EP.WE.351Changes in social behaviour during the COVID-19 pandemic and consequences on hospital admissions from acute alcoholic related pancreatitis

Background Shifts in social behaviours as a consequence of the COVID-19 pandemic may make people more prone to alcohol use as a coping mechanism. This study aims to investigate whether there was an impact on acute alcohol-related pancreatitis cases given potential changes in alcohol consumption during the first COVID-19 lockdown period in the United Kingdom. It considers the time period since social establishments re-opened in July 2020, to evaluate whether increase alcoholic pancreatitis cases, as a proxy for altered drinking habits, persisted. Methods All codes relating to pancreatitis were used to identify cases between March to September (2016 to 2020). Inclusion criteria: acute alcohol-related pancreatitis only. These cases were screened by a group of independent medical juniors and analysed using Excel. Results A total of 1905 patients with pancreatitis were identified in the initial search, of which 136 were admitted with acute alcoholic pancreatitis. There was an increase in absolute number of new cases in 2020 compared to previous years (27 compared to a mean of 16 in the previous 4 years). When shops and pubs reopened, cases reduced by 37.5%. Conclusion This study highlights the issue of increased admission with acute pancreatitis relating to alcohol in the COVID-19 lock down period. During which, this group of patients are likely socially isolated with a lack of support. This calls for an increase in community support for such patients with emphasis on admission avoidance. This is especially important in an era when there is increased hospital admission due to COVID-19.

Joint contribution of alcohol abuse and the rs6580502 polymorphism of the SPINK1 gene to the risk of acute alcoholic pancreatitis

Основным фактором риска развития острого алкогольного панкреатита (ОАП) является злоупотребление алкоголем. Алкоголь инициирует экзокринную гиперсекрецию поджелудочной железы, создает предпосылки для повышения давления в протоках. Энзимы проникают в паренхиму, активируют протеолитические ферменты и вызывают аутолиз клеток поджелудочной железы. При избыточном накоплении трипсина в тканях начинается переваривание тканей железы собственными ферментами. SPINK1 - панкреатический секреторный ингибитор трипсина - препятствует преждевременной активации зимогенов. Цель - определить совместный вклад полиморфного локуса rs6580502 гена SPINK1 и злоупотребления алкоголем в развитие острого панкреатита и его осложнений. Образцы ДНК получены от 471 неродственного больного острым небилиарным панкреатитом и 573 неродственных индивидов без заболеваний желудочно-кишечного тракта. Генотипирование выполнено методом ПЦР с дискриминацией аллелей с помощью TaqMan-зондов. Для оценки ассоциаций аллелей и генотипов с риском развития заболевания использовали критерий χ2 и отношение шансов (OR) с 95% доверительными интервалами (CI). Статистический анализ осуществлялся с использованием программы Statistica 6.0 (StatSoft, США). В ходе исследования обнаружена ассоциация генотипа ТТ rs6580502 гена SPINK1 с повышенным риском развития ОАП (corOR (95% CI)= 1,69 (1,22-2,33); р=0,0015R). У носителей генотипа ТТ риск развития ОАП повышали такие факторы риска, как частота употребления алкоголя более 2 раз в неделю (corOR (95% CI) = 1,66 (1,08-2,57); р=0,02R) и объем употребления алкоголя более 200 г в неделю (corOR (95% CI) = 6,04 (1,81-20,17); р= 0,001R). Также была выявлена ассоциация генотипа ТТ с повышенным риском развития отечного панкреатита (corOR (95% CI)= 2.10 (1.44-3.05); p= 1×10-4 R). The main risk factor for the acute non-biliary pancreatitis is alcohol abuse. Alcohol initiates exocrine hypersecretion of the pancreas, creates the prerequisites for increasing pressure in the ducts. Enzymes activate proteolytic enzymes and cause autolysis of pancreatic cells. With an excessive accumulation of trypsin in the tissues, the digestion of the tissues of the gland by its own enzymes begins. SPINK1, a pancreatic secretory trypsin inhibitor, prevents premature activation of zymogens. Aim: to determine the contribution of the rs6580502 polymorphism of the SPINK1 gene and alcohol abuse in the development of acute pancreatitis and its complications. DNA samples obtained from 471 unrelated patients with acute non-biliary pancreatitis and 573 unrelated individuals without gastrointestinal diseases. Genotyping was performed using the PCR method with discrimination of alleles using TaqMan probes. The χ2 criterion and the odds ratio (OR) with 95% confidence intervals (CI) were used to assess the associations of alleles and genotypes of genes with the risk of developing the disease. Statistical analysis was carried out using the Statistica 6.0 software (StatSoft, USA). We found an association of the T/T SPINK1 rs6580502 genotype with an increased risk of developing acute non-biliary pancreatitis (corOR (95% CI)= 1.69 (1.22-2.33); p=0,0015R). In carriers of the TT genotype, the risk of developing SNP was increased by such risk factors as the frequency of drinking more than 2 times per week (corOR (95% CI)= 1,66(1,08-2,57); p=0,02R) and the volume of alcohol consumption more than 200 grams per week (corOR (95% CI)= 6,04(1,81-20,17); p= 0,001R). An association of the T/T genotype with an increased risk of developing edematous pancreatitis was also revealed (corOR (95% CI)= 2.10 (1.44-3.05); Р= 1×10-4 R).

