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Pain in acute pancreatitis and its relation with prognosis: A prospective and descriptive study
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Abstracts / Pancreatology 13 (2013) e1–e19
P31. Pain in acute pancreatitis and its relation with prognosis: A prospective and descriptive study lez 1, D.R. Remedios Espino 1, E. mez 1, M. Francisco Gonza F. Valentín Go ndez 1, J. Ferna ndez Seara 1. ndez 2, J. Cubiella Ferna Seco Herna 1
Servicio Aparato Digestivo, Spain Servicio de Medicina Interna, Complejo Hospitalario Universitario de Ourense, Spain
AZA/MP. 18 of these patients (50% male) developed AP caused by AZA/MP. The mean age was 43.22 years old (20-70). 16.7% are UC and 83.3% are CD. The mean period from the beginning of the treatment to the development of the AP was of 19.6 days. All of them developed a mild AP and only a 55.6% needed admission in our hospital. In 61.1% AZA/MP was the only treatment; 38.9% were receiving steroids at the same time. None was receiving mesalazine. Conclusions:
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Introduction: Initial treatment of acute pancreatitis (AP) is based on pain control, oral refeeding and the prevention and treatment of local and systemic complications. Aims & methods: To describe the intensity of pain in AP and the required analgesia during the first 3 days of hospitalization and to determine if there is a relation between pain intensity, AP severity and length of admission. All patients admitted due to an AP episode between February’12 and January’13 were proposed to participate in a prospective and descriptive study. Pain was evaluated with a visual analogue scale (VAS) from 0 to 10 on admission, thrice a day and whenever patient referred pain. Besides, the requirements of analgesic treatment (paracetamol, metamizol and morfine equivalent dose) were quantified. Pain relief was considered if there was a 66% reduction in VAS score. We determined if there was any association between pain relief or disappearance, AP severity and length of admission with Fischer exact test and Mann-Whitney’s U test. Results: 89 patients (6717.14 years, 58.4% male) accepted to participate in the study. BISAP score on admission was 0.960.86, 14 (15.7%) moderately severe AP episodes were included, the mean length of hospitalization was 8.535.7 days and all patients were discharged alive. VAS score on admission, at day 1, 2 and 3 were 5.261.91, 1.21.65, 11.56 and 0.821.5. Pain relief was achieved in 69.7%, 82% and 84% of the patients. Furthermore, 47.2%, 48.3% and 33.7% referred no pain at days 1, 2 and 3. Metamizol was administered to 61 (2.950.88grs), 60 (2.850.67grs) and 52 (2.840.73grs) patients at days 1, 2 and 3. Paracetamol was administered to 44 (2.270.97grs), 33 (2.330.87grs) and 23 (2.650.7grs) patients at days 1, 2 and 3. Morphine derivatives were administered to 28 (26.2917.33mgrs), 22 (19.617.15mgrs) and 16 (31.1512.17mgrs) patients at days 1, 2 and 3. Pain relief or absence of pain was not associated with the risk of developing a moderately severe acute pancreatitis. Finally, only individuals who remained without pain at day 3 had statistically shorter admissions (no pain: 5.166days, pain: 6.94.66days; p¼0.009). Conclusion: Pain is adequately controlled in most patients with the drugs available. We found no relation between pain relief and AP severity. We only found an association between pain persistence at day 3 and length of hospitalization.
P32. Acute pancreatitis caused by azathioprine/mercaptopurine in patients with inflammatory bowel disease zar, F. Bolado Concejo, C. E. Rubio Guindulain, E. Valdivielso Corta Rodríguez Gutierrez, C. Prieto Martínez, O. Nantes Castillejo, J.M. Urman ndez. Ferna Servicio de Aparato Digestivo, Complejo Hospitalario de Navarra-A, Spain Objectives: 0’3-1’4% of the acute pancreatitis (AP) are caused by drugs, including azathioprine and mercaptopurine (AZA/MP). This adverse effect appears in 1-6% of the patients with Inflammatory Bowel Disease (IBD) treated with AZA/MP. We intend to analyze the characteristics of the AP caused by AZA/MP in patients with IBD in our hospital. Material and methods: retrospective and descriptive analysis of the AP caused by AZA/MP in patients with IBD in our hospital. Results: 241 patients (43%) of 588 patients with IBD (60% ulcerative colitis-UC, 38’6% Crohn Disease-CD, 1’4% indeterminate colitis -IC) registered in our hospital are receiving or have received treatment with
7’4% of the patients treated with AZA/MP developed AP Most of patients with AP caused by AZA/MP were diagnosed of CD All AP were mild. Almost half of them did not need admission in our hospital.
