Humans ; Acute Disease ; Pancreatitis/diagnosis* ; Follow-Up Studies ; Patient Discharge ; Disease Progression

A case of IgG4-related disease presented with a duodenal ulcer to improve the understan-ding of IgG4-related diseases was reported. A 70-year-old male presented with cutaneous pruritus and abdominal pain for four years and blackened stools for two months. Four years ago, the patient went to hospital for cutaneous pruritus and abdominal pain. Serum IgG4 was 3.09 g/L (reference value 0-1.35 g/L), alanine aminotransferase 554 U/L (reference value 9-40 U/L), aspartate aminotransferase 288 U/L (reference value 5-40 U/L), total bilirubin 54.16 μmol/L (reference value 2-21 μmol/L), and direct bilirubin 29.64 μmol/L (reference value 1.7-8.1 μmol/L) were all elevated. The abdominal CT scan and magnetic resonance cholangiopancreatography indicated pancreatic swelling, common bile duct stenosis, and secondary obstructive dilation of the biliary system. The patient was diagnosed with IgG4-related disease and treated with prednisone at 40 mg daily. As jaundice and abdominal pain improved, prednisone was gradually reduced to medication discontinuation. Two months ago, the patient developed melena, whose blood routine test showed severe anemia, and gastrointestinal bleeding was diagnosed. The patient came to the emergency department of Beijing Hospital with no improvement after treatment in other hospitals. Gastroscopy revealed a 1.5 cm firm duodenal bulb ulcer. After treatment with omeprazole, the fecal occult blood was still positive. The PET-CT examination was performed, and it revealed no abnormality in the metabolic activity of the duodenal wall, and no neoplastic lesions were found. IgG4-related disease was considered, and the patient was admitted to the Department of Rheumatology and Immunology of Beijing Hospital for further diagnosis and treatment. The patient had a right submandibular gland mass resection history and diabetes mellitus. After the patient was admitted to the hospital, the blood test was reevaluated. The serum IgG4 was elevated at 5.44 g/L (reference value 0.03-2.01 g/L). Enhanced CT of the abdomen showed that the pancreas was mild swelling and was abnormally strengthened, with intrahepatic and extrahepatic bile duct dilation and soft tissue around the superior mesenteric vessels. We pathologically reevaluated and stained biopsy specimens of duodenal bulbs for IgG and IgG4. Immunohistochemical staining revealed remarkable infiltration of IgG4-positive plasma cells into duodenal tissue, the number of IgG4-positive cells was 20-30 cells per high-powered field, and the ratio of IgG4/IgG-positive plasma cells was more than 40%. The patient was treated with intravenous methylprednisolone at 40 mg daily dosage and cyclophosphamide, and then the duodenal ulcer was healed. IgG4 related disease is an immune-medicated rare disease characterized by chronic inflammation and fibrosis. It is a systemic disease that affects nearly every anatomic site of the body, usually involving multiple organs and diverse clinical manifestations. The digestive system manifestations of IgG4-related disease are mostly acute pancreatitis and cholangitis and rarely manifest as gastrointestinal ulcers. This case confirms that IgG4-related disease can present as a duodenal ulcer and is one of the rare causes of duodenal ulcers.
Aged ; Humans ; Male ; Abdominal Pain/drug therapy* ; Acute Disease ; Bilirubin ; Duodenal Ulcer/etiology* ; Immunoglobulin G ; Immunoglobulin G4-Related Disease/diagnosis* ; Pancreatitis/drug therapy* ; Positron Emission Tomography Computed Tomography ; Prednisone/therapeutic use* ; Pruritus/drug therapy*

