Effects of PRSS1-PRSS2 rs10273639, CLDN2 rs7057398 and MORC4 rs12688220 polymorphisms on individual susceptibility to pancreatitis: A meta-analysis.

BACKGROUND: Genetic association studies regarding relationship between PRSS1-PRSS2 rs10273639/CLDN2 rs7057398/MORC4 rs12688220 polymorphisms and pancreatitis yielded conflicting results. We performed this meta-analysis to explore associations between these polymorphisms and pancreatitis in a larger pooled population. METHODS: A systematic search of the literature was conducted for eligible studies. We used Review Manager to conduct statistical analyses. RESULTS: Fifteen studies were included in this meta-analysis. The results of pooled analyses showed that CLDN2 rs7057398, MORC4 rs12688220 and PRSS1-PRSS2 rs10273639 polymorphisms were all significantly associated with susceptibility to acute pancreatitis in Caucasians. Moreover, MORC4 rs12688220 and PRSS1-PRSS2 rs10273639 polymorphisms were also significantly associated with susceptibility to chronic pancreatitis in Asians. CONCLUSIONS: Our findings suggested that rs7057398, rs12688220 and rs10273639 polymorphisms could be used to identify individuals at an elevated susceptibility to acute pancreatitis in Caucasians. Moreover, rs12688220 and rs10273639 polymorphisms could be used to identify individuals at an elevated susceptibility chronic pancreatitis in Asians.

Pancreatitis in pre-adolescent children: a 10 year experience in the pediatric emergency department.

BACKGROUND: The diagnosis of pediatric pancreatitis has been increasing over the last 15 years but the etiology of this is uncertain. The population of pre-adolescent patients with pancreatitis in the emergency department has not been specifically described. Our objective was to determine the characteristics of these patients to illuminate this population and disease in order to better identify them and avoid a delay in diagnosis and treatment. METHODS: This was a retrospective descriptive study of consecutive pediatric patients under the age of 13 years between 2006 and 2016 who presented to our pediatric emergency department with a diagnosis of atraumatic pancreatitis. Patient characteristics, lab and imaging results, identified etiology of pancreatitis, and recurrence rates were recorded and evaluated. RESULTS: There were 139 visits, of which 85 were for a first episode of acute pancreatitis, and 54 were patients with an episode of recurrent pancreatitis. The median age for all visits was 8 years (IQ range 5-11). Of the acute cases, 26% had uncertain or undetermined etiologies of which half were thought to likely be viral related; 20% had systemic inflammatory or autoimmune diseases; 19% were associated with medications, with the most common being valproic acid; 16% were cholelithiasis-related; and 15% were found to have a genetic, congenital or structural etiology. No patients had elevated triglycerides. Those with cholelithiasis and genetic or structural defects were found to have a higher recurrence rate than those with other etiologies. There were only four patients diagnosed with chronic pancreatitis. CONCLUSIONS: The etiology of pancreatitis in pre-adolescent children has a different distribution than in adolescents and adults, with gallstone disease less frequent and concurrent contributing illness more common. Patients on pancreatitis-causing medications or with known genetic risk or structural pancreatic problems should be tested for pancreatitis if presenting with concerning symptoms. Hypertriglyceridemia and chronic pancreatitis with evidence of pancreatic exocrine insufficiency is uncommon in this population.

Defining Pancreatitis as a Risk Factor for Pancreatic Cancer: The Role, Incidence, and Timeline of Development.

OBJECTIVES: Acute and/or chronic pancreatitis has been implicated as an important risk factor for pancreatic cancer; however, the incidence and temporal relationship of pancreatitis before pancreatic cancer diagnosis are unclear. We aim to understand the role and incidence of pancreatitis temporally with the development of pancreatic cancer. METHODS: A population-based study was used to investigate a temporal relationship between pancreatitis and pancreatic cancer diagnoses. Intervals of 3, 6, 12, 24, and 36 months were developed. Demographical data including age, sex, and race were also recorded and analyzed. RESULTS: A total of 50,080 patients were found to have a diagnosis of pancreatic cancer, of which 7420 (14.8%) had prior diagnoses of pancreatitis. Of those, 92% were between the ages of 40 and 89 years. African Americans had a higher rate of pancreatitis before cancer diagnosis when compared with whites (21.2% vs 14.8%, P < 0.0001). Further analysis revealed that pancreatitis occurred in 81.3% of patients 3 months before a diagnosis of pancreas cancer and 98.9% had established diagnoses of pancreatic cancer within 3 years. CONCLUSIONS: Screening of patients older than 40 years who have pancreatitis and unclear etiology of pancreatitis may be warranted, especially in African Americans and male individuals.