Mutual Effect of NAT2 rs1799930 (590G>A) Polymorphism and Alcohol Abuse on Risk of Acute Pancreatitis

Aim. Estimation of the contribution of rs1799930 (590G>A) polymorphism of gene NAT2 to the development of acute alcoholic pancreatitis.Materials and methods. DNA samples were obtained from 547 unrelated patients with acute alcoholic pancreatitis and 573 unrelated individuals without gastrointestinal diseases. A survey selected individuals with the alcohol consumption of >200 g/week pure ethanol two times a week or more during 10 or more years. Genotyping was performed with PCR using TaqMan allelic discrimination assays.Results. No association was observed between the NAT2 allelic rs1799930 (590G>A) polymorphism, risk of acute alcoholic pancreatitis, duration and rate of alcohol consumption. The 590G>A variant of rs1799930 in gene NAT2 correlated with an increased risk of acute alcoholic pancreatitis (odds ratio 2.16; 95% confidence interval 1.13–4.12) under alcohol consumption >200 g/week pure ethanol.Conclusion. The rs1799930 G/A polymorphism of gene NAT2 increases the risk of acute pancreatitis under alcohol consumption >200 g/week pure ethanol.

Retroperitoneoscopic Pancreatic Necrosectomy: Taming the Relentless March of the Great Marauder

We hereby report a case of a 35-year-old male who presented to us with infected pancreatic necrosis, 4 weeks after an episode of acute alcoholic pancreatitis. Imaging investigations showed a predominantly left-sided pancreatic and peripancreatic infected collection. This case was managed successfully in a single sitting by retroperitoneoscopic intervention.

Specificity of Lipase & Amylase Separately, in Alcoholic & Non-Alcoholic Pancreatitis

BACKGROUND Clinically, the course of all causes of acute pancreatitis is similar; however, inpatients with severe biliary pancreatitis, we can prevent complications with the help of ERCP. Serum L / A ratio of > 2 could help diagnose alcohol as the causative agent1 . Hence, our study aims at assessing the validity in Government Medical College, Thiruvananthapuram, after assessing the specificity and sensitivity of amylase and lipase in alcoholic and non-alcoholic patients separately and lipase amylase ratio as an indicator to distinguish acute alcoholic from non-alcoholic pancreatitis. We also wanted to study the prevalence of pancreatitis in age group of 20 - 40. METHODS This is a diagnostic test evaluation conducted among 92 inpatients of Department of General Surgery selected through consecutive sampling. After randomly selecting patients admitted with a provisional diagnosis of acute pancreatitis, the first investigator administered the consent form, if accepted, examined the patient, evaluated the laboratory parameters. Then these patients were prospectively followed and evaluated. Data are then analysed using Excel spread sheet version 2019 and SPSS software and sensitivity, specificity, prevalence and diagnostic accuracy were determined. RESULTS Among 92 patients, 80 (87 %), 55 (58.8%) and 25 (27.2%) were found to have pancreatitis, alcoholic and non-alcoholic causes respectively. 35 (38 %) patients were in the age group of 31 – 35 years. It was found that lipase has 94.55 % & 91.6 % sensitivity and specificity in alcoholic and 84 % & 91.6 % sensitivity and specificity in non-alcoholic pancreatitis patients, respectively, and amylase has 69 % & 91.67 % sensitivity and specificity in alcoholic and 72 % & 91.67 % sensitivity and specificity in non-alcoholic pancreatitis respectively. CONCLUSIONS Serum amylase and lipase are inevitable investigations with good sensitivity and specificity in the diagnosis of acute pancreatitis. Lipase amylase ratio >2 is diagnostic of alcoholic pancreatitis. KEYWORDS Acute Pancreatitis, Acute Alcoholic Pancreatitis, Acute Non-Alcoholic Pancreatitis, Specificity of Lipase and Amylase, Lipase Amylase Ratio