OBJECTIVE: To investigate the predictive value of pancreatitis activity scoring system (PASS) combined with Neutrophil to lymphocyte ratio (NLR) and C-reactive protein (CRP) for infected pancreatic necrosis (IPN) in patients with severe acute pancreatitis (SAP). METHODS: Clinical data of SAP patients admitted to the First Affiliated Hospital of Zhengzhou University from January 2020 to January 2023 were retrospectively collected, including basic information, vital signs at admission, first laboratory indexes within 48 hours of admission. The PASS scores at admission and 24, 48 and 72 hours after admission were calculated. According to the diagnostic criteria of IPN, the patients were divided into the non-IPN group and the IPN group, and the independent risk factors of SAP complicating IPN were determined by using univariate analysis and multifactorial Logistic regression. The receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of NLR, CRP, and PASS score, alone and in combination for IPN in patients with SAP. RESULTS: A total of 149 SAP patients were enrolled, including 102 in the non-IPN group and 47 in the IPN group. The differences in PASS score at each time point, NLR, CRP, procalcitonin (PCT), blood urea nitrogen, blood chloride, and days of hospitalization between the two groups were statistically significant. Multifactorial Logistic regression analysis showed that 72 hours admission PASS score [odds ratio (OR) = 1.034, 95% confidence interval (95%CI) was 1.005-1.065, P = 0.022], NLR (OR = 1.284, 95%CI was 1.139-1.447, P = 0.000), and CRP (OR = 1.015, 95%CI was 1.006-1.023, P = 0.001) were independent risk factors for IPN in patients with SAP. ROC curve analysis showed that the area under the ROC curve (AUC) of the PASS score at 72 hours of admission, NLR, and CRP alone in predicting IPN in SAP patients were 0.828, 0.771, and 0.701, respectively. The AUC of NLR combined with CRP, PASS combined with NLR, and PASS combined with CRP were 0.818, 0.895, and 0.874, respectively. The combination of PASS score at 72 hours after admission, NLR, and CRP had a better predictive ability for IPN in patients with SAP (AUC = 0.922, 95%CI was 0.877-0.967), and the sensitivity was 72.3% when the cut-off value was 0.539. CONCLUSIONS The predictive value of the PASS score at 72 hours after admission, NLR and CRP in combination for IPN in SAP patients is better than that of the combination of each two and individual detection and has better test efficacy.
Humans ; Pancreatitis, Acute Necrotizing/diagnosis* ; C-Reactive Protein/metabolism* ; Acute Disease ; Neutrophils/metabolism* ; Retrospective Studies ; ROC Curve ; Lymphocytes ; Prognosis

OBJECTIVE: To explore the correlation of coagulation function with the severity and prognosis of acute pancreatitis (AP) and identify the laboratory markers for early prediction and dynamic monitoring of the prognosis of AP. METHODS: We retrospectively analyzed the clinical data of patients with AP admitted less than 72 h after onset to our hospital from December 1, 2017 to November 30, 2018. The correlation of coagulation function-related markers at admission and their changes during hospitalization with the prognosis of the patients was analyzed. RESULTS: We screened the data of a total of 1260 patients with AP against the inclusion and exclusion criteria, and eventually 175 patients were enrolled in this analysis, among whom 52 patients had severe AP (SAP) and 12 patients died. Logistic regression analysis identified vWF: Ag, PT, PC, AT Ⅲ and D-dimer markers at admission as independent risk factors for predicting SAP and death. Dynamic monitoring of the changes in coagulation function-related markers in the disease course had greater predictive value of the patients' prognosis, and the indicators including vWF: Ag_max, PT_max, APTT_max, TT_max, FIB_min, D-dimer_max, PLT_min, PC_min, PLG_min, AT Ⅲ_min, and their variations were all independent risk factors for predicting SAP and death. ROC analysis suggested that dynamic monitoring of the changes in the indicators, especially those of △vWF: Ag, △PT, △APTT, △FIB, △TT, △D-dimer, △PLT, △PC, △AT Ⅲ, △PLG, could effectively predict SAP and death in these patients (with AUC range of 0.63-0.84). CONCLUSION Patients with AP have vascular endothelial injuries and coagulation disorders. The markers including vWF: Ag, PT, PC, AT Ⅲ and D-dimer at admission are independent risk factors for predicting SAP and death, and dynamic monitoring of the changes in vWF: Ag、PT、APTT、TT、FIB、D-dimer、PLT、PC、AT Ⅲ and PLG can further increase the predictive value.
Acute Disease ; Biomarkers ; Humans ; Pancreatitis/diagnosis* ; Prognosis ; ROC Curve ; Retrospective Studies ; Severity of Illness Index ; von Willebrand Factor

