Acute pancreatitis secondary prevention: Difference between revisions
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==Overview== | ==Overview== | ||
The secondary prevention of acute pancreatitis primarily focuses on prevention of recurrence. The secondary prevention of acute pancreatitis varies according to the underlying etiology of the primary event. Cholecystectomy, alcohol abstinence, withdrawal of aggravating medications, weight control, and control of hyperlipidemia are among the most common methods of preventing recurrence of acute pancreatitis. | The secondary prevention of acute pancreatitis primarily focuses on prevention of recurrence. The secondary prevention of acute pancreatitis varies according to the underlying etiology of the primary event. Cholecystectomy, alcohol abstinence, withdrawal of aggravating medications, weight control, and control of [[Hyperlipoproteinemia|hyperlipidemia]] are among the most common methods of preventing recurrence of acute pancreatitis. | ||
==Secondary Prevention== | ==Secondary Prevention== | ||
The secondary prevention of acute pancreatitis varies according to the underlying etiology of the primary event. | The secondary prevention of acute pancreatitis varies according to the underlying etiology of the primary event. | ||
===Cholecystectomy=== | ===Cholecystectomy=== | ||
A delay of cholecystectomy for more than a few weeks after acute pancreatitis puts the patient at a high risk for relapse. There is a correlation between delay of cholecystectomy and rate of recurrence. For patients in which cholecystectomy cannot be safely performed. Endoscopic biliary sphincterotomy may prevent recurrence of pancreatitis.<ref name="pmid22470079">{{cite journal| author=van Baal MC, Besselink MG, Bakker OJ, van Santvoort HC, Schaapherder AF, Nieuwenhuijs VB et al.| title=Timing of cholecystectomy after mild biliary pancreatitis: a systematic review. | journal=Ann Surg | year= 2012 | volume= 255 | issue= 5 | pages= 860-6 | pmid=22470079 | doi=10.1097/SLA.0b013e3182507646 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22470079 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22842716 Review in: Evid Based Med. 2013 Apr;18(2):e11] </ref> | A delay of [[cholecystectomy]] for more than a few weeks after acute pancreatitis puts the patient at a high risk for relapse. There is a correlation between delay of cholecystectomy and rate of recurrence. For patients in which [[cholecystectomy]] cannot be safely performed. Endoscopic biliary sphincterotomy may prevent recurrence of pancreatitis.<ref name="pmid22470079">{{cite journal| author=van Baal MC, Besselink MG, Bakker OJ, van Santvoort HC, Schaapherder AF, Nieuwenhuijs VB et al.| title=Timing of cholecystectomy after mild biliary pancreatitis: a systematic review. | journal=Ann Surg | year= 2012 | volume= 255 | issue= 5 | pages= 860-6 | pmid=22470079 | doi=10.1097/SLA.0b013e3182507646 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22470079 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22842716 Review in: Evid Based Med. 2013 Apr;18(2):e11] </ref> | ||
===Alcohol Abstinence=== | ===Alcohol Abstinence=== | ||
Patients who developed acute pancreatitis secondary to alcohol abuse are at high risk of recurrent pancreatitis or even chronic pancreatitis. ~50% of patients with alcoholic pancreatitis suffer from recurrence if they continue abusing alcohol. The risk is significantly reduced after abstaining from alcohol. A focused approach directed at alcohol and smoking cessation should be taken with the patient.<ref name="pmid17592227">{{cite journal| author=Sand J, Lankisch PG, Nordback I| title=Alcohol consumption in patients with acute or chronic pancreatitis. | journal=Pancreatology | year= 2007 | volume= 7 | issue= 2-3 | pages= 147-56 | pmid=17592227 | doi=10.1159/000104251 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17592227 }} </ref><ref name="pmid18415757">{{cite journal| author=Pelli H, Lappalainen-Lehto R, Piironen A, Sand J, Nordback I| title=Risk factors for recurrent acute alcohol-associated pancreatitis: a prospective analysis. | journal=Scand J Gastroenterol | year= 2008 | volume= 43 | issue= 5 | pages= 614-21 | pmid=18415757 | doi=10.1080/00365520701843027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18415757 }} </ref> | Patients who developed acute pancreatitis secondary to alcohol abuse are at high risk of recurrent pancreatitis or even chronic pancreatitis. ~50% of patients with alcoholic pancreatitis suffer from recurrence if they continue abusing alcohol. The risk is significantly reduced after abstaining from alcohol. A focused approach directed at alcohol and smoking cessation should be taken with the patient.<ref name="pmid17592227">{{cite journal| author=Sand J, Lankisch PG, Nordback I| title=Alcohol consumption in patients with acute or chronic pancreatitis. | journal=Pancreatology | year= 2007 | volume= 7 | issue= 2-3 | pages= 147-56 | pmid=17592227 | doi=10.1159/000104251 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17592227 }} </ref><ref name="pmid18415757">{{cite journal| author=Pelli H, Lappalainen-Lehto R, Piironen A, Sand J, Nordback I| title=Risk factors for recurrent acute alcohol-associated pancreatitis: a prospective analysis. | journal=Scand J Gastroenterol | year= 2008 | volume= 43 | issue= 5 | pages= 614-21 | pmid=18415757 | doi=10.1080/00365520701843027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18415757 }} </ref> | ||
