Does obesity confer an increased risk and/or more severe course of post-ERCP pancreatitis?: a retrospective, multicenter study.

BACKGROUND: Pancreatitis is the most common major complication of endoscopic retrograde cholangiopancreatography (ERCP). Recent studies have suggested that obesity may serve as a prognostic indicator of poor outcome in non-ERCP-induced acute pancreatitis. However, to our knowledge, no one has ever investigated the potential association of obesity and ERCP-induced pancreatitis. Thus, the purpose of our study was to determine whether obesity conferred an increased risk and/or more severe course of post-ERCP pancreatitis. METHODS: A 160 variable database was prospectively collected by a defined protocol on patients undergoing diagnostic or therapeutic ERCP at 15 centers in the Midwest Pancreaticobiliary Group and participating in a randomized controlled study, evaluating whether prophylactic corticosteroids reduces the incidence of post-ERCP pancreatitis. Body mass indices (BMIs) were available on 964 of the 1115 patients from the original study. A BMI > or = 30 kg/m2 was defined as obese (World Health Organization) and used as a cutoff point in this study. BMIs were analyzed in a retrospective fashion to determine whether obesity confers an increased risk and/or more severe course of post-ERCP pancreatitis. Data were collected before the ERCP, at the time of procedure, and 24 to 72 hours after discharge. Standardized criteria were used to diagnose and grade the severity of postprocedure pancreatitis. RESULTS: Nine hundred sixty four patients were enrolled in the study. Pancreatitis occurred in 149 patients (15.5%) and was graded as mild in 101 (67.8%), moderate in 42 (28.2%), and severe in 6 (4.0%). The patients were categorized by BMI (kg/m2) using the following breakdowns: BMI < 20, 20 to < 25, 25 to < 30, and > or = 30, as well as BMI < 30 or > or = 30. The groups were similar with respect to the patient and procedure risk factors for post-ERCP pancreatitis except the group with BMI > or = 30 had a higher frequency of females, were younger, had less frequent chronic pancreatitis, a lower number of pancreatic duct injections, and fewer patients received more than 2 pancreatic duct injections. Of the patients with a BMI < 30, 119 (16.4%) developed post-ERCP pancreatitis compared with 30 (12.5%) of those with a BMI > or = 30 (P=0.14). There was no association between the presence of obesity and the severity of pancreatitis (P=0.74). Patients with a BMI < 20, 20 to < 25, 25 to < 30, and > or = 30 had a similar incidence of post-ERCP pancreatitis. CONCLUSIONS: Obesity did not seem to confer an increased risk for ERCP-induced pancreatitis. A statistically significant association between obesity and the severity of ERCP-induced pancreatitis was not apparent.

[Motor and endocrine function disturbances of the gastrointestinal tract in patients with chronic renal failure (CRF)]. / Zaburzenia czynnosci motorycznej oraz endokrynnej przewodu pokarmowego u chorych z przewlekla niewydolnoscia nerek (PNN).

In the chronic renal failure (CRF) there are several upper gastrointestinal symptoms, which result from both disturbed motor function (associated with the delayed gastric emptying) and myoelectrical one (associated with abnormal electrogastrography registration). In patients suffering from CRF, disturbances of the endocrine digestive system function were also demonstrated, which are related to the observations of many gastrointestinal hormones increased levels.

[Gastroesophageal reflux disease and its' influence on nutritional status in patients treated with peritoneal dialysis]. / Choroba refluksowa przelyku (GERD) a stan odzywienia chorych leczonych dializa otrzewnowa.

AIM: The aim of our study was to estimate the correlation between GERD symptoms and nutritional status of (PD) patients. METHODS: 52 patients (32 m, 20 f; age 30-86, mean 61.6+/-14.3) treated with continuous ambulatory PD were reviewed using standarized GERD symptoms questionnaire. The frequency, duration, intensity and day/night prevalence of typical GERD sypmtoms were estimated and calculated as symptom score index (0-80). Than to evaluate the nutritional status, normalized protein catabolic rate (nPCR) was calculated. Correlation was calculated with r - Pearson's correlation coefficient. Additionally the correlation between GERD symptom score index and following parameters was evaluated: the time from the diagnosis of chronic renal failure, the time from the onset of CAPD, weekly clearance of endogenous creatinine and Kt/V value. RESULTS: 43 patients had symptoms of GERD. The symptom score index was between 4 and 50 (mean 11.3+/-10.7). Symptoms were present also in patients with ongoing H2-blockers (18 pts) and PPI therapy (2 pts). Mean value of nPCR for the study group was 0.99+/-0.26. Evident negative correlation was observed between these two values (R = -0.28; p = 0.04). Kt/V index was 2.28+/-0.57 and weekly KEK was 89.26+/-23.37. Both parameters showed only very weak correlation with GERD index (respectively: R = -0.16; p = 0.25 and R = -0.142; p = 0.31). There was no correlation between symptom score index and albumin nor transferine level. Interestingly, there was positive correlation observed between GERD symptom score and the time from onset of CAPD (R = 0.229; p = 0.10) and no correlation with the time from the first diagnosis of chronic renal failure. CONCLUSIONS: Gastro-esophageal reflux disease symptoms adversely affect nutritional status, estimated via nPCR value in chronic renal failure patients, treated with peritoneal dialysis. Moreover, as all the patients had weekly clearance of endogenous creatinine within normal range or even above, we can conclude that the occurrence of GERD symptoms in CAPD patients is not related to the adequacy of dialysis but rather to other factors as the presence of fluid in peritoneal cavity. Even more probable is that other mechanisms (autonomic dysfunction or hormonal imbalance) contribute, as the GERD symptom score index correlates with the time past from the CAPD onset.

