Keywords
acute pancreatitis, dyslipidemia, hypertriglyceridemic pancreatitis, lipoprotein lipase deficiency, clinical management
How to Cite
de Pretis, N., Amodio, A., & Frulloni, L. (2019). Hypertriglyceridemic pancreatitis: epidemiology, pathophysiology and clinical management. Herald of Pancreatic Club, 42(1), 10-17. https://doi.org/10.33149/vkp.2019.01.02
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Abstract
Hypertriglyceridemic pancreatitis (HTGP) typically occurs in patients with an underlying dyslipidemia (such as type I, IV or V dyslipidemia) and in the presence of a secondary condition, such as inadequately controlled diabetes, excess alcohol consumption or medication use. Although the symptoms of HTGP are similar to those of acute pancreatitis from other etiologies, HTGP is often associated with greater clinical severity and rate of complications. Therefore, accurate diagnosis of HTGP is essential so that patients receive the appropriate treatment. Novel therapies that aim to reduce the incidence of pancreatitis in this patient population are now available or in development. Understanding the etiology, pathophysiology and clinical characteristics of HTGP will enable future development of therapeutic agents to treat HTGP.
References
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29. Gryn S. E., Hegele R. A. Novel therapeutics in hypertriglyceridemia. Curr. Opin. Lipidol. 2015. Vol. 26. P. 484–491.
30. Gupta N., Ahmed S., Shaffer L., et al. Severe hypertriglyceridemia induced pancreatitis in pregnancy. Case Rep. Obstet. Gynecol. 2014. Vol. 2014. P. 485–493.
31. Holzl B., Iglseder B., Sandhofer A., et al. Insulin sensitivity is impaired in heterozygous carriers of lipoprotein lipase deficiency. Diabetologia. 2002. Vol. 45. P. 378–384.
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34. Lloret Linares C., Pelletier A. L., Czernichow S., et al. Acutepancreatitis in a cohort of 129 patients referred for severe hypertriglyceridemia. Pancreas. 2008. Vol. 37. P. 13–22.
35. Meyers C. D., Tremblay K., Amer A., et al. Effect of theDGAT1 inhibitor pradigastat on triglyceride and apoB48 levels in patients with familial chylomicronemia syndrome. Lipids Health Dis. 2015. Vol. 14. P. 8.
36. Murphy M. J., Sheng X., MacDonald T. M., et al. Hypertriglyceridemia and acute pancreatitis. JAMA Intern. Med. 2013. Vol. 173. P. 162–164.
37. Panta R., Dahal K., Kunwar S. Efficacy and safety ofmipomersen in treatment of dyslipidemia: a meta-analysis of randomized controlled trials. J. Clin. Lipidol. 2015. Vol. 9. P. 217–225.
38. Papachristou G. I., Machicado J. D., Stevens T., et al. Acute Pancreatitis Patient Registry to Examine Novel Therapies in Clinical Experience (APPRENTICE). An international, multicenter consortium for the study of acute pancreatitis. Ann. Gastroenterol. 2017. Vol. 30. P. 106–113.
39. Pownall H. J. Dietary ethanol is associated with reduced lipolysis of intestinally derived lipoproteins. J. Lipid Res. 1994. Vol. 35. P. 2105–2113.
40. Pownall H. J., Ballantyne C. M., Kimball K. T., et al. Effect of moderate alcohol consumption on hypertriglyceridemia: a study in the fasting state. Arch. Intern. Med. 1999. Vol. 159. P. 981–987.
41. Sandhu S., Al-Sarraf A., Taraboanta C., et al. Incidence of pancreatitis, secondary causes, and treatment of patients referred to a specialty lipid clinic with severe hypertriglyceridemia: a retrospective cohort study. Lipids Health Dis. 2011. Vol. 10. P. 157.
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44. Tsuang W., Navaneethan U., Ruiz L., et al. Hypertriglyceridemic pancreatitis: presentation and management. Am. J. Gastroenterol. 2009. Vol. 104. P. 984–991.