No abstract available.
Diagnosis ; Pancreatic Neoplasms ; Pancreatitis

OBJECTIVE: To investigate the factors related to severe acute pancreatitis (SAP) with intestine functional disturbance (IFD) and to establish the multiple predictor models of SAP with IFD. METHODS: Clinical data of consecutive SAP patients admitted to department of gastroenterology of Beijing Shijitan Hospital, Capital Medical University from January 2015 to March 2019 were retrospectively collected and analyzed. According to the occurrence of IFD at 48 hours after onset, the patients were divided into IFD group and control group. The clinical indicators within 4 hours after admission were compared between the two groups, and the independent predictive factors for SAP with IFD were screened by single factor analysis and multiple classified Logistic regression analysis. The unweighted predictive score (unwScore) and weighted predictive score (wScore) models were constructed by combining the independent predictors. The receiver operating characteristic (ROC) curves of SAP patients with IFD were plotted by independent predictive factors and predictive models, and the clinical predictive effect of each independent predictive index and predictive models were analyzed. RESULTS: A total of 149 patients with SAP were enrolled, including 87 males and 62 females, with age of (52.8±18.1) years old. There were 45 patients in IFD group and 104 patients in control group.Univariate analysis and multiple classified Logistic regression analysis showed that high sensitive C-reactive protein (hs-CRP), blood urea nitrogen (BUN), serum creatinine (SCr), serum calcium (Ca), procalcitonin (PCT) and neutrophil-lymphocyte ratio (NLR) were independent predictive factors of SAP with IFD. The ROC curve was used to calculate the cut-off value of the above indexes to predict IFD, and unwScore model was established. The cut-off score of IFD prediction by the unwScore model was 3 points, and the probability of IFD increased with the increase of the score. The area under ROC curve (AUC) of unwScore was 0.944, the sensitivity was 95.6%, the specificity was 94.2%, the positive predictive value (PPV) was 87.8%, and the negative predictive value (NPV) was 98.0%. The binary Logistic regression analysis of hs-CRP, BUN, Ca, SCr, PCT and NLR were carried out, and wScore model was established. The AUC of wScore was 0.959, the sensitivity was 95.9%, the specificity was 96.2%, the PPV was 91.5%, and the NPV was 98.1%; predictive value was superior to each independent index and unwScore model. CONCLUSIONS hs-CRP, BUN, SCr, Ca, PCT and NLR were independent predictive factors of SAP with IFD. The multiple predictor models of SAP with IFD have a good predictive efficiency which may provide valuable clinical reference for prediction and treatment.
Acute Disease ; Adult ; Aged ; Female ; Humans ; Intestines ; Male ; Middle Aged ; Pancreatitis/diagnosis* ; Prognosis ; ROC Curve ; Retrospective Studies

Type I autoimmune pancreatitis (AIP), a form of chronic pancreatitis, is included within the spectrum of immunoglobulin G4-related diseases (IgG4-RD). IgG4-RD can involve the salivary glands, bile ducts, kidneys and retroperitoneum, and the pancreas, and responds well to corticosteroid treatment. However, gastric involvement in IgG4-RD has been rarely reported. Here we report the case of a 56-year-old man with type I autoimmune pancreatitis who presented with a giant gastric ulcer mimicking advanced gastric cancer, which was subsequently determined to be IgG4-RD. Both the patient' symptoms and his ulcerative lesions in the stomach responded to steroid treatment, which obviated the need for major surgery such as gastrectomy. Our case demonstrates the importance of recognizing potential gastric involvement in IgG4-RD, especially in a patient with concurrent AIP/IgG4-RD or a history of the disease, who is evaluated for an intractable and/or atypical gastric ulcer. A prompt diagnosis and proper management will avoid unnecessary surgery.
Bile Ducts ; Diagnosis ; Gastrectomy ; Humans ; Immunoglobulins ; Kidney ; Middle Aged ; Pancreas ; Pancreatitis ; Pancreatitis, Chronic ; Salivary Glands ; Stomach Neoplasms ; Stomach Ulcer ; Stomach ; Ulcer ; Unnecessary Procedures