Factors Associated With Opioid Use in Patients Hospitalized for Acute Pancreatitis.

Importance: Limited guidance exists regarding the optimal approach to management of pain in acute pancreatitis (AP). Objectives: To investigate sources of variability in opioid use for treatment of acute pain in patients hospitalized for AP and to explore a potential association of opioid prescribing patterns with length of stay. Design, Setting, and Participants: This retrospective cohort study included 4307 patients 18 years and older hospitalized for AP in a community-based integrated health care system, from January 1, 2008, to June 30, 2015. Analysis began in November 2017. Exposures: Opioid use was quantified by morphine equivalent dose (MED). Main Outcomes and Measures: Three analyses were performed: (1) factors associated with increased opioid administration during the initial 12 hours of hospitalization (baseline), (2) association of baseline opioid use with length of stay, and (3) frequency of opioid use 90 days after hospital discharge (persistent use). Results: The cohort included 4307 patients (median [interquartile range] age, 57.4 [44.0-70.2] years; 2241 women [52.0%]) with AP. At baseline, 3443 patients (79.9%) received opioids, and 388 patients (9.6%) had persistent opioid use after discharge. After adjusting for pain and other clinical factors, women received less MED than men (adjusted event ratio, 0.83; 95% CI, 0.79-0.86; P < .001). Hispanic and Asian patients received less MED than non-Hispanic white patients (adjusted event ratio, 0.85; 95% CI, 0.81-0.90; P < .001; and adjusted event ratio, 0.79; 95% CI, 0.72-0.86; P < .001, respectively). Alcohol-related AP etiology was associated with increased MED vs gallstone disorders (adjusted event ratio, 1.11; 95% CI, 1.05-1.18; P < .001). Two of 13 hospitals administered significantly less opioids compared with the others. Median (interquartile range) length of stay was independently associated with MED at baseline, with 3.0 (2.1-4.5) days among patients not receiving opioids vs 5.0 (3.2-8.7) days among patients in the highest quintile of MED (P < .001). Conclusions and Relevance: In addition to pain and disease severity, opioid use varied by etiology of AP, sex, race/ethnicity, and institution of treatment. Increased opioid use at baseline was associated with longer hospitalization. These findings suggest opportunities for improved approaches to pain control for patients with AP.

Association between IL-10 polymorphisms rs1800896 and rs1800871 and risk of acute pancreatitis in Chinese Han population: An update systemic review and meta-analysis.

The association between interleukin-10 (IL-10) promoter region (1082 A/G (rs1800896), 819 C/T (rs1800871)) polymorphisms, and acute pancreatitis (AP) is inconclusive in Chinese Han population. In this study, six eligible studies extracted from the databases of PubMed, Web of Science, and Cochrane Library were evaluated. The results revealed a significant association between 1082 A/G (rs1800896) polymorphism and AP risk in all these five models (AG/AA: OR = 1.19, 95% Cl = 1.02-1.40, P = 0.03; GG/AA: OR = 1.80, 95% Cl = 1.38-2.23, P = 0.01; AG+GG/AA: OR = 1.29, 95% Cl = 1.11-1.50, P = 0.01; GG/AG+AA: OR = 1.62, 95% Cl = 1.27-2.08, P = 0.01; G/A: OR = 1.29, 95% Cl = 1.15-1.45, P = 0.01). In contrast, no statistically significant association was found in all these five models for 819 C/T (rs1800871) polymorphism. In summary, IL-10 polymorphism 1082 A/G (rs1800896) could increase the risk of AP in Chinese Han population.

African-Americans and Indigenous Peoples Have Increased Burden of Diseases of the Exocrine Pancreas: A Systematic Review and Meta-Analysis.