Chronic pancreatitis
P33. Effect of tobacco in the proliferation and migration of pancreatic stellate cells (PSC) ~ eira-Alvarin ~ o 1, M. Luaces-Regueira 1, J.E. Domínguez-Mun ~ oz 1, 2. M. Castin 1
Foundation for Research in Digestive Diseases, Santiago de Compostela, Spain 2 University Hospital of Santiago, Gastroenterology, Santiago de Compostela, Spain PSC proliferation and migration are essential in pancreatic fibrogenesis. Alcohol has been associated with activation and survival of PSC, but the effect of tobacco is unknown Aim: To evaluate the effect of tobacco, ethanol and the combination of both in migration and proliferation of PSC. Methods: Isolated PSC from rat pancreas were exposed to increasing concentrations of tobacco (0.01-0.4mg/ml), ethanol (5 -100mM) or the combination of both. Lactate dehydrogenase activity was evaluated as a measure of cytotoxicity. PSC proliferation was determined by WST-1 assay and migration by wound healing assay and Transwell Migration Assay. Results: Tobacco at 0.1, 0.2 and 0.4 mg/ml had a cytotoxic effect in PSC (28% to 49% cell death, p<0.05). This cytotoxic effect was associated with a decrease of cell proliferation that was not modified by addition of ethanol. In presence of tobacco at 0.01mg/mL, ethanol at 5, 10 and 50mM increased PSC migration in a dose-dependent manner (p<0.05). Conclusions: Tobacco at concentrations of 0.1mg/mL or higher induces cell death and decreases PSC proliferation. In the presence of non-cytotoxic concentrations of tobacco, ethanol induces a dose-dependent increase of PSC migration. In conclusion, combined consumption of alcohol and tobacco is probably involved in the process of fibrogenesis in chronic pancreatitis.
P34. Role of tobacco vs alcohol, in intracellular calcium levels and enzyme secretion in pancreatic acinar cells ~ eira-Alvarin ~ o 1, M. CastroM. Luaces-Regueira 1, M. Castin ~ o 2, M. Campos-Toimil 2, J.E. Manzanares 1,2, A. Carrascal-Minin ~ oz 1. Domínguez-Mun 1
Foundation for Research in Digestive Diseases, Department of Gastroenterology, University Hospital of Santiago de Compostela, Spain 2 Farmacology Department, University of Santiago de Compostela, Spain
Abstracts / Pancreatology 13 (2013) e1–e19
P31. Pain in acute pancreatitis and its relation with prognosis: A prospective and descriptive study lez 1, D.R. Remedios Espino 1, E. mez 1, M. Francisco Gonza F. Valentín Go ndez 1, J. Ferna ndez Seara 1. ndez 2, J. Cubiella Ferna Seco Herna 1
Servicio Aparato Digestivo, Spain Servicio de Medicina Interna, Complejo Hospitalario Universitario de Ourense, Spain
AZA/MP. 18 of these patients (50% male) developed AP caused by AZA/MP. The mean age was 43.22 years old (20-70). 16.7% are UC and 83.3% are CD. The mean period from the beginning of the treatment to the development of the AP was of 19.6 days. All of them developed a mild AP and only a 55.6% needed admission in our hospital. In 61.1% AZA/MP was the only treatment; 38.9% were receiving steroids at the same time. None was receiving mesalazine. Conclusions:
2
Introduction: Initial treatment of acute pancreatitis (AP) is based on pain control, oral refeeding and the prevention and treatment of local and systemic complications. Aims & methods: To describe the intensity of pain in AP and the required analgesia during the first 3 days of hospitalization and to determine if there is a relation between pain intensity, AP severity and length of admission. All patients admitted due to an AP episode between February’12 and January’13 were proposed to participate in a prospective and descriptive study. Pain was evaluated with a visual analogue scale (VAS) from 0 to 10 on admission, thrice a day and whenever patient referred pain. Besides, the requirements of analgesic treatment (paracetamol, metamizol and morfine equivalent dose) were quantified. Pain relief was considered if there was a 66% reduction in VAS score. We determined if there was any association between pain relief or disappearance, AP severity and length of admission with Fischer exact test and Mann-Whitney’s U test. Results: 89 patients (6717.14 years, 58.4% male) accepted to participate in the study. BISAP score on admission was 0.960.86, 14 (15.7%) moderately severe AP episodes were included, the mean length of hospitalization was 8.535.7 days and all patients were discharged alive. VAS score on admission, at day 1, 2 and 3 were 5.261.91, 1.21.65, 11.56 and 0.821.5. Pain relief was achieved in 69.7%, 82% and 84% of the patients. Furthermore, 47.2%, 48.3% and 33.7% referred no pain at days 1, 2 and 3. Metamizol was administered to 61 (2.950.88grs), 60 (2.850.67grs) and 52 (2.840.73grs) patients at days 1, 2 and 3. Paracetamol was administered to 44 (2.270.97grs), 33 (2.330.87grs) and 23 (2.650.7grs) patients at days 1, 2 and 3. Morphine derivatives were administered to 28 (26.2917.33mgrs), 22 (19.617.15mgrs) and 16 (31.1512.17mgrs) patients at days 1, 2 and 3. Pain relief or absence of pain was not associated with the risk of developing a moderately severe acute pancreatitis. Finally, only individuals who remained without pain at day 3 had statistically shorter admissions (no pain: 5.166days, pain: 6.94.66days; p¼0.009). Conclusion: Pain is adequately controlled in most patients with the drugs available. We found no relation between pain relief and AP severity. We only found an association between pain persistence at day 3 and length of hospitalization.
