Original article
Evaluation and management of acute pancreatitis in SpainEvaluación y manejo de pancreatitis aguda en España

https://doi.org/10.1016/j.gastrohep.2018.06.012Get rights and content

Abstract

Introduction

The aim of this systematic review is to summarize epidemiological data and areas of future acute pancreatitis research in Spain.

Methods

We conduct an independent search in PubMed and Web of Science and analyse articles by Spanish researchers from 2008 to 2018.

Results

We identified an overall incidence of 72/100,000 person-years, with biliary pancreatitis as the most common etiology. BISAP was useful but suboptimal for predicting severity and some biomarkers such as Oleic acid chlorohydrin have shown promising results. The modified determinant-based classification can help to classify patients admitted to intensive care units. Ringer's lactate solution is currently the fluid of choice and classic surgery has been surpassed by minimally-invasive approaches. Starting a full-caloric diet is safe when bowel sounds are present.

Discussion

There are numerous well-defined research fields in Spain. Future multicentre studies should focus on management, predicting severity and cost-effectiveness.

Resumen

Introducción

El objetivo de esta revisión sistemática es sintetizar datos epidemiológicos y campos de investigación en pancreatitis aguda en España.

Métodos

Realizamos una búsqueda independiente en PubMed y Web of Science, analizando artículos de investigadores españoles desde 2008 hasta 2018.

Resultados

La incidencia global fue de 72/100.000 personas/año, siendo la etiología biliar la más común. BISAP resultó útil, aunque subóptimo en predicción de gravedad y ciertos biomarcadores como el ácido oleico clorhídrico han mostrado resultados prometedores. La clasificación basada en determinantes modificada puede ayudar en la clasificación de pacientes ingresados en UCI. La sueroterapia basada en Ringer lactato es actualmente de elección y la cirugía tradicional ha sido sustituida por abordajes mínimamente invasivos. La dieta amplia de inicio, cuando los ruidos intestinales están presentes es segura.

Discusión

Existen múltiples áreas de investigación bien definidas en España. Futuros estudios multicéntricos deberían centrarse en manejo, predicción de la gravedad y el coste/efectividad.

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.

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