Ethnic health disparity is a well-acknowledged issue in many disease settings, but not diseases of the exocrine pancreas. A systematic review and meta-analysis was conducted to explore the race- and ethnicity-specific burden of diseases of the exocrine pancreas. Studies that compared health-related endpoints between two or more ethnicities were eligible for inclusion. Proportion meta-analyses were conducted to compare burden between groups. A total of 42 studies (24 on pancreatic cancer, 17 on pancreatitis, and one on pancreatic cyst) were included in the systematic review, of which 19 studies were suitable for meta-analyses. The incidence of pancreatic cancer was 1.4-fold higher among African-Americans, while the incidence of acute pancreatitis was 4.8-fold higher among an indigenous population (New Zealand Maori) compared with Caucasians. The prevalence of post-pancreatitis diabetes mellitus was up to 3.0-fold higher among certain ethnicities, including Asians, Pacific Islanders, and indigenous populations compared with Caucasians. The burden of diseases of the exocrine pancreas differs between ethnicities, with African-Americans and certain indigenous populations being at the greatest risk of developing these diseases. Development of race- and ethnicity-specific screening as well as protocols for lifestyle modifications may need to be considered with a view to reducing the disparities in burden of diseases of the exocrine pancreas.

Causative Agents of Drug-Induced Pancreatitis: A Nationwide Assessment.

OBJECTIVES: The aim of this study was to analyze causes of drug-induced acute pancreatitis (DIAP) in Korea and factors associated with serious DIAP. METHODS: Case records of DIAP voluntarily reported to the Korea Adverse Event Reporting System from 2004 to 2013 were reviewed. When a patient took 2 or more drugs, each drug was identified as a potential cause. The seriousness of each case was determined based on the International Conference on Harmonization E2D Guideline. Logistic regression was performed to identify factors associated with the seriousness of DIAP. RESULTS: During the study period, 210 (0.05%) of 442,523 adverse event reports were (0.05%) DIAP. The most common causative medication of the DIAP cases with certain, probable/likely, and possible causality (n = 74) was L-asparaginase (n = 18), followed by azathioprine (n = 6), methylprednisolone (n = 6), and fenofibrate (n = 5). Serious events occurred in 43 cases (58%) with certain, probable/likely, and possible causality. They were significantly associated with the year of report (odds ratio, 0.572; P = 0.025) and the number of concurrently used medications (odds ratio, 2.659; P = 0.006). CONCLUSIONS: L-Asparaginase is the most common cause of DIAP in Korea. Serious DIAP is more likely to occur in patients taking multiple medications.

IgG4-related disease: features and treatment response in a multi-ethnic cohort in Singapore.

OBJECTIVES: To describe the features and treatment outcomes of IgG4-RD in multi-ethnic patients in Singapore. METHODS: Retrospective study was performed on IgG4-RD patients identified from patient databases in a tertiary hospital. RESULTS: Fourty-two patients (76% male) were included; 79% fulfilled the 2011 comprehensive diagnostic criteria for IgG4-RD for definite IgG4-RD. 81% were Chinese and 19% were Malays. Common initial manifestations included jaundice (52%), abdominal pain (36%) and swollen salivary glands (26%). Only 36% had a history of allergy. 83% had ≥ 1 organ involvement. Erythrocyte sedimentation rate, immunoglobulin E, IgG2 and IgG4 levels were elevated in 84%, 100%, 70% and 44% of patients, respectively. The most common histopathological feature was >10 IgG4+ cells per high power field (66%). 94% (34/36) of patients were treated with moderate to high doses of glucocorticoids, including 17 patients with combination immunosuppressants. Of these, all patients responded to therapy by 3 months. With a median (range) follow-up of 4.1 (0.4-13.8) years, 69% (25/36) needed low dose of glucocorticoids to maintain disease remission. Twenty-six per cent had relapse of disease, of which 82% had disease recurrence in the same organs. CONCLUSIONS: Pancreatitis, lymphoadenopathy and cholangitis were the commonest manifestations in Asians with IgG4-RD. All patients responded to glucocorticoid therapy by 3 months, two-thirds required maintenance therapy with glucocorticoids, and one-quarter developed relapse of disease.

Association of a genetic polymorphism of IL1RN with risk of acute pancreatitis in a Korean ethnic group.

