Background: Acute pancreatitis (AP) is an inflammatory process affecting the pancreas. Hypertriglyceridemic AP (HTAP) is its third leading cause after gallstones followed by alcohol use. It develops when stars align viz. triggers (acquired surges) in patients with genetic hypertriglyceridemia. Case: severe and acute pancreatitis had developed in a 57-year-old man with type IIb familial hyperlipidemia after heavy fatty meals. The acute phase was controlled by holding oral intake with weekly Evolocumab therapy and long-term prevention by weight reduction and Fenofibrate alone. His pancreatic endocrine and exocrine functions remained normal after 2 years of follow-up. Conclusion: Those four measures were safe, practical and effective for short- and long-term management of HTAP.
References
[1]
Ortiz Morales, C.M., Girela Baena, E.L., Olalla Muñoz, J.R., Parlorio de Andrés, E. and López Corbalán, J.A. (2019) Radiology of Acute Pancreatitis Today: The Atlanta Classification and the Current Role of Imaging in Its Diagnosis and Treatment. Radiologia, 61, 453-466. https://doi.org/10.1016/j.rxeng.2019.06.005
[2]
Li, C.L., Jiang, M., Pan, C.Q., Li, J. and Xu, L.G. (2021) The Global, Regional, and National Burden of Acute Pancreatitis in 204 Countries and Territories, 1990-2019. BMC Gastroenterology, 21, Article No. 332. https://doi.org/10.1186/s12876-021-01906-2
[3]
Werge, M., Novovic, S., Schmidt, P.N. and Gluud, L.L. (2016) Infection Increases Mortality in Necrotizing Pancreatitis: A Systematic Review and Meta-Analysis. Pancreatology, 16, 698-707. https://doi.org/10.1016/j.pan.2016.07.004
[4]
Gapp, J., Tariq, A. and Chandra, S. (2023) Acute Pancreatitis. StatPearls Publishing.
[5]
Pancreas Study Group, Chinese Society of Gastroenterology, Chinese Medical Association, Editorial Board of Chinese Journal of Pancreatology and Editorial Board of Chinese Journal of Digestion (2019) Chinese Guidelines for the Management of Acute Pancreatitis (Shenyang, 2019). Journal of Clinical Hepatology, 35, 2706-2711.
[6]
Fredrickson, D.S. and Lees, R.S. (1965) A System for Phenotyping Hyperlipoproteinemia. Circulation, 31, 321-327.
[7]
Brahm, A. and Hegele, R.A. (2013) Hypertriglyceridemia. Nutrients, 5, 981-1001. https://doi.org/10.3390/nu5030981
[8]
Bays, H.E., Jones, P.H., Orringer, C.E., Brown, W.V. and Jacobson, T.A. (2016) National Lipid Association Annual Summary of Clinical Lipidology 2016. Journal of Clinical Lipidology, 10, S1-S43. https://doi.org/10.1016/j.jacl.2015.08.002
[9]
Dominguez-Muñoz, J.E., Malfertheiner, P., Ditschuneit, H.H., Blanco-Chavez, J., Uhl, W., et al. (1991) Hyperlipidemia in Acute Pancreatitis. Relationship with Etiology, Onset, and Severity of the Disease. International Journal of Pancreatology, 10, 261-267. https://doi.org/10.1007/BF02924164
[10]
Pascual, I., Sanahuja, A., García, N., Vázquez, P., Moreno, O., et al. (2019) Association of Elevated Serum Triglyceride Levels with a More Severe Course of Acute Pancreatitis: Cohort Analysis of 1457 Patients. Pancreatology, 19, 623-629. https://doi.org/10.1016/j.pan.2019.06.006
[11]
Vipperla, K., Somerville, C., Furlan, A., Koutroumpakis, E., Saul, M., Chennat, J., et al. (2017) Clinical Profile and Natural Course in a Large Cohort of Patients with Hypertriglyceridemia and