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47. Xu Q., Wang S., Zhang Z. A 23-year, single-center, retrospective analysis of 36 cases of acute pancreatitis in pregnancy. Int. J. Gynaecol. Obstet. 2015. Vol. 130. P. 123–126.
48. Yadav D., Lowenfels A. B. Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review. Pancreas. 2006. Vol. 33. P. 323–330.
49. Yadav D., Pitchumoni C. S. Issues in hyperlipidemic pancreatitis. J. Clin. Gastroenterol. 2003. Vol. 36. P. 54–62.
50. Zheng Y., Zhou Z., Li H., et al. A multicenter study on etiology of acute pancreatitis in Beijing during 5 years. Pancreas. 2015. Vol. 44. P. 409–414.
2. Alagozlu H., Cindoruk M., Unal S. Tamoxifen-induced severe hypertriglyceridaemia and acute pancreatitis. Clin. Drug Investig. 2006. Vol. 26. P. 297–302.
3. Anderson F., Thomson S. R., Clarke D. L., et al. Dyslipidaemic pancreatitis clinical assessment and analysis of disease severity and outcomes. Pancreatology. 2009. Vol. 9. P. 252–257.
4. Athyros V. G., Giouleme O. I., Nikolaidis N. L., et al. Long-term follow-up of patients with acute hypertriglyceridemia-induced pancreatitis. J. Clin. Gastroenterol. 2002. Vol. 34. P. 472–475.
5. Banks P. A., Bollen T. L., Dervenis C., et al. Classification ofacute pancreatitis —2012. Revision of the Atlanta classification and definitions by international consensus. Gut. 2013. Vol. 62. P. 102–111.
6. Brahm A., Hegele R. A. Hypertriglyceridemia. Nutrients. 2013. Vol. 5. P. 981–1001.
7. Burnett J. R., Hooper A. J., Hegele R. A. Familial lipoprotein lipase deficiency. GeneReviews. Seattle, WA: University of Washington, 1999 (updated 2017 June 22). URL: http://www.ncbi.nlm.nih.gov/pubmed/20301485 (last accessed: 17.10.2018)
8. Castro M. R., Nguyen T. T., O’Brien T. Clomiphene-induced severe hypertriglyceridemia and pancreatitis. Mayo Clin. Proc. 1999. Vol. 74. P. 1125–1128.
9. Cavallini G., Frulloni L., Bassi C., et al. Prospective multicentre survey on acute pancreatitis in Italy (ProInfAISP): Results on 1005 patients. Dig. Liver Dis. 2004. Vol. 36. P. 205–211.
10. Chang Y. T., Chang M. C., Su T. C., et al. Association of cystic fibrosis transmembrane conductance regulator (CFTR) mutation/variant/haplotype and tumor necrosis factor (TNF) promoter polymorphism in hyperlipidemic pancreatitis. Clin. Chem. 2008. Vol. 54. P. 131–138.
11. Chapman S. J., Woolley I. J., Visvanathan K., et al. Acute pancreatitis caused by tipranavir/ritonavir-induced hypertriglyceridaemia. AIDS. 2007. Vol. 21. P. 532–533.
12. Charlesworth A., Steger A., Crook M. A. Acute pancreatitis associated with severe hypertriglyceridaemia: a retrospective cohort study. Int. J. Surg. 2015. Vol. 23 (Pt A). P. 23–27.
13. Christian J. B., Arondekar B., Buysman E. K., et al. Determining triglyceride reductions needed for clinical impact in severe hypertriglyceridemia. Am. J. Med. 2014. Vol. 127. P. 36–44 (e31).
14. Clemens D. L, Schneider K. J., Arkfeld C. K., et al. Alcoholic pancreatitis: New insights into the pathogenesis and treatment. World J. Gastrointest. Pathophysiol. 2016. Vol. 7. P. 48–58.
15. Costantini N., Mameli A., Marongiu F. Plasmapheresis for preventing complication of hypertriglyceridemia: a case report and review of literature. Am. J. Ther. 2016. Vol. 23. P. e288–e291.
