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)

Common bile duct (CBD) strictures associated with chronic pancreatitis may cause significant hepatobiliary disease. Nine patients with chronic alcohol-related pancreatitis and CBD obstruction requiring operative biliary or pancreatobiliary decompression are reported. Alkaline phosphatase was the most specific biochemical indicator of cholestasis. Abnormal CBD anatomy was delinated accurately in 89 per cent of cases with percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP). All strictures were localized to the intrapancreatic portion of the distal CBD. Pancreatic pseudocysts (PPC) were identified in six (67%) cases. All nine patients underwent biliary decompression. Simultaneous PPC drainage or pancreatic duct decompression (Peustow procedure) was performed in eight cases (89%). No perioperative mortality occurred, and all patients reported subjective improvement in symptoms. Biliary tract strictures sufficient to cause clinical or biochemical cholestasis are a poorly recognized complication of chronic pancreatitis. Cholangiography (PTC or ERCP) should be obtained in order to delineate radiographic features, and extent and severity of the biliary stricture because there is no predictable correlation between levels of serum alkaline phosphatase and liver histopathology. A percutaneous biopsy is requisite to document changes in hepatic morphology. In order to prevent potential hepatobiliary complications such as cholangitis and secondary biliary cirrhosis, biliary strictures should be managed surgically even in anicteric and otherwise asymptomatic patients. Simultaneous treatment of associated pancreatic pathology can be performed if necessary with little added morbidity.
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PMID:Common bile duct strictures associated with chronic pancreatitis. 661 52

Nine lysosomal enzymes and alkaline phosphatase have been assayed in human pancreatic juice from controls and patients with chronic calcifying pancreatitis. Specific activities were evaluated by a nonparametric test (Wilcoxon) with a probability of 2 P less than or equal to 0.5. The values of acid phosphatase, alpha-glucosidase, beta-glucosidase and alpha-galactosidase are significantly higher in pathological juices; the values of alpha-mannosidase and beta-glucuronidase are also increased in the same patients but at the limit of significance. Alkaline phosphatase, beta-hexosaminidase and alpha-fucosidase follows the same trend but the values are not statistically significant between the two groups of patients. Studies on skin cultures of four patients with chronic calcifying pancreatitis demonstrate that the increased specific activities of lysosomal enzymes in the pathological juices do not correspond to a leakage of these enzymes into the extracellular space as described for cystic fibrosis.
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PMID:Alkaline phosphatase and acid lysosomal hydrolases in pancreatic juice and fibroblast cell cultures of patients with chronic calcifying pancreatitis. 680 85

We analyzed 388 cases of primary sclerosing cholangitis (PSC) in Japan, according to a questionnaire sent to gastroenterologists. There was male predominance (59%), and interestingly there were two peaks in the age distribution as seen in the previous study. Jaundice and itching, major symptoms in PSC patients included in the diagnostic criteria, were observed only 28 and 16%, respectively. Alkaline phosphatase level was less than twofold of the upper limit of the normal range in 35%. In this regard, the diagnostic criteria in 2003 from Mayo Clinic, including cholestatic symptoms and two to three-fold increases in serum alkaline phosphatase, should be modified in Japan. Inflammatory bowel diseases were complicated in 37%, and autoimmune pancreatitis (AIP) in 7.2%. PSC cases with inflammatory bowel diseases were younger than the average, creating the first peak in the age distribution, and have similar characteristics compared to patients with PSC in foreign countries. By contrast, those with AIP, who were more than 50 years old, responded well to corticosteroid therapy. In addition, even after the exclusion of cases of sclerosing cholangitis complicated with AIP, the second peak in the age distribution was clearly evident. Therefore, we conclude that PSC patients without apparent involvement of the pancreas are present in the older patients and seem to be specific in Japan.
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PMID:Analysis of 388 cases of primary sclerosing cholangitis in Japan; Presence of a subgroup without pancreatic involvement in older patients. 1520 79

