer K. Heparin and insulin in the treatment of acute hypertriglyceridemia-induced pancreatitis. Schweiz Med Wochenschr 1999;129:1242-8. 5. Fortson MR, Freedman SN, Webster PD III. Clinical assessment of hyperlipidemic pancreatitis. Am J Gastroenterol 1995;90:2134-9. 6. Durrington P. Dyslipidaemia. Lancet 2003;362:717-31. 7. Saligram S1, Lo D, Saul M, Yadav D. Analyses of hospital administrative data that use diagnosis codes overestimate the cases of acute pancreatitis. Clin Gastroenterol Hepatol 2012;10:805-11. 8. Van de Wiel A. The effect of alcohol on postprandial and fasting triglycerides. Int J Vasc Med 2012; 2012:862504. 9. Valdivielso P, Ramírez-Bueno A, Ewald N. Current knowledge of hypertriglyceridemic pancreatitis. Eur J Intern Med 2014;25:689-94. 10. Click B, Ketchum AM, Turner R, et al. The role of apheresis in hypertriglyceridemia-induced acute pancreatitis: A systematic review. Pancreatology 2015;15:313-20. 11. Gubensek J, Buturovic-Ponikvar J, Romozi K, Ponikvar R. Factors affecting outcome in acute hypertriglyceridemic pancreatitis treated with plasma exchange: anobservational cohort study. PLoS One 2014;9:e102748. 12. Al-Humoud H, Alhumoud E, Al-Hilali N. Therapeutic plasma exchange for acute hyperlipidemic pancreatitis: a case series. Ther Apher Dial 2008;12:202-4. 13. Schwartz J, Winters JL, Padmanabhan A, et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the writing committee of the American Society for Apheresis: the sixth special issue. J Clin Apher 2013;28:145-284. 14. Mishalov VG, Markulan LY, Matveyev RM, et al. Efficacy and security of a conventional procedure of plasmapheresis in comlpex of treatment of nonbiliary acute pancreatitis in early phase of the disease. Klin Khir 2016;(2):31-3. 15. Scherer J, Singh VP, Pitchumoni CS, Yadav D. Issues in hypertriglyceridemic pancreatitis: an update. J Clin Gastroenterol 2014;48:195-203. 16. Chen JH, Yeh JH, Lai HW, Liao CS. Therapeutic plasma exchange in patients with hyperlipidemic pancreatitis. World J Gastroenterol 2004;10:2272-4.
Abstract
Giriş ve Amaç: Akut pankreatitin %1-5 nedeni hipertrigliseridemidir.
İnsülin infüzyonu, heparin infüzyonu ve plazmaferez hipertrigliseridemiye bağlı
Akut pankreatitin tedavisinde yer almaktadır. Biz bu çalışmamızda
hipertrigliseridemiye bağlı oluşan Akut pankreatitli hastalarımızın demografik
özelliklerini, pankreatitlerinin seyrini, uygulanan tedavi yöntemlerini ve
plazmaferezin etkinliğini araştırdık. Gereç ve Yöntem: Türkiye Yüksek İhtisas Hastanesi Gastroenteroloji
Kliniği’nde 2012-2016 yılları arasında akut pankreatit tanısı konulan hastalar
retrospektif olarak tarandı. İlk başvuruda trigliserid değeri 900 mg/dl ve
üzeri olan hastalar, diğer etiyolojik nedenlerin yokluğunda
hipertrigliseridemiye bağlı Akut pankreatit olarak kabul edildi. Hastaların
medikal bilgilerine hasta dosyaları ve hastane otomasyon bilgi sisteminden
ulaşıldı. Bulgular: Toplam 10 hasta (E/K: 4/6, yaş ortalaması 41,4 (26-51)
çalışmaya alındı. Hastalarımızda akut pankreatit atak sıklığı 1,4 (1-3) olarak
bulundu. Akut pankreatit şiddetini belirlemede BISAP skorlaması kullanıldı.