16. Cuchel M., Meagher E. A, du ToitTheron H., et al. Efficacy and safety of a microsomal triglyceride transfer protein inhibitor in patients with homozygous familial hypercholesterolaemia: a single-arm, open-label, phase 3 study. Lancet. 2013. Vol. 381. P. 40–46.
17. Domınguez-Munoz J. E, Junemann F., Malfertheiner P. Hyperlipidemia in acute pancreatitis. Cause or epiphenomenon? Int. J. Pancreatol. 1995. Vol. 18. P. 101–106.
18. Ducarme G., Maire F., Chatel P., et al. Acute pancreatitis during pregnancy: a review. J. Perinatol. 2014. Vol. 34. P. 87–94.
19. Durrington P. N, Cairns S. A. Acute-pancreatitis: a complication of beta-blockade. Br. Med. J. (Clin. Res. Ed.). 1982. Vol. 284. P. 1016.
20. Ewald N., Hardt P. D., Kloer H. U. Severe hypertriglyceridemia and pancreatitis. Presentation and management. Curr. Opin. Lipidol. 2009. Vol. 20. P. 497–504.
21. Flynn W. J., Freeman P. G., Wickboldt L. G. Pancreatitis associated with isotretinoin-induced hypertriglyceridemia. Ann. Intern. Med. 1987. Vol. 107. P. 63.
22. Forsmark C. E., Vege S. S., Wilcox C. M. Acute pancreatitis. N. Engl. J. Med. 2016. Vol. 375. P. 1972–1981.
23. Fredrickson D. S, Lees R. S. A system for phenotypinghyperlipoproteinemia. Circulation. 1965. Vol. 31. P. 321–327.
24. Gan S. I., Edwards A.L., Symonds C. J., et al. Hypertriglyceridemia-induced pancreatitis: a case-based review. World J. Gastroenterol. 2006. Vol. 12. P. 7197–7202.
25. Gaudet D, de Wal J., Tremblay K., et al. Review of theclinical development of alipogenetiparvovec gene therapy for lipoprotein lipase deficiency. Atheroscler Suppl. 2010. Vol. 11. P. 55–60.
26. Gaudet D., Brisson D., Tremblay K., et al. TargetingAPOC3 in the familial chylomicronemia syndrome. N. Engl. J. Med. 2014. Vol. 371. P. 2200–2206.
27. Gaudet D., Methot J., Dery S., et al. Efficacy and long-term safety of alipogenetiparvovec (AAV1-LPLS447X) gene therapy for lipoprotein lipase deficiency: An open label trial. Gene Ther. 2013. Vol. 20. P. 361–369.
28. Goldenberg N. M, Wang P., Glueck C. J. An observational study of severe hypertriglyceridemia, hypertriglyceridemic acute pancreatitis, and failure of triglyceride-lowering therapy when estrogens are given to women with and without familial hypertriglyceridemia. Clin. Chim. Acta. 2003. Vol. 332. P. 11–19.
29. Gryn S. E., Hegele R. A. Novel therapeutics in hypertriglyceridemia. Curr. Opin. Lipidol. 2015. Vol. 26. P. 484–491.
30. Gupta N., Ahmed S., Shaffer L., et al. Severe hypertriglyceridemia induced pancreatitis in pregnancy. Case Rep. Obstet. Gynecol. 2014. Vol. 2014. P. 485–493.
31. Holzl B., Iglseder B., Sandhofer A., et al. Insulin sensitivity is impaired in heterozygous carriers of lipoprotein lipase deficiency. Diabetologia. 2002. Vol. 45. P. 378–384.
32. Jin J., Yu Y. H., Zhong M., et al. Analyzing and identifying risk factors for acute pancreatitis with different etiologies in pregnancy. J. Matern. Fetal. Neonatal. Med. 2015. Vol. 28. P. 267–271.
