Effects of enteral glutamine supplementation on intestinal permeability in acute pancreatitis: A literature review

Hospital at home is a service that provides active treatment by healthcare professionals in the patient’s home for a condition that otherwise would require acute hospital in-patient care. However, the clinical benefit of this intervention and its effect on health costs are not established. This Cochrane systematic review aimed to assess the effectiveness and costs of managing patients with hospital at home compared with inpatient hospital care. A systematic review of the literature was carried out by searching the following databases to 9 January 2017: Cochrane Effective Practice and Organization of Care Group (EPOC) register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, EconLit and clinical trials registries. Thirty-two randomized trials (2 of which unpublished), including 4746 patients, were included. The present review provides insufficient objective evidence of economic benefit (through a reduction in hospital length of stay) or improved health outcomes.

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Recent advances in understanding and managing acute pancreatitis

F1000Research ◽

10.12688/f1000research.14244.1 ◽

2018 ◽

Vol 7 ◽

pp. 959 ◽

Cited By ~ 5

Author(s):

Amar Mandalia ◽

Erik-Jan Wamsteker ◽

Matthew J. DiMagno

Keyword(s):

Acute Pancreatitis ◽

Clinical Decision Making ◽

Clinical Decision ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Biliary Pancreatitis ◽

Treatment Interventions ◽

Local Complication ◽

Acute Biliary Pancreatitis

This review highlights advances made in recent years in the diagnosis and management of acute pancreatitis (AP). We focus on epidemiological, clinical, and management aspects of AP. Additionally, we discuss the role of using risk stratification tools to guide clinical decision making. The majority of patients suffer from mild AP, and only a subset develop moderately severe AP, defined as a pancreatic local complication, or severe AP, defined as persistent organ failure. In mild AP, management typically involves diagnostic evaluation and supportive care resulting usually in a short hospital length of stay (LOS). In severe AP, a multidisciplinary approach is warranted to minimize morbidity and mortality over the course of a protracted hospital LOS. Based on evidence from guideline recommendations, we discuss five treatment interventions, including intravenous fluid resuscitation, feeding, prophylactic antibiotics, probiotics, and timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis. This review also highlights the importance of preventive interventions to reduce hospital readmission or prevent pancreatitis, including alcohol and smoking cessation, same-admission cholecystectomy for acute biliary pancreatitis, and chemoprevention and fluid administration for post-ERCP pancreatitis. Our review aims to consolidate guideline recommendations and high-quality studies published in recent years to guide the management of AP and highlight areas in need of research.

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Immunosuppression and the infection caused by gut mucosal barrier dysfunction in patients with early severe acute pancreatitis

Frontiers in Bioscience ◽

10.2741/4150 ◽

2013 ◽

Vol 18 (3) ◽

pp. 892 ◽

Cited By ~ 6

Author(s):

Yuan-Long Gu

Keyword(s):

Acute Pancreatitis ◽

Severe Acute Pancreatitis ◽

Mucosal Barrier ◽

Barrier Dysfunction ◽

Gut Mucosal Barrier

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Comparison of clinical characteristics and outcomes between alcohol-induced and gallstone-induced acute pancreatitis: An Australian retrospective observational study

SAGE Open Medicine ◽

10.1177/20503121211030837 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110308

Author(s):

Santiago Cegarra Garcia ◽

Michael Toolis ◽

Max Ubels ◽

Taha Mollah ◽

Eldho Paul ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Acute Pancreatitis ◽

Intensive Care ◽

Length Of Stay ◽

Hospital Mortality ◽

Intensive Care Unit Mortality ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Index Of Severity