BACKGROUND/AIMS: Several epidemiological studies have validated the association of interleukin gene polymorphisms with acute pancreatitis (AP) in different populations. However, there have been few studies in Asian ethnic groups. We aimed to investigate the relationships between inflammatory cytokine polymorphisms and AP as pilot research in a Korean ethnic group. METHODS: Patients who had been diagnosed with AP were prospectively enrolled. DNA was extracted from whole blood, and DNA sequencing was subsequently performed. Single-nucleotide polymorphisms (SNPs) of the interleukin 1ß (IL1B), interleukin 1 receptor antagonist (IL1RN), and tumor necrosis factor α (TNFA) genes of patients with AP were compared to those of normal controls. RESULTS: Between January 2011 and January 2013, a total of 65 subjects were enrolled (40 patients with AP vs. 25 healthy controls). One intronic SNP (IL1RN -1129T>C, rs4251961) was significantly associated with the risk of AP (odds ratio, 0.304; 95% confidence interval, 0.095 to 0.967; p = 0.043). However, in our study, AP was not found to be associated with polymorphisms in the promoter regions of inflammatory cytokine genes, including IL1B (-118C>T, c47+242C>T, +3954C/T, and -598T>C) and TNFA (-1211T>C, -1043C>A, -1037C>T, -488G>A, and -418G>A). CONCLUSION: IL1RN -1129T>C (rs4251961) genotypes might be associated with a significant increase of AP risk in a Korean ethnic group.

Ethnic differences in risk factors of acute pancreatitis.

OBJECTIVE: The ethnic difference in the risk factors of acute pancreatitis remains unknown. The objective of this study is to investigate the differences in the risk factors of acute pancreatitis between Taiwanese aborigines and nonaborigines. DESIGN: A retrospective study of 622 patients with acute pancreatitis admitted to our hospital (Puli Christian Hospital) from 2006 to 2014. The risk factors and biochemical properties of acute pancreatitis were comapred between aborgines and nonaborgines. RESULTS: The first episode of acute pancreatitis amongst the aboriginal group was commonly observed in young age groups (39.3 versus 47.8 years, p < 0.05), female patients (0.61 versus 0.27, p < 0.05), and patients with a habit of drinking alcohol (84% versus 65%, p < 0.05). Analysis of the biochemical properties and risk factors demonstrated siginifcantly high uric acid levels (7.63 versus 6.56 mg/dL, p < 0.05), and an increased prevalence of alcohol-related pancreatitis (60.0% versus 49.6%, p < 0.05) in the aboriginal group. CONCLUSIONS: Taiwanese aborigines were reported to be more susceptible to alcohol-related pancreatitis than nonaborigines. The decreasing levels of excessive alcohol consumption may reduce the disease burden of acute pancreatitis.

Therapeutic Endoscopic Retrograde Cholangiopancreatography in Pediatric Patients With Acute Recurrent and Chronic Pancreatitis: Data From the INSPPIRE (INternational Study group of Pediatric Pancreatitis: In search for a cuRE) Study.

OBJECTIVE: The aim of this study was to characterize utilization and benefit of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in children with acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP). METHODS: From August 2012 to February 2015, 301 children with ARP or CP were enrolled in the INSPPIRE (INternational Study group of Pediatric Pancreatitis: In search for a cuRE) study. Physicians reported utilization and benefit of therapeutic ERCP at enrollment. Differences were analyzed using appropriate statistical methods. RESULTS: One hundred seventeen children (38.9%) underwent at least 1 therapeutic ERCP. The procedure was more commonly performed in children with CP compared with those with ARP (65.8% vs 13.5%, P < 0.0001). Utility of therapeutic ERCP was reported to be similar between ARP and CP (53% vs 56%, P = 0.81) and was found to be helpful for at least 1 indication in both groups (53/99 patients [53.5%]). Predictors for undergoing therapeutic ERCP were presence of obstructive factors in ARP and CP, Hispanic ethnicity, or white race in CP. CONCLUSIONS: Therapeutic ERCP is frequently utilized in children with ARP or CP and may offer benefit in selected cases, specifically if ductal obstruction is present. Longitudinal studies are needed to clarify the efficacy of therapeutic ERCP and to explore subgroups that might have increased benefit from such intervention.

Impact of Seasons and Festivals on the Onset of Acute Pancreatitis in Shanghai, China.