Obesity is associated with various comorbidities, such as type II diabetes, hypertension, dyslipidemia, and cardiovascular disease. Gastrointestinal complications are also frequent and obesity is a direct cause of nonalcoholic fatty liver disease, and are risk factors for gastroesophageal reflux disease, pancreatitis, gallstone disease, diarrhea, dyssynergic defection, and various gastrointestinal cancers. Diagnosis is usually made by measuring body mass index (BMI). Although BMI is correlated with body fat mass, it may overestimate subjects with high muscle mass and underestimate subjects with low muscle mass. Co-measurement of waist circumference as a reflection of abdominal obesity for subjects with BMIs ranging from 25 to 35 kg/m2 has been recommended; however, it is still an anthropometric diagnosis that does not clearly discriminate subjects at risk for developing comorbidities. Biomarkers reflect the underlying biological mechanisms of obesity and can be used to characterize the obesity phenotype (i.e., at high risk for disease development) as well as a target for disease-causing factors. In this article, we describe the conventional diagnosis, biomarkers of obesity, and current challenges.
Adipose Tissue ; Biomarkers ; Body Mass Index ; Cardiovascular Diseases ; Comorbidity ; Diagnosis ; Diarrhea ; Dyslipidemias ; Gallstones ; Gastroesophageal Reflux ; Gastrointestinal Diseases ; Gastrointestinal Neoplasms ; Hypertension ; Non-alcoholic Fatty Liver Disease ; Obesity ; Obesity, Abdominal ; Pancreatitis ; Phenotype ; Risk Factors ; Waist Circumference

Sex and gender medicine investigates the impact of sex and gender differences on normal conditions, pathogenesis, and clinical features of diseases. By considering sex and gender differences during diagnosis, treatment and prevention, a person can receive the best individualized treatment based on scientific evidence. In this review, sex and gender differences in the field of pancreatobiliary diseases are described regarding gallstones, acute cholecystitis, acute and chronic pancreatitis, and cancers of the pancreas and biliary tract. In addition, recent policy on clinical and preclinical research which states that sex and gender analysis should be included during planning, conducting, and interpretation of the researches and websites containing resources about sex and gender medicine are introduced. This review highlights the importance of considering sex and gender aspect in research, clinics, and medical education.
Biliary Tract ; Cholecystitis, Acute ; Diagnosis ; Education, Medical ; Gallstones ; Humans ; Pancreas ; Pancreatitis, Chronic

Congenital pancreatic cysts are rare in newborn babies, and this makes prenatal diagnosis difficult. Diagnosis can be delayed for a few months after birth until the infant presents with an abdominal mass, abdominal distension, or vomiting due to gastric outlet obstruction. Excision of the cyst is the treatment of choice. A congenital pancreatic cyst should be considered if the fetus has an abdominal cyst without a definite origin. A prompt diagnosis is crucial to prevent fatal complications such as cholangitis, pancreatitis, cyst rupture, and peritonitis. We report a case of neonate with multiple congenital pancreatic cysts suspected prenatally to be stomach diverticulum or duplication cysts of the intestine.
Cholangitis ; Diagnosis ; Diverticulum, Stomach ; Fetus ; Gastric Outlet Obstruction ; Humans ; Infant ; Infant, Newborn ; Intestines ; Pancreatic Cyst ; Pancreatic Pseudocyst ; Pancreatitis ; Parturition ; Peritonitis ; Prenatal Diagnosis ; Rupture ; Vomiting