The possible association of proton pump inhibitor use with acute cholangitis in patients with choledocholithiasis: a multi-center study.

BACKGROUND: Gallstone disease is common worldwide and can lead to severe complications, including cholangitis; thus, it is important to identify modifiable risk factors for cholangitis. Proton pump inhibitors (PPIs) are commonly prescribed to treat gastroenterological disorders. We aimed to explore whether PPI use is associated with an increased risk of acute cholangitis in patients with gallstone disease. METHODS: This retrospective multicenter study included all patients arriving to the hospital over a 10-year period with various presentations of choledocholithiasis. We compared active PPI use in two groups: those with cholangitis (group A) vs. without cholangitis (group B). RESULTS: Overall, 811 patients were included, 161 in group A and 650 in group B. The average age ± standard deviation (SD) in groups A and B was 74.5 ± 20.6 vs. 61.6 ± 20.9 years, respectively. PPI use in group A was higher vs. group B (42.9% vs. 29.1%, p = 0.001). On univariate analysis, male gender (OR 1.47, 95% confidence interval (CI) 1.04-2.08), age (OR 1.04, 95% CI 1.03-1.05), ischemic heart disease (IHD) (OR 1.68, 95% CI 1.07-2.64), hyperlipidemia (OR 1.59, 95% CI 1.11-2.29), hypertension (OR 1.81, 95% CI 1.28-2.57) and PPI use (OR 1.83, 95% CI 1.28-2.61), all were associated with acute cholangitis. On multivariate analysis, only PPI use kept its association after adjustment for age (OR 1.64, 95% CI 1.2-3.7). CONCLUSIONS: Active PPI use was associated with a higher rate of cholangitis among patients with choledocholithiasis. We advocate considering this risk before prescribing PPIs to patients with gallstones. TRIAL REGISTRATION NUMBER: NHR-0263-20 received on 14/01/2021 date 'retrospectively registered'.

Scheduled percutaneous endoscopic gastrostomy tube replacement did not reduce PEG-related complications.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) tube insertion is used for enteral nutrition. Each manufacturer has its own instructions for planned tube replacement. Accordingly, caregivers have adopted the policy of elective change at a fixed period of time (3-6 months). AIM: The current study aimed to assess whether retained PEG for more than 6 months was associated with a higher rate of PEG-related complications. METHODS: A retrospective single-center study included all patients who underwent PEG insertion were included in the study. RESULTS: Overall, 303 patients were included, 48 patients (16.2%) had PEG tube replacement. Peristomal PEG tube leak was the commonest complication, occurring in 20 patients (41.7%), followed by dislodgement in 18 patients (37.5%) and obstruction in 10 patients (20.8%). Among the patients with a leak, it occurred within and beyond 6 months from PEG insertion in 40 and 60% of patients, respectively (OR 0.68, 95% CI 0.21-2.18, p = .57). Similarly, 50% of patients had PEG tube obstruction within 6 months and 50% had it beyond 6 months from insertion (OR 1.46, 95% CI 0.34-6.26, p = .72). Moreover, there was no difference in PEG dislodgement after PEG insertion within or beyond 6 months (nine patients, 50% vs. nine patients, 50%), respectively, (OR 1.37, 95% CI 0.42-4.47, p = .76). CONCLUSION: Retained PEG tubes for more than 6-months were not associated with more PEG-tube-related complications.

Fatty pancreas was associated with a higher acute pancreatitis Systemic Inflammatory Response Syndrome score at hospital admission.

BACKGROUND: Pancreatic fat infiltration was shown to be linked with acute pancreatitis and probably its severity. These interesting findings merit more investigation to elucidate the effect of fatty pancreas on acute pancreatitis severity. METHODS: We performed a retrospective study of patients hospitalized with documented acute pancreatitis. Pancreatic fat was determined according to pancreas attenuation on computed tomography. Patients were divided into two groups, with and without fatty pancreas. The Systemic Inflammatory Response Syndrome (SIRS) score was compared. RESULTS: Overall, 409 patients were hospitalized with acute pancreatitis. Among them, 48 patients had fatty pancreas (group A), vs. 361 patients who did not (group B). The mean ± SD age in group A was 54.6 ±â€…21.3, vs. 57.6 ±â€…16.8 in group B ( P  = 0.51). Patients in group A, had a significantly higher rate of fatty liver, as compared to group B (85.4% vs. 35.5%, P  < 0.001). There was no significant difference in the medical history among the two groups. Fatty pancreas was associated with more severe acute pancreatitis as assessed by SIRS score at admission. The mean ± SD of SIRS score was significantly higher in group A (0.92 ±â€…0.87), as compared to 0.59 ±â€…0.74 in group B ( P  = 0.009). Positive SIRS score was present in a significantly higher proportion of patients with fatty pancreas (25%), as compared to only 11.4% in group B ( P  = 0.02). CONCLUSION: The occurrence of acute pancreatitis with higher SIRS score was significantly associated with fatty pancreas. Fatty pancreas may represent a predictor of acute pancreatitis severity.

The Possible Association of Non-Alcoholic Fatty Liver Disease with Acute Cholangitis: A Retrospective Multicenter Cohort Study.

Non-alcoholic fatty liver disease (NAFLD) is increasingly encountered. It is associated with several comorbid diseases. However, its association with infectious biliary diseases is still unknown. Aims: We aimed to assess whether NAFLD is a risk factor for the development of acute cholangitis among patients with common bile duct (CBD) stones. Methods: We performed a retrospective study, including all patients with a documented diagnosis of CBD stone that had available data on the presence or absence of NAFLD. Descriptive analysis using univariate and multivariate models was used to assess whether an association existed between NAFLD and acute cholangitis. Results: We included 811 patients. Of them, 161 patients presented with acute cholangitis, vs. 650 patients who presented with symptomatic CBD stone without cholangitis. NAFLD was significantly more common in the cholangitis group compared to the non-cholangitis group (15.5% vs. 8.3%, p = 0.01). In univariate analysis, age (Odds ratio (OR) 1.04, p < 0.0001), male gender (OR 1.47, p = 0.03), hypertension (OR 1.81, p = 0.0008), hyperlipidemia (OR 1.59, p = 0.01), and NAFLD (OR 2.04, p = 0.006) were significantly associated with acute cholangitis. In multivariate analysis, NAFLD kept its association with acute cholangitis irrespective of age (OR 2.15, p = 0.005). Conclusions: NALFD showed a significant association with acute cholangitis among patients with a CBD stone. Clinicians should encourage treatment of NAFLD in general, and especially in the setting of gallstone disease.