Original articleEvaluation and management of acute pancreatitis in SpainEvaluación y manejo de pancreatitis aguda en España
Introduction
Acute pancreatitis (AP) is the third cause of hospitalization in the United States1 and constitutes a heterogeneous disease with various causes, morbidity and potential mortality.2 For these reasons, it is a major problem in gastroenterology departments worldwide and its management has been well described in several recent guidelines.2, 3 In addition, there is significant heterogeneity not only related to individual patient factors but with the variety of incidence rates,4 etiology,5 scoring systems for severity6 and management,7 which can be diverse among countries. Thus, efforts to understand these differences while unifying areas of similarity between countries are important. In this setting, we have reviewed data from Spanish centers with the main aim of describing Spanish areas of research in AP and guide future research. We also have searched for epidemiological data to better understanding the current situation of AP in our country.
Section snippets
Review protocols
The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist8 was used for the performance of this systematic review.
Ethics
The authors declare no conflict of personal interests and no funding has been received for the present study.
Definitions
AP was diagnosed according to current guidelines2, 3 with patients meeting 2 of the 3 of the following criteria: abdominal pain consistent with the disease, serum amylase and/or lipase greater than 3 times the upper limit of normal, and/or
Results
A total of 171 abstracts were initially identified in the literature search (Fig. 1), 137 of them in PubMed and 44 in Web Of Science. 25 articles were identified when using the term “epidemiology Acute pancreatitis Spain”, 74 when using the term “severe acute pancreatitis Spain” and 28 articles when using the term “management acute pancreatitis Spain”. 44 articles were identified by using the term “Acute Pancreatitis Spain” in Web of Science. After removing the duplicate, 129 articles remained
Epidemiology
In Spain, the overall incidence was 72 patients per 100,000 inhabitants-year in a population-based retrospective study using the Spanish National Hospital Database. This study also reports a higher incidence rate especially in patients with type 2 diabetes, but these patients had lower in hospital mortality than non-diabetics.9 Another population-based case-control study found a slight increase in risk of AP in patients with type 2 diabetes although apparently less in those using insulin.10
Etiology
Data about etiologies is shown in Table 1 but only those articles in which, the most common etiologies were identified are listed.11, 12, 15, 16, 17, 18, 19 Regarding general cohorts, the articles included show that biliary etiology is the most common cause in patients with AP, ranging from 50.7% to 65.8%, slightly lower in ICU cohorts (46.5–48.2%), and followed by alcoholic (10.4–21%) and idiopathic (6.3–15.2%).
Diagnosis
A quasi-experimental study from an emergency department has assessed the role of amylase and lipase in diagnosis of AP.20 This study shows higher sensitivity and specificity for lipase (0.85 and 0.96 respectively) in comparison with amylase (0.70 and 0.85). When adding amylase in patients with limits values of lipase, sensitivity and specificity did not change but they found higher rates of positive predictive values than using lipase alone (77% vs. 47%).20
The diagnostic role of endoscopic
Classification and prediction of severity
The severity classifications in AP (Determinants Based Classification and Revised Atlanta) have been assessed by a study which performed a post hoc analysis of a prospective cohort in Spain, finding that the in hospital mortality was higher in patients with SAP (80%) in the Revised Atlanta classification and in severe and critical categories (67%) in the Determinant-Based Classification. The other categories in both classifications showed no deaths during the hospital stay.19 In a prospective
Fluid therapy
Early aggressive intravenous hydration has been assessed by a multicenter retrospective study, enrolling 1010 patients. In this study, early aggressive hydration was defined as more than 1000 ml from time of admission to the emergency room until more than 4 h after diagnosis, moderate hydration as 500–1000 ml and nonaggressive as less than 500 ml. When comparing both moderate and aggressive with nonaggressive hydration, there was less need of invasive treatment compared to the moderate group (OR
Discussion
This systematic review summarizes the most important findings in AP in the last decade from Spain in terms of epidemiology, etiology, diagnosis, classification, severity prediction and general management. Furthermore, we highlight important observations in our nation as well as from international collaboration, which can guide evaluation, management and future researches.
Regarding epidemiology, AP is an increasing problem with an overall mortality of 4.2%,11 but when persistent organ failure
Conflict of interest
The authors declare no conflict of personal interests and no funding has been received for the present study.
References (57)
- et al.
The incidence and aetiology of acute pancreatitis across Europe
Pancreatology
(2017) - et al.
National trends in incidence and outcomes of acute pancreatitis among type 2 diabetics and non-diabetics in Spain (2001–2011)
Pancreatology
(2015) - et al.
Update of the Atlanta Classification of severity of acute pancreatitis: should a moderate category be included?
Pancreatology
(2010) - et al.
Evolution and results of the surgical management of 143 cases of severe acute pancreatitis in a referral center
Cir Esp
(2014) - et al.
New Atlanta Classification of acute pancreatitis in intensive care unit: complications and prognosis
Eur J Intern Med
(2016) - et al.
Validation of the determinant-based classification and revision of the Atlanta classification systems for acute pancreatitis
Clin Gastroenterol Hepatol
(2014) - et al.
Utilidad de la ecoendoscopia en el diagnóstico etiológico de los pacientes con pancreatitis aguda idiopática
Gastroenterol Hepatol
(2008) - et al.
Early factors associated with fluid sequestration and outcomes of patients with acute pancreatitis
Clin Gastroenterol Hepatol
(2014) - et al.
Obesity and fat distribution imply a greater systemic inflammatory response and a worse prognosis in acute pancreatitis
Pancreatology
(2008) - et al.
A simple prognostic score for risk assessment in patients with acute pancreatitis
Eur J Intern Med
(2009)
The expression and activation of the AIM2 inflammasome correlates with inflammation and disease severity in patients with acute pancreatitis
Pancreatology
Development and validation of a multivariate prediction model for patients with acute pancreatitis in Intensive Care Medicine
Pancreatology
Minimally invasive surgery in the era of step-up approach for treatment of severe acute pancreatitis
Int J Surg
A double-blind, placebo-controlled trial of ciprofloxacin prophylaxis in patients with acute necrotizing pancreatitis
J Gastrointest Surg
Early and/or immediately full caloric diet versus standard refeeding in mild acute pancreatitis: a randomized open-label trial
Pancreatology
Timing of enteral nutrition in acute pancreatitis: meta-analysis of individuals using a single-arm of randomised trials
Pancreatology
Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis
Gastroenterology
Utilidad de la somatostatina administrada en bolo para prevenir la pancreatitis tras CPRE: estudio controlado no aleatorizado
Gastroenterol Hepatol
Acute pancreatitis
Lancet
Reduction in mortality with delayed surgical therapy of severe pancreatitis
J Gastrointest Surg
Surgical versus nonsurgical treatment of infected pancreatic necrosis: more arguments to change the paradigm
J Gastrointest Surg
Burden of gastrointestinal, liver, and pancreatic diseases in the United States
Gastroenterology
American College of Gastroenterology guideline: management of acute pancreatitis
Am J Gastroenterol
IAP/APA evidence-based guidelines for the management of acute pancreatitis. Working Group IAP/APA Acute Pancreatitis Guidelines
Pancreatology
Acute pancreatitis in five European countries: etiology and mortality
Pancreas
Development and use of a new staging system for severe acute pancreatitis based on a nationwide survey in Japan
Pancreas
Utility of the new Japanese severity score and indications for special therapies in acute pancreatitis
J Gastroenterol
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement
Int J Surg
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