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Identifying the offending medication is a challenging task and is often not achieved. In the absence of any aggrevating conditions, a trial of changing drug regimens or cessation of an implicated drug may be reasonable after discussion with the prescribing physician.<ref name="pmid18209761">{{cite journal| author=Kaurich T| title=Drug-induced acute pancreatitis. | journal=Proc (Bayl Univ Med Cent) | year= 2008 | volume= 21 | issue= 1 | pages= 77-81 | pmid=18209761 | doi= | pmc=2190558 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18209761 }} </ref> | Identifying the offending medication is a challenging task and is often not achieved. In the absence of any aggrevating conditions, a trial of changing drug regimens or cessation of an implicated drug may be reasonable after discussion with the prescribing physician.<ref name="pmid18209761">{{cite journal| author=Kaurich T| title=Drug-induced acute pancreatitis. | journal=Proc (Bayl Univ Med Cent) | year= 2008 | volume= 21 | issue= 1 | pages= 77-81 | pmid=18209761 | doi= | pmc=2190558 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18209761 }} </ref> | ||
===Control of Hyperlipidemia=== | ===Control of Hyperlipidemia=== | ||
Control of hypertriglyceridemia is effective in preventing recurrence of pancreatitis. Repeated measurements of serum triglycerides after discharge may be beneficial.<ref name="pmid12488710">{{cite journal| author=Yadav D, Pitchumoni CS| title=Issues in hyperlipidemic pancreatitis. | journal=J Clin Gastroenterol | year= 2003 | volume= 36 | issue= 1 | pages= 54-62 | pmid=12488710 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12488710 }} </ref><ref name="pmid25269432">{{cite journal| author=Valdivielso P, Ramírez-Bueno A, Ewald N| title=Current knowledge of hypertriglyceridemic pancreatitis. | journal=Eur J Intern Med | year= 2014 | volume= 25 | issue= 8 | pages= 689-94 | pmid=25269432 | doi=10.1016/j.ejim.2014.08.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25269432 }} </ref> | Control of [[Hyperlipoproteinemia|hypertriglyceridemia]] is effective in preventing recurrence of pancreatitis. Repeated measurements of serum triglycerides after discharge may be beneficial.<ref name="pmid12488710">{{cite journal| author=Yadav D, Pitchumoni CS| title=Issues in hyperlipidemic pancreatitis. | journal=J Clin Gastroenterol | year= 2003 | volume= 36 | issue= 1 | pages= 54-62 | pmid=12488710 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12488710 }} </ref><ref name="pmid25269432">{{cite journal| author=Valdivielso P, Ramírez-Bueno A, Ewald N| title=Current knowledge of hypertriglyceridemic pancreatitis. | journal=Eur J Intern Med | year= 2014 | volume= 25 | issue= 8 | pages= 689-94 | pmid=25269432 | doi=10.1016/j.ejim.2014.08.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25269432 }} </ref> | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Tarek Nafee, M.D. [2]
Overview
The secondary prevention of acute pancreatitis primarily focuses on prevention of recurrence. The secondary prevention of acute pancreatitis varies according to the underlying etiology of the primary event. Cholecystectomy, alcohol abstinence, withdrawal of aggravating medications, weight control, and control of hyperlipidemia are among the most common methods of preventing recurrence of acute pancreatitis.
Secondary Prevention
The secondary prevention of acute pancreatitis varies according to the underlying etiology of the primary event.
Cholecystectomy
A delay of cholecystectomy for more than a few weeks after acute pancreatitis puts the patient at a high risk for relapse. There is a correlation between delay of cholecystectomy and rate of recurrence. For patients in which cholecystectomy cannot be safely performed. Endoscopic biliary sphincterotomy may prevent recurrence of pancreatitis.[1]
Alcohol Abstinence
Patients who developed acute pancreatitis secondary to alcohol abuse are at high risk of recurrent pancreatitis or even chronic pancreatitis. ~50% of patients with alcoholic pancreatitis suffer from recurrence if they continue abusing alcohol. The risk is significantly reduced after abstaining from alcohol. A focused approach directed at alcohol and smoking cessation should be taken with the patient.[2][3]
Withdrawal of Medication
Identifying the offending medication is a challenging task and is often not achieved. In the absence of any aggrevating conditions, a trial of changing drug regimens or cessation of an implicated drug may be reasonable after discussion with the prescribing physician.[4]
Control of Hyperlipidemia
Control of hypertriglyceridemia is effective in preventing recurrence of pancreatitis. Repeated measurements of serum triglycerides after discharge may be beneficial.[5][6]
References
- ↑ van Baal MC, Besselink MG, Bakker OJ, van Santvoort HC, Schaapherder AF, Nieuwenhuijs VB; et al. (2012). "Timing of cholecystectomy after mild biliary pancreatitis: a systematic review". Ann Surg. 255 (5): 860–6. doi:10.1097/SLA.0b013e3182507646. PMID 22470079. Review in: Evid Based Med. 2013 Apr;18(2):e11
- ↑ Sand J, Lankisch PG, Nordback I (2007). "Alcohol consumption in patients with acute or chronic pancreatitis". Pancreatology. 7 (2–3): 147–56. doi:10.1159/000104251. PMID 17592227.
- ↑ Pelli H, Lappalainen-Lehto R, Piironen A, Sand J, Nordback I (2008). "Risk factors for recurrent acute alcohol-associated pancreatitis: a prospective analysis". Scand J Gastroenterol. 43 (5): 614–21. doi:10.1080/00365520701843027. PMID 18415757.
- ↑ Kaurich T (2008). "Drug-induced acute pancreatitis". Proc (Bayl Univ Med Cent). 21 (1): 77–81. PMC 2190558. PMID 18209761.
- ↑ Yadav D, Pitchumoni CS (2003). "Issues in hyperlipidemic pancreatitis". J Clin Gastroenterol. 36 (1): 54–62. PMID 12488710.
- ↑ Valdivielso P, Ramírez-Bueno A, Ewald N (2014). "Current knowledge of hypertriglyceridemic pancreatitis". Eur J Intern Med. 25 (8): 689–94. doi:10.1016/j.ejim.2014.08.008. PMID 25269432.