OBJECTIVES: Seasonal variation on acute pancreatitis (AP) has not been investigated in Eastern Asia. The aims of the study were to assess the association of the onset of AP with the occurrence of seasons and Chinese festivals and to investigate trends in AP incidence in Shanghai, China. METHODS: From January 2009 to December 2014, a total of 1780 patients with AP were considered. The incidence was assessed by different etiology and severity. Monthly disease prevalence was investigated to explore the seasonal variation. The prevalence on weekdays, weekends, and festivals was evaluated to establish any weekly or festival influences in AP. RESULTS: Acute pancreatitis increased from 30.5 per 100,000 in 2009 to 39.2 in 2014 (5.1% annual increase), with greatest increases in alcoholic (19.8% annually) and severe AP (13.7% annually). Time series analysis indicated that prevalence was significantly higher form February to May (spring) and from September to October (autumn). Acute pancreatitis increased during Chinese festivals, 17% and 28% greater than that observed on weekdays and weekends, respectively. Prevalence was greatest in Chinese Spring Festival week. CONCLUSIONS: Acute pancreatitis increased in Shanghai and had a seasonal variation, with a higher frequency of events in the spring and autumn. Chinese festivals are associated with a high prevalence of AP.

Ethnic and geographic variations in the incidence of pancreatitis and post-pancreatitis diabetes mellitus in New Zealand: a nationwide population-based study.

AIM: To determine the incidence of acute pancreatitis (AP), chronic pancreatitis (CP), and post-pancreatitis diabetes mellitus (DP) in New Zealand, and the effect of ethnic and geographic variations. METHODS: Data were collected from all district health boards in New Zealand by the Ministry of Health (Manatu Hauora). Diagnosis of AP, CP and DP was determined by the International Classification of Diseases-10 codes. Incidence rates per 100,000 population per year were calculated using incident AP, CP and DP cases as the numerator, and the adult resident population of New Zealand as the denominator. Poisson distribution was used to estimate 95% confidence intervals. The district health board domicile codes and corresponding incidence rates were used to map geographical variations for AP, CP and DP. RESULTS: On average, 2,072 new cases of AP, CP and DP were diagnosed in New Zealand every year. The crude incidence of AP was 58.42 [57.55, 59.30], CP - 3.97 [3.74, 4.20], and DP - 7.95 [7.62, 8.27] per 100,000 population per year. Maori had the highest incidence of AP (95.21 [91.74, 98.68] per 100,000 population per year), CP (6.27 [5.37, 7.16] per 100,000 population per year), and DP (18.23 [16.71, 19.76] per 100,000 population per year). Incidence of AP and DP was at least 1.8 and 2.6 times higher in Maori than New Zealand Europeans in every age group, and incidence of DP was at least 1.9 times higher in Pacific people than New Zealand Europeans in every age group. Auckland/Northland had the highest incidence of AP (135.25 [134.82, 135.68] per 100,000 population), and CP (9.03 [8.60, 9.46] per 100,000 population), while Lakes/Waikato had the highest incidence of DP (20.64 [20.21, 21.07] per 100,000 population) in New Zealand. CONCLUSIONS: New Zealanders have a very high incidence rate of AP, with Maori having the highest reported incidence of AP worldwide. There is a significant geographic variation in incidence of pancreatic diseases, with the Upper North Island having the highest incidence rates of AP, CP and DP in the country. Future high-quality studies are required to understand the mechanisms of pancreatitis and DP in order to develop preventive and therapeutic strategies that would benefit New Zealanders in general and Maori in particular.

Genetic Susceptibility in Acute Pancreatitis: Genotyping of GSTM1, GSTT1, GSTP1, CASP7, CASP8, CASP9, CASP10, LTA, TNFRSF1B, and TP53 Gene Variants.

