Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030305 (pancreatitis)
 16,014 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Eight-four patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) were randomized to receive 100 micrograms of octreotide intravenously immediately prior to ERCP, and 100 micrograms subcutaneously 45 min after the initial dose, or placebo. Amylase, lipase, and glucose were measured and clinical assessment was performed before, and 2 and 24 h after, ERCP. We define clinical pancreatitis as the combination of elevated amylase or lipase with abdominal pain and tenderness. Interim analysis in 84 patients revealed an 11% incidence of clinical pancreatitis in the control group and 35% in the treatment group (p < 0.01). There were no differences in either group with respect to sphincterotomy, gender, age, duration of ERCP, number of cannulations of the pancreatic duct, degree of duct injection, or the volume of contrast injected. Analysis of group differences stratified by sphincterotomy revealed the following: 1) In patients who did not undergo a sphincterotomy, there was a significantly higher rate of pancreatitis in the treatment group [10/17 (59%) versus 1/17 (6%) RR 10.0 (95% CI 1.4-69.8)]. 2) Sphincterotomy reduced the rate of pancreatitis in patients who received octreotide from 10/17 (59% no sphincterotomy), to 3/20 (15% sphincterotomy) (p = 0.01), which equals the rate in patients who received placebo and underwent sphincterotomy [4/25 (16%)]. 3) Although the incidence of pancreatitis was higher in the treatment group, octreotide may reduce the severity of pancreatitis measured by the number of days NPO (Wilcoxon rank sum, p = 0.02), length of stay after ERCP (p = 0.13), the number of days of pain (p = 0.11), and the degree of amylase elevation (p = 0.04). We conclude that: 1) Octreotide appears to increase the incidence of pancreatitis when given prophylactically for diagnostic ERCP. 2) Although pancreatitis was more common in the octreotide group, it was less severe than the placebo group. 3) Sphincterotomy may afford protection against pancreatitis in patients who received octreotide. 4) We cannot recommend the use of prophylactic octreotide during diagnostic or therapeutic ERCP.
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PMID:A multicenter, randomized, controlled trial to evaluate the effect of prophylactic octreotide on ERCP-induced pancreatitis. 836 55

The known relationship of hyperlipidemia and pancreatitis raises the question whether intravenous fat emulsion is detrimental in acute pancreatitis. Pancreatitis was induced in 52 male Sprague-Dawley rats followed by placement of a jugular catheter which was anchored to the back with a Teflon button. The animals were placed NPO in metabolic cages and continuously infused, initially with normal saline. The 37 animals surviving 24 hr were randomly assigned to group I (mean iv intake: glucose 222 kcal/kg/day; amino acids 13.1 g/kg/day) or group II (glucose 191 kcal/kg/day; intravenous fat emulsion 10% 47 kcal/kg/day; amino acids 12.9 g/kg/day). Nine animals were eliminated from the study because of mechanical problems leaving 14 in each group for analysis. Per cent survival on days 3, 5, and 7 was 64, 50 and 36 in group I, and 50, 36 and 36 in group II. Mean urinary amylase excretion was 244 +/- 185 units/day in group I and 262 +/- 127 units/day in group II. There was no significant difference in survival or urine amylase excretion nor in pancreatic histology or gross appearance of the animals between the two groups. In this model of acute pancreatitis, intravenous fat emulsion was not detrimental as measured by survival, urinary amylase excretion, and pancreatic histology.
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PMID:Effect of intravenous fat emulsion on experimental acute pancreatitis. 619 Oct 54

Although ductal disruptions are common in persistent, smoldering pancreatitis, pancreatic necrosis, or acute pancreatic fluid collections, chronic pancreatic fistulas have traditionally been defined as internal or external. Closure of these fistulas depends upon site and size of duct disruption, superinfection, downstream obstruction as a consequence of stricture or stone, or the presence of the "disconnected duct syndrome." Medical treatment is aimed at minimizing pancreatic secretion (low fat diet, pancreatic enzymes vs. NPO/hyperalimentation, octreotide, repeated/chronic drainage procedures). Resective or decompressive pancreatic surgery requires preoperative ERCP to define the anatomy. More recently, transpapillary endoprostheses have been used in a patient subset and deserve additional consideration in patients who fail to respond to conservative measures.
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PMID:Endoscopic therapy of complete and partial pancreatic duct disruptions. 940 50