Objectives: To compare the characteristics and outcomes of patients presenting to hospital with alcohol-induced and gallstone-induced acute pancreatitis. Methods: Retrospective study of all patients with alcohol-induced or gallstone-induced pancreatitis during the period 1 June 2012 to 31 May 2016. The primary outcome measure was hospital mortality. Secondary outcome measures included hospital length of stay, requirements for intensive care unit admission, intensive care unit mortality, mechanical ventilation, renal replacement therapy, requirement of inotropes and total parenteral nutrition. Results: A total of 642 consecutive patients (49% alcohol; 51% gallstone) were included. No statistically significant differences were found between alcohol-induced and gallstone-induced acute pancreatitis with respect to hospital mortality, requirement for intensive care unit admission, intensive care unit mortality and requirement for mechanical ventilation, renal replacement therapy, inotropes or total parenteral nutrition. There was significant difference in hospital length of stay (3.07 versus 4.84; p < 0.0001). On multivariable regression analysis, Bedside Index of Severity in Acute Pancreatitis score (estimate: 0.393; standard error: 0.058; p < 0.0001) and admission haematocrit (estimate: 0.025; standard error: 0.008; p = 0.002) were found to be independently associated with prolonged hospital length of stay. Conclusion: Hospital mortality did not differ between patients with alcohol-induced and gallstone-induced acute pancreatitis. The duration of hospital stay was longer with gallstone-induced pancreatitis. Bedside Index of Severity in Acute Pancreatitis score and admission haematocrit were independently associated with hospital length of stay.

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The clinical traits of acute pancreatitis in aging patients: a retrospective analysis of 473 cases

10.21203/rs.2.24010/v1 ◽

2020 ◽

Author(s):

Nonghua Lu ◽

Bingjun Yu ◽

Fengwen Xie

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Acute Pancreatitis ◽

Intensive Care ◽

Abdominal Pain ◽

Length Of Stay ◽

Organ Failure ◽

Death Rate ◽

Hospital Length ◽

Hospital Length Of Stay

Abstract Background The incidence of acute pancreatitis in aging patients has increasing in recent years. Controversial results about clinical outcomes of acute pancreatitis in aging patients were reported in different literature. The aim of our study was to compare the clinical outcomes of AP in aging patients between 60-79 years old and over 80 years old. Methods 80 patients aged ≥ 80 years old(oldest group) were compared to 393 patients aged 60 to 79 years old(older group). The clinical course, biochemical, radiological data were enrolled. The primary endpoint was to compare the death rate, intensive care unit admission rate and in-hospital length of stay(LOS). The secondary endpoint was operative treatment and the complications of AP. Results Abdominal symptom of abdominal pain (61.3% vs 46.3%, P=0.013) was less in oldest group, while diarrhea(18.3% vs 30.0%, P=0.018), jaundice(8.9% vs 17.5%, P=0.021), dyspnea(11.5% vs 26.3%, P=0.001) were more obvious in older group than oldest group. A higher death rate (8.9% vs 16.3%, P = 0.003) and longer hospital length of stay (11.51±10.19 vs 15.26±11.04, P = 0.001) were found in aging patients aged ≥80 years old. Mean BMI was lower in oldest group compared to older group(22.36±2.89 vs 21.07±3.18, P = 0.001). Multivariate analysis identified aged over 80 years(OR 3.299, 95%CI 1.316-8.269, P=0.011) and organ failure(P<0.05) as independent risk factors of mortality. More severe of AP(OR 11.722, 95%CI 4.780-28.764, P=0.001), abdominal pain(OR 1.906, 95%CI 1.052-3.453, P=0.033) and organ failure(P<0.05) were recognized as influencing intensive care unit rate. Aging patients aged over 80 years old(OR 0.149, 95%CI 2.027-6.268, P=0.001), more severe of AP(OR 0.218, 95%CI 1.567-4.322, P=0.001), female(OR 0.093, 95%CI 0.336-3.542, P=0.018), Jaundice(OR 0.080, 95%CI 0.146-5.324, P=0.038), operative treatment(P<0.05) and organ failure(P<0.05) were the risk factors for LOS.

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A Combined Paging Alert and Web-Based Instrument Alters Clinician Behavior and Shortens Hospital Length of Stay in Acute Pancreatitis

The American Journal of Gastroenterology ◽

10.1038/ajg.2013.282 ◽

2014 ◽

Vol 109 (3) ◽

pp. 306-315 ◽

Cited By ~ 19

Author(s):

Matthew J DiMagno ◽

Erik-Jan Wamsteker ◽

Rafat S Rizk ◽

Joshua P Spaete ◽

Suraj Gupta ◽

...