Does prophylactic administration of corticosteroid reduce the risk and severity of post-ERCP pancreatitis: a randomized, prospective, multicenter study.

BACKGROUND: Pancreatitis is the most common major complication of diagnostic and therapeutic ERCP. There have been continuing efforts to identify a pharmacologic agent capable of reducing the frequency and severity of this complication. On the basis of several case reports, experimental data, and knowledge of their mechanism of action, corticosteroids might be effective in this regard. The aim of this randomized, double-blind, controlled trial was to determine whether prophylactic, orally administered corticosteroid reduces the frequency and/or severity of post-ERCP pancreatitis. METHODS: A total of 1115 patients were randomized to receive either prednisone (40 mg) or a placebo orally 15 hours and 3 hours before ERCP. A 160 variable database was prospectively collected according to a defined protocol on patients undergoing diagnostic or therapeutic ERCP at 15 centers in the Midwest Pancreaticobiliary Group. Standardized criteria were used to diagnose and grade the severity of postprocedure pancreatitis. RESULTS: The overall frequency of pancreatitis was 15.07%. It occurred in 92 of 555 patients in the corticosteroid group (16.6%), and in 76 of 560 patients in the control group (13.6%; p = 0.19). The pancreatitis was mild in 10.04%, moderate in 4.04%, and severe in 0.99%. There was no difference between the groups with regard to the severity of pancreatitis. Moreover, the groups were similar with regard to age, gender, body mass index, frequency of prior pancreatitis, type of procedure performed (diagnostic or therapeutic), difficulty of cannulation, frequency of pre-cut sphincterotomy, pancreatic sphincterotomy, sphincter of Oddi dysfunction, sphincter of Oddi manometry, pancreatic acinarization, chronic pancreatitis, number of pancreatic duct injections, and bile duct diameter. CONCLUSION: Prophylactic orally administered corticosteroid did not reduce the frequency or severity of post-ERCP pancreatitis.

The effect of transcutaneous nerve stimulation on intraductal biliary pressure in post-cholecystectomy patients with T-drainage.

OBJECTIVE: To evaluate the effects of transcutaneous electrical nerve stimulation (TENS) on intraductal biliary pressure (IDP) in basal conditions and after intravenous morphine and oral meal stimulation. DESIGN AND METHODS: Fifteen patients (5 male, 10 female) aged 31-83 years (mean 61.5 +/- 13.7 years) with prior cholecystectomy and residual in situ T-tube were examined. Final radiographs excluded any organic abnormalities. The study consisted of three sessions. On the first day (session 1), after the initial manometric intraductal pressure was measured for 15 min, TENS (using a PRO-TENS pocket stimulator) was applied for 15 min. Measurement was continued for 15 min after termination of TENS. The measurement was performed using a water-perfused manometry system (Synectics Medical, Stockholm, Sweden) by a triple-channel manometric catheter inserted into the common bile duct through a T-drain. On the following day (session 2), the protocol was similar except that, after basal IDP measurement, morphine hydrochloride 0.08 mg/kg was injected intravenously 10 min before TENS. On the third day (session 3), after basal measurements were taken, patients were given a standard test meal and the IDP was recorded continuously for 45 min. To estimate the effects of the stimuli applied, absolute intraductal pressure changes were analysed. RESULTS: In session 1, TENS reduced basal IDP in all patients by a mean of 3.95 +/- 1.6 mmHg. In 13 patients, 15 min after cessation of TENS a further decrease in IDP was observed. In two patients, termination of TENS was followed by a rebound increase in IDP; however, it did not reach the initial value (mean total decrease 5.05 +/- 2.25 mmHg). In session 2, administration of morphine produced an evident increase in IDP in all subjects by 6.9 +/- 2.7 mmHg. TENS decreased IDP in 13 patients. In two patients, TENS initially failed to lower elevated pressure, but it appeared several minutes after the end of stimulation. In 13 patients, the final IDP values were lower than the baseline pressures. In session 3, after administration of a test meal, IDP decreased within 30-40 min by a mean of 4.89 +/- 1.29 mmHg. CONCLUSIONS: TENS decreased basal as well as elevated IDP in the majority of the T-drain patients studied. The effect of TENS persisted after its termination. Elevated IDP is believed to be responsible for pain in patients with sphincter of Oddi dysfunction (SOD). Therefore, we think that TENS can be used effectively and safely as an optional therapeutic method in the treatment of biliary dyskinesia.