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Issues in hypertriglyceridemic pancreatitis: an update.

Abstract

Hypertriglyceridemia (HTG) is a well-established but underestimated cause of acute pancreatitis and recurrent acute pancreatitis. The clinical presentation of HTG-induced pancreatitis (HTG pancreatitis) is similar to other causes. Pancreatitis secondary to HTG is typically seen in the presence of one or more secondary factors (uncontrolled diabetes, alcoholism, medications, pregnancy) in a patient with an underlying common genetic abnormality of lipoprotein metabolism (familial combined hyperlipidemia or familial HTG). Less commonly, a patient with rare genetic abnormality (familial chylomicronemic syndrome) with or without an additional secondary factor is encountered. The risk of acute pancreatitis in patients with serum triglycerides >1000 and >2000 mg/dL is ∼ 5% and 10% to 20%, respectively. It is not clear whether HTG pancreatitis is more severe than when it is due to other causes. Clinical management of HTG pancreatitis is similar to that of other causes. Insulin infusion in diabetic patients with HTG can rapidly reduce triglyceride (TG) levels. Use of apheresis is still experimental and better designed studies are needed to clarify its role in the management of HTG pancreatitis. Diet, lifestyle changes, and control of secondary factors are key to the treatment, and medications are useful adjuncts to the long-term management of TG levels. Control of TG levels to 500 mg/dL or less can effectively prevent recurrences of pancreatitis.

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    ,

    *Department of Medicine, Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA †Division of Gastroenterology, St. Peters University Hospital, New Brunswick, NJ.

    , ,

    Source

    Journal of clinical gastroenterology 48:3 2014 Mar pg 195-203

    MeSH

    Acute Disease
    Biomarkers
    Genetic Predisposition to Disease
    Humans
    Hypertriglyceridemia
    Pancreatitis
    Risk Factors
    Secondary Prevention
    Treatment Outcome
    Triglycerides
    Up-Regulation

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Review

    Language

    eng

    PubMed ID

    24172179

    Citation

    Scherer, John, et al. "Issues in Hypertriglyceridemic Pancreatitis: an Update." Journal of Clinical Gastroenterology, vol. 48, no. 3, 2014, pp. 195-203.
    Scherer J, Singh VP, Pitchumoni CS, et al. Issues in hypertriglyceridemic pancreatitis: an update. J Clin Gastroenterol. 2014;48(3):195-203.
    Scherer, J., Singh, V. P., Pitchumoni, C. S., & Yadav, D. (2014). Issues in hypertriglyceridemic pancreatitis: an update. Journal of Clinical Gastroenterology, 48(3), pp. 195-203. doi:10.1097/01.mcg.0000436438.60145.5a.
    Scherer J, et al. Issues in Hypertriglyceridemic Pancreatitis: an Update. J Clin Gastroenterol. 2014;48(3):195-203. PubMed PMID: 24172179.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Issues in hypertriglyceridemic pancreatitis: an update. AU - Scherer,John, AU - Singh,Vijay P, AU - Pitchumoni,C S, AU - Yadav,Dhiraj, PY - 2013/11/1/entrez PY - 2013/11/1/pubmed PY - 2014/10/10/medline SP - 195 EP - 203 JF - Journal of clinical gastroenterology JO - J. Clin. Gastroenterol. VL - 48 IS - 3 N2 - Hypertriglyceridemia (HTG) is a well-established but underestimated cause of acute pancreatitis and recurrent acute pancreatitis. The clinical presentation of HTG-induced pancreatitis (HTG pancreatitis) is similar to other causes. Pancreatitis secondary to HTG is typically seen in the presence of one or more secondary factors (uncontrolled diabetes, alcoholism, medications, pregnancy) in a patient with an underlying common genetic abnormality of lipoprotein metabolism (familial combined hyperlipidemia or familial HTG). Less commonly, a patient with rare genetic abnormality (familial chylomicronemic syndrome) with or without an additional secondary factor is encountered. The risk of acute pancreatitis in patients with serum triglycerides >1000 and >2000 mg/dL is ∼ 5% and 10% to 20%, respectively. It is not clear whether HTG pancreatitis is more severe than when it is due to other causes. Clinical management of HTG pancreatitis is similar to that of other causes. Insulin infusion in diabetic patients with HTG can rapidly reduce triglyceride (TG) levels. Use of apheresis is still experimental and better designed studies are needed to clarify its role in the management of HTG pancreatitis. Diet, lifestyle changes, and control of secondary factors are key to the treatment, and medications are useful adjuncts to the long-term management of TG levels. Control of TG levels to 500 mg/dL or less can effectively prevent recurrences of pancreatitis. SN - 1539-2031 UR - https://www.unboundmedicine.com/medline/citation/24172179/full_citation L2 - http://Insights.ovid.com/pubmed?pmid=24172179 DB - PRIME DP - Unbound Medicine ER -