OBJECTIVES: Genetic testing could play a critical role in diagnosis and prognosis of acute pancreatitis (AP) and guide effective therapeutic interventions. We hypothesized that genetic polymorphisms in apoptosis and oxidative stress genes could determine incidence or severity in AP. METHODS: We conducted a hospital-based case-control study in a white Portuguese population (133 AP patients and 232 age- and sex-matched healthy controls) to evaluate the role of 15 gene polymorphisms (2 deletions and 13 single nucleotide polymorphisms [SNPs]) in oxidative stress (GSTM1, GSTT1, GSTP1) and apoptosis genes (CASP7, CASP8, CASP9, CASP10, LTA, TNFRSF1B, TP53) in AP. Criteria for AP were abdominal pain, hyperamylasemia, and contrast-enhanced computed tomography. RESULTS: The presence of GSTM1 is associated with increased susceptibility for AP, and the GSTP1 Val105Ile SNP is associated with an increased risk for AP in men. CASP9 Phe136Leu/Phe136Phe SNPs (heterozygotes) increases the risk for mild AP (odds ratio, 3.616; 95% confidence interval, 1.151-11.364; P < 0.05), whereas the homozygotic genotype of CASP9 Ala28Val decreases risk for mild AP (odds ratio, 0.296; 95% confidence interval, 0.091-0.963; P < 0.05). CONCLUSIONS: Our results suggest that variations in GSTM1, GSTP1, and CASP9 may influence risk for AP.

Incretin-based pharmacotherapy and risk of adverse pancreatic events in the ethnic Chinese with diabetes mellitus: A population-based study in Taiwan.

BACKGROUND: Pancreatic safety remains a concern for diabetic patients using incretin-based medications. We aimed to determine if there was an association between incretin-based therapy and an increased risk for acute pancreatitis and pancreatic cancer in patients with type 2 diabetes mellitus (DM). METHODS: This retrospective population-based cohort study analyzed data from the Taiwan National Health Insurance Research Database. A total of 13 171 eligible type 2 DM patients who had received incretin-based treatment for a minimum of two months were matched 1:1 for age, gender, diabetes complications severity index, and inception date with DM patients who never used this pharmacotherapy. The cohorts were compared for occurrence of acute pancreatitis and pancreatic cancer. The association between incretin-based therapy and acute pancreatitis was assessed using a Cox proportional hazard model and stratified analyses. RESULTS: Acute pancreatitis occurred in 71 (0.54%) incretin users and 66 (0.50%) non-users, respectively (P = 0.67). The association remained insignificant (adjusted hazard ratio [HR], 1.06; 95% confidence interval [CI] = 0.72-1.55) after adjustment for cholelithiasis (adjusted HR, 2.76; 95% CI = 1.32-5.75) and alcohol-related disease (adjusted HR 9.14, 95% CI = 2.08-40.14) in the Cox model. Stratified analyses affirmed no association between incretin-based therapy and pancreatitis in any subgroup. Pancreatic cancer occurred in 6 (0.05%) and 10 (0.08%) patients in the user and non-user cohort, respectively (P = 0.32). CONCLUSION: Incretin-based therapy is not associated with acute pancreatitis and short-term pancreatic cancer risk among ethnic Chinese patients with diabetes. This study supports the pancreatic safety of incretin-based pharmacotherapy.

A body mass index ≥25 kg/m2 is associated with a poor prognosis in patients with acute pancreatitis: a study of Japanese patients.

BACKGROUND: In Asian population, there is limited information on the relevance between obesity and poor outcomes in acute pancreatitis (AP). The objective of this study was to examine the clinical impact of obesity based on body mass index (BMI) on prognosis of AP in Japanese patients. METHODS: A total of 116 patients with AP were enrolled in this study. Univariate and multivariate logistic regression analyses were performed to examine relations between BMI and patients' outcomes. Additionally, to investigate whether including obesity as a prognostic factor improved the predictive accuracy of a Japanese prognostic factor score (PF score), a receiver-operating characteristic (ROC) curve analysis of mortality was conducted. RESULTS: Multiple logistic regression analyses revealed that BMI =25 kg/m2 was associated with a significant higher mortality [odds ratio (OR)=15.8; 95% confidence interval (CI): 1.1-227; P=0.043]. The area under the ROC curve (AUC) for the combination of PF score and BMI =25 kg/m2 (AUC=0.881; 95% CI: 0.809-0.952) was higher than that for the PF score alone (AUC=0.820; 95% CI: 0.713-0.927) (P=0.034). CONCLUSIONS: The negative impact of a high BMI on the prognosis of AP was confirmed in a Japanese population. Including BMI =25 kg/m2 as an additional parameter to PF score enhanced the predictive value of the PF score for AP-related mortality.

Influence of interleukin-18 gene polymorphisms on acute pancreatitis susceptibility in a Chinese population.