P32. Acute pancreatitis caused by azathioprine/mercaptopurine in patients with inflammatory bowel disease zar, F. Bolado Concejo, C. E. Rubio Guindulain, E. Valdivielso Corta Rodríguez Gutierrez, C. Prieto Martínez, O. Nantes Castillejo, J.M. Urman ndez. Ferna Servicio de Aparato Digestivo, Complejo Hospitalario de Navarra-A, Spain Objectives: 0’3-1’4% of the acute pancreatitis (AP) are caused by drugs, including azathioprine and mercaptopurine (AZA/MP). This adverse effect appears in 1-6% of the patients with Inflammatory Bowel Disease (IBD) treated with AZA/MP. We intend to analyze the characteristics of the AP caused by AZA/MP in patients with IBD in our hospital. Material and methods: retrospective and descriptive analysis of the AP caused by AZA/MP in patients with IBD in our hospital. Results: 241 patients (43%) of 588 patients with IBD (60% ulcerative colitis-UC, 38’6% Crohn Disease-CD, 1’4% indeterminate colitis -IC) registered in our hospital are receiving or have received treatment with
7’4% of the patients treated with AZA/MP developed AP Most of patients with AP caused by AZA/MP were diagnosed of CD All AP were mild. Almost half of them did not need admission in our hospital.
Chronic pancreatitis
P33. Effect of tobacco in the proliferation and migration of pancreatic stellate cells (PSC) ~ eira-Alvarin ~ o 1, M. Luaces-Regueira 1, J.E. Domínguez-Mun ~ oz 1, 2. M. Castin 1
Foundation for Research in Digestive Diseases, Santiago de Compostela, Spain 2 University Hospital of Santiago, Gastroenterology, Santiago de Compostela, Spain PSC proliferation and migration are essential in pancreatic fibrogenesis. Alcohol has been associated with activation and survival of PSC, but the effect of tobacco is unknown Aim: To evaluate the effect of tobacco, ethanol and the combination of both in migration and proliferation of PSC. Methods: Isolated PSC from rat pancreas were exposed to increasing concentrations of tobacco (0.01-0.4mg/ml), ethanol (5 -100mM) or the combination of both. Lactate dehydrogenase activity was evaluated as a measure of cytotoxicity. PSC proliferation was determined by WST-1 assay and migration by wound healing assay and Transwell Migration Assay. Results: Tobacco at 0.1, 0.2 and 0.4 mg/ml had a cytotoxic effect in PSC (28% to 49% cell death, p<0.05). This cytotoxic effect was associated with a decrease of cell proliferation that was not modified by addition of ethanol. In presence of tobacco at 0.01mg/mL, ethanol at 5, 10 and 50mM increased PSC migration in a dose-dependent manner (p<0.05). Conclusions: Tobacco at concentrations of 0.1mg/mL or higher induces cell death and decreases PSC proliferation. In the presence of non-cytotoxic concentrations of tobacco, ethanol induces a dose-dependent increase of PSC migration. In conclusion, combined consumption of alcohol and tobacco is probably involved in the process of fibrogenesis in chronic pancreatitis.
P34. Role of tobacco vs alcohol, in intracellular calcium levels and enzyme secretion in pancreatic acinar cells ~ eira-Alvarin ~ o 1, M. CastroM. Luaces-Regueira 1, M. Castin ~ o 2, M. Campos-Toimil 2, J.E. Manzanares 1,2, A. Carrascal-Minin ~ oz 1. Domínguez-Mun 1
Foundation for Research in Digestive Diseases, Department of Gastroenterology, University Hospital of Santiago de Compostela, Spain 2 Farmacology Department, University of Santiago de Compostela, Spain