33. Lindkvist B., Appelros S., Regner S., et al. A prospective cohort study on risk of acute pancreatitis related to serum triglycerides, cholesterol and fasting glucose. Pancreatology. 2012. Vol. 12. P. 317–324.
34. Lloret Linares C., Pelletier A. L., Czernichow S., et al. Acutepancreatitis in a cohort of 129 patients referred for severe hypertriglyceridemia. Pancreas. 2008. Vol. 37. P. 13–22.
35. Meyers C. D., Tremblay K., Amer A., et al. Effect of theDGAT1 inhibitor pradigastat on triglyceride and apoB48 levels in patients with familial chylomicronemia syndrome. Lipids Health Dis. 2015. Vol. 14. P. 8.
36. Murphy M. J., Sheng X., MacDonald T. M., et al. Hypertriglyceridemia and acute pancreatitis. JAMA Intern. Med. 2013. Vol. 173. P. 162–164.
37. Panta R., Dahal K., Kunwar S. Efficacy and safety ofmipomersen in treatment of dyslipidemia: a meta-analysis of randomized controlled trials. J. Clin. Lipidol. 2015. Vol. 9. P. 217–225.
38. Papachristou G. I., Machicado J. D., Stevens T., et al. Acute Pancreatitis Patient Registry to Examine Novel Therapies in Clinical Experience (APPRENTICE). An international, multicenter consortium for the study of acute pancreatitis. Ann. Gastroenterol. 2017. Vol. 30. P. 106–113.
39. Pownall H. J. Dietary ethanol is associated with reduced lipolysis of intestinally derived lipoproteins. J. Lipid Res. 1994. Vol. 35. P. 2105–2113.
40. Pownall H. J., Ballantyne C. M., Kimball K. T., et al. Effect of moderate alcohol consumption on hypertriglyceridemia: a study in the fasting state. Arch. Intern. Med. 1999. Vol. 159. P. 981–987.
41. Sandhu S., Al-Sarraf A., Taraboanta C., et al. Incidence of pancreatitis, secondary causes, and treatment of patients referred to a specialty lipid clinic with severe hypertriglyceridemia: a retrospective cohort study. Lipids Health Dis. 2011. Vol. 10. P. 157.
42. Scherer J., Singh V. P., Pitchumoni C. S., et al. Issues in hypertriglyceridemic pancreatitis: an update. J. Clin. Gastroenterol. 2014. Vol. 48. P. 195–203.
43. Taskinen M. R., Valimaki M., Nikkila E. A., et al. Sequence of alcohol-induced initial changes in plasma lipoproteins (VLDL and HDL) and lipolytic enzymes in humans. Metabolism. 1985. Vol. 34. P. 112–119.
44. Tsuang W., Navaneethan U., Ruiz L., et al. Hypertriglyceridemic pancreatitis: presentation and management. Am. J. Gastroenterol. 2009. Vol. 104. P. 984–991.
45. Valdivielso P., Ramırez-Bueno A., Ewald N. Current knowledge of hypertriglyceridemic pancreatitis. Eur. J. Intern. Med. 2014. Vol. 25. P. 689–694.
46. Waage C., Carlsson H., Nielsen E. W. Olanzapine-induced pancreatitis: a case report. JOP. 2004. Vol. 5. P. 388–391.
47. Xu Q., Wang S., Zhang Z. A 23-year, single-center, retrospective analysis of 36 cases of acute pancreatitis in pregnancy. Int. J. Gynaecol. Obstet. 2015. Vol. 130. P. 123–126.
48. Yadav D., Lowenfels A. B. Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review. Pancreas. 2006. Vol. 33. P. 323–330.
49. Yadav D., Pitchumoni C. S. Issues in hyperlipidemic pancreatitis. J. Clin. Gastroenterol. 2003. Vol. 36. P. 54–62.
50. Zheng Y., Zhou Z., Li H., et al. A multicenter study on etiology of acute pancreatitis in Beijing during 5 years. Pancreas. 2015. Vol. 44. P. 409–414.