We investigate the relationship between IL-18 -607C/A and -137G/C genetic polymorphisms and development of acute pancreatitis in a Chinese population. A total of 153 patients were consecutively recruited from the First Affiliated Hospital of Chongqing Medical University between January 2013 and November 2014. Genotyping of IL-18 -607C/A and -137G/C variants was performed using the polymerase chain reaction-restriction fragment length polymorphism method. We observed a significant difference between acute pancreatitis patients and control subjects with respect to age (t = 2.15, P = 0.02), gender (chi-square = 3.95, P = 0.04), body mass index (t = 5.85, P < 0.001), and alcohol consumption (chi-square = 9.74, P = 0.002). Using chi-square tests, we found that the genotype distributions of IL-18 -607C/A (chi-square = 0.81, P = 0.67) and -137G/C (chi-square = 1.16, P = 0.56) polymorphisms did not differ between the acute pancreatitis and control groups. Genotype frequencies of these variants were consistent with Hardy-Weinberg equilibrium in both patient and control groups. In addition, logistic regression analysis failed to identify a significant association between these polymorphisms and acute pancreatitis risk. Our study firstly examined their association in a Chinese population, and we suggest that the IL-18 -607C/A and -137G/ C polymorphisms do not influence susceptibility to acute pancreatitis in the Chinese population studied in the present study.

Prospective Study of Alcohol Drinking, Smoking, and Pancreatitis: The Multiethnic Cohort.

OBJECTIVES: We conducted a prospective analysis of 145,886 participants in the multiethnic cohort to examine the relationship of alcohol drinking and smoking with pancreatitis. METHODS: Pancreatitis cases were categorized as gallstone-related acute pancreatitis (GSAP) (N = 1,065), non-GSAP (N = 1,222), and recurrent acute (RAP)/chronic pancreatitis (CP) (N = 523). We used the baseline questionnaire to identify alcohol intake and smoking history. Associations were estimated by hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox models. RESULTS: Cigarette smoking was associated with non-GSAP and RAP/CP. Moderate alcohol intake was inversely associated with all types of pancreatitis in women (HRs, 0.66 to 0.81 for <1 drink per day), and with RAP/CP in men (HR, 0.57; 95% CI, 0.41-0.79 for <2 drinks per day). The risk of non-GS pancreatitis associated with current smoking was highest among men who consumed more than 4 drinks per day (HR, 2.06; 95% CI, 1.28-3.30), whereas among never smokers, moderate drinking was associated with a reduced risk (HR, 0.70; 95% CI, 0.51-0.96). In women, drinking less than 2 drinks per day was associated with a reduced risk of GSAP among never smokers (HR, 0.61; 95% CI, 0.46-0.80). CONCLUSIONS: Smoking is a risk factor for non-GS pancreatitis. Moderate alcohol intake is protective against all types of pancreatitis in women and against RAP/CP in men.

Time Trend of Outcomes for Severe Acute Pancreatitis After Publication of Japanese Guidelines Based on a National Administrative Database.

OBJECTIVES: This study aimed to investigate the recent time trend of outcomes for severe acute pancreatitis after publication of Japanese guidelines based on a national administrative database. METHODS: A total of 10,400 patients with severe acute pancreatitis were referred to 1021 hospitals between 2010 and 2012 in Japan. We collected patients' data from the administrative database to compare in-hospital mortality (within 28 days and overall), length of stay (LOS), and medical costs during hospitalization. The study periods were categorized into 3 groups according to fiscal year: 2010 (n = 2698), 2011 (n = 3842), and 2012 (n = 3860). RESULTS: In-hospital mortality within 28 days and overall in-hospital mortality were significantly decreased according to fiscal year (6.3% [2010] vs 5.7% [2011] vs 4.5% [2012], P = 0.005; 7.6% vs 7.1% vs 5.6%, P = 0.002, respectively). However, mean LOS and medical costs were not different between fiscal years (27.0 vs 27.1 vs 26.9 days, P = 0.218; 13,998.0 vs 14,156.4 vs 14,319.2 USD, P = 0.232, respectively). CONCLUSIONS: This study shows that mortality of severe acute pancreatitis was reduced according to the time course, whereas LOS or medical costs were stable after publication of the Japanese guidelines.