At a workshop on primary sclerosing cholangitis (PSC) held during Digestive Disease Week - Japan 2003, 388 PSC cases in Japan were analyzed. Two peaks in the age distribution were also observed in this survey. Jaundice and itching, major symptoms in PSC patients included in the diagnostic criteria, were observed in only 28% and 16%, respectively. Alkaline phosphatase levels were less than twofold of the upper limit of the normal range in 35%. In this regard, the diagnostic criteria in 2003 from the Mayo Clinic, including cholestatic symptoms and two- to threefold increases in serum alkaline phosphatase, should be modified in Japan. Inflammatory bowel diseases were complicated in 37%, and autoimmune pancreatitis (AIP) in 7.2%. PSC cases with inflammatory bowel diseases were younger than the average, creating the firstpeak in age distribution, and have similar characteristics compared to patients with PSC in foreign countries. In addition, even after the exclusion of cases of sclerosing cholangitis complicated with AIP, the second peak in the age distribution was clearly evident. Recently, a concept of immunoglobulin G4-related sclerosing cholangitis has been postulated, which has a similar pathogenesis to AIP but without apparent pancreatic lesions. PSC patients without apparent involvement of the pancreas may be present in older patients and seem to be specific to Japan.
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PMID:Characteristics of primary sclerosing cholangitis in Japan. 1793 Dec 5

Dear Editor, Granulomatosis with polyangiitis (GPA) previously known as Wegener's Granulomatosis is an anti-neutrophilic cytoplasmic autoantibody (ANCA) associated vasculitis (AAV), usually initially presents with respiratory, renal, and/or ear, nose & throat (ENT) involvement [1]. Recently, rituximab (RTX) is increasingly used for either induction or maintenance phases in GPA [2, 3]. During the GPA, various organs could be involved. However, pancreas involvement in GPA is rarely reported. Until now, there are few reported cases with either a pancreas mass or acute pancreatitis, which in most cases were the first presentation of disease [4-6]. Here we report a complicated ANCA negative GPA patient with both pancreas mass and acute pancreatitis presentation, who had been expired weeks after RTX due sepsis occurrence. A 38-year-old woman with complaining from swelling, pain, and nasal congestion and discharge admitted to Amir-Alam otolaryngology tertiary referral center, Tehran University of Medical Sciences in February 2019. Taking biopsy had confirmed Wegener's granulomatosis. At the time of admission, assessment severity through the Birmingham Vasculitis Activity Score (BVAS) reveled score of 24, and the patient fell into a major relapse. Prednisolone at the dose of 1 mg/kg/day and one cycle of cyclophosphamide at the dose of 1000 mg were initiated. While she showed drug reaction to cyclophosphamide. Ten days later, the patient started to have epigastric pain, nausea, vomiting, icter and had a progressive rise in liver function tests and bilirubin. Alkaline phosphatase and total bilirubin levels reached at the peak up 1900 unit/liter and 16 mg/dl, respectively. In abdominal CT scan and magnetic resonance cholangiography (MRCP), a mass in pancreas head with the diameter of 26*23 mm in the posterior part of the pancreatic head dilated common bile duct with a diameter of 14mm has been recorded. Accordingly, an endosonography (EUS) was done, showing a pancreas mass in pancreas head. Fine needle biopsy (FNA) pathology showed pancreatitis pattern with no malignant cell. Then an ERCP (endoscopic retrograde cholangio pancreatography) was done and a stent was placed in pancreatic duct along with initiation of prednisolone at the dose of 1 mg/kg/day. After 20 days, the patient's symptoms resolved, pancreatic mass became smaller, and LFTs became normal. RTX at the dose of 1000 gr has been initiated and the patient discharged with 60 mg/day prednisolone. Two weeks later, she received the second dose of RTX at the dose of 1000 gr. One month after the last dose of RTX, sepsis had occurred and she expired a few days later. In most of the previously reported cases, pancreas involvement was reported as the first presentation of the disease, while in our case was not. Indeed, she first was presented with nasal and respiratory involvement and 1 year later pancreatitis symptoms appeared. In our cases, although RTX and high dose corticosteroids resolved issue, they led in a serious lethal infection. Taken together, both acute pancreatitis and non-malignant pancreatic mass could be presented as the secondary presentations in GPA patients. Although such conditions could be well-managed with high dose glucocorticoids and probably RTX, risk of serious and lethal infections is warned.
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PMID:Fatal outcome of rituximab in an ANCA negative granulomatosis with polyangiitis patient with acute pancreatitis and pancreatic mass. 3241 81