BISAP skoru yüksek olan hastalara plasmaferez uygulandı (4 hasta). Bu
hastaların 3 tanesinde psödokist ve walled-off nekroz oluştuğu görüldü.
Walled-off nekroz oluşan bir hastaya perkütan drenaj yapıldı. Toplamda hiçbir
hastada mortalite izlenmedi. Sonuç: Hipertrigliseridemi, diğer nedenlere kıyasla akut
pankreatite nadiren yol açar. Bu hastaların erken tanınması ve uygun tedavisi
hastalık ilişkili morbidite ve mortalitenin azalmasına yol açar. Plazmaferez
özellikle ciddi seyreden hastalarda etkili bir tedavi yöntemidir.
References
- 1. Frossard JL, Steer ML, Pastor CM. Acute pancreatitis. Lancet 2008;371:143-52. 2. Hamada S, Masamune A, Kikuta K, et al; Research Committee of Intractable Diseases of the Pancreas. Nationwide epidemiological survey of acute pancreatitis in Japan. Pancreas 2014;43:1244-8. 3. Yeh JH, Chen JH, Chiu HC. Plasmapheresis for hyperlipidemic pancreatitis. J Clin Apher 2003;18:181-5. 4. Henzen C, Rock M, Schnieper C, Heer K. Heparin and insulin in the treatment of acute hypertriglyceridemia-induced pancreatitis. Schweiz Med Wochenschr 1999;129:1242-8. 5. Fortson MR, Freedman SN, Webster PD III. Clinical assessment of hyperlipidemic pancreatitis. Am J Gastroenterol 1995;90:2134-9. 6. Durrington P. Dyslipidaemia. Lancet 2003;362:717-31. 7. Saligram S1, Lo D, Saul M, Yadav D. Analyses of hospital administrative data that use diagnosis codes overestimate the cases of acute pancreatitis. Clin Gastroenterol Hepatol 2012;10:805-11. 8. Van de Wiel A. The effect of alcohol on postprandial and fasting triglycerides. Int J Vasc Med 2012; 2012:862504. 9. Valdivielso P, Ramírez-Bueno A, Ewald N. Current knowledge of hypertriglyceridemic pancreatitis. Eur J Intern Med 2014;25:689-94. 10. Click B, Ketchum AM, Turner R, et al. The role of apheresis in hypertriglyceridemia-induced acute pancreatitis: A systematic review. Pancreatology 2015;15:313-20. 11. Gubensek J, Buturovic-Ponikvar J, Romozi K, Ponikvar R. Factors affecting outcome in acute hypertriglyceridemic pancreatitis treated with plasma exchange: anobservational cohort study. PLoS One 2014;9:e102748. 12. Al-Humoud H, Alhumoud E, Al-Hilali N. Therapeutic plasma exchange for acute hyperlipidemic pancreatitis: a case series. Ther Apher Dial 2008;12:202-4. 13. Schwartz J, Winters JL, Padmanabhan A, et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the writing committee of the American Society for Apheresis: the sixth special issue. J Clin Apher 2013;28:145-284. 14. Mishalov VG, Markulan LY, Matveyev RM, et al. Efficacy and security of a conventional procedure of plasmapheresis in comlpex of treatment of nonbiliary acute pancreatitis in early phase of the disease. Klin Khir 2016;(2):31-3. 15. Scherer J, Singh VP, Pitchumoni CS, Yadav D. Issues in hypertriglyceridemic pancreatitis: an update. J Clin Gastroenterol 2014;48:195-203. 16. Chen JH, Yeh JH, Lai HW, Liao CS. Therapeutic plasma exchange in patients with hyperlipidemic pancreatitis. World J Gastroenterol 2004;10:2272-4.
Details
| Journal Section | Articles |
|---|---|
| Authors | |
| Publication Date | November 20, 2017 |
| Published in Issue | Year 2017 Volume: 16 Issue: 3 |
test-5