Keyword(s):

Acute Pancreatitis ◽

Length Of Stay ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Web Based

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Sa1361 PATIENT-CONTROLLED ANALGESIA LEADS TO INCREASED HOSPITAL LENGTH OF STAY, GREATER TIME TO ORAL INTAKE, AND HIGHER RATES OF OUTPATIENT OPIOID USAGE COMPARED TO CONVENTIONAL IV PUSH ADMINISTRATION IN ACUTE PANCREATITIS

Gastroenterology ◽

10.1016/s0016-5085(20)31527-4 ◽

2020 ◽

Vol 158 (6) ◽

pp. S-332-S-333

Author(s):

Shilpa Reddy ◽

G.R. Smith ◽

Kassandra Samuel ◽

Caleb Lou ◽

Mary Kwasny ◽

...

Keyword(s):

Acute Pancreatitis ◽

Length Of Stay ◽

Oral Intake ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Patient Controlled Analgesia

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The Effects of Probiotic/Synbiotic on Serum Level of Zonulin as a Biomarker of Intestinal Permeability: A Systematic Review and Meta-Analysis

Iranian Journal of Public Health ◽

10.18502/ijph.v49i7.3575 ◽

2020 ◽

Author(s):

Amirhossein RAMEZANI AHMADI ◽

Mehdi SADEGHIAN ◽

Meysam ALIPOUR ◽

Samira AHMADI TAHERI ◽

Sepideh RAHMANI ◽

...

Keyword(s):

Systematic Review ◽

Intestinal Permeability ◽

Web Of Science ◽

Human Subjects ◽

Meta Analysis ◽

Serum Levels ◽

Cochrane Central Register ◽

Inclusion Criteria ◽

Central Register ◽

High Level

Background: This systematic review and meta-analysis was conducted to obtain a conclusive result on the influence of probiotics/synbiotic on serum levels of zonulin. Data related to serum levels of zonulin were extracted to determine the effects of probiotic/synbiotic on intestinal permeability. Methods: The literature search was conducted across the Cochrane Central Register of Controlled Trials, PubMed, Scopus and ISI Web of Science, Search up to Nov 2018. Clinical trials evaluating the effect of probiotic/synbiotic on serum zonulin levels of all human subjects were included. Results: Nine studies (including 496 intervention and 443 control subjects) met the inclusion criteria for the meta-analysis. According to the meta-analysis, probiotic/synbiotic has a significant effect on serum zonulin reduction (WMD=-10.55 [95% CI: -17.76, -3.34]; P=0.004). However, the high level of heterogeneity was observed among the studies (I2=97.8, P<0.001). The subgroup analysis suggested study quality, blinding, study duration, Participants age, subject's health status and supplement type as sources of heterogeneity. Conclusion: Probiotic/synbiotic have favorable effects on serum levels of zonulin as a measure of intestinal permeability. However, the results should be interpreted with caution due to the high heterogeneity and further evidence is required before definitive recommendations can be made.

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Recent advances in understanding and managing acute pancreatitis

F1000Research ◽

10.12688/f1000research.14244.2 ◽

2019 ◽

Vol 7 ◽

pp. 959 ◽

Cited By ~ 1

Author(s):

Amar Mandalia ◽

Erik-Jan Wamsteker ◽

Matthew J. DiMagno

Keyword(s):

Acute Pancreatitis ◽

Clinical Decision Making ◽

Clinical Decision ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Biliary Pancreatitis ◽

Treatment Interventions ◽

Local Complication ◽

Acute Biliary Pancreatitis

This review highlights advances made in recent years in the diagnosis and management of acute pancreatitis (AP). We focus on epidemiological, clinical, and management aspects of AP. Additionally, we discuss the role of using risk stratification tools to guide clinical decision making. The majority of patients suffer from mild AP, and only a subset develop moderately severe AP, defined as a pancreatic local complication, or severe AP, defined as persistent organ failure. In mild AP, management typically involves diagnostic evaluation and supportive care resulting usually in a short hospital length of stay (LOS). In severe AP, a multidisciplinary approach is warranted to minimize morbidity and mortality over the course of a protracted hospital LOS. Based on evidence from guideline recommendations, we discuss five treatment interventions, including intravenous fluid resuscitation, feeding, prophylactic antibiotics, probiotics, and timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis. This review also highlights the importance of preventive interventions to reduce hospital readmission or prevent pancreatitis, including alcohol and smoking cessation, same-admission cholecystectomy for acute biliary pancreatitis, and chemoprevention and fluid administration for post-ERCP pancreatitis. Our review aims to consolidate guideline recommendations and high-quality studies published in recent years to guide the management of AP and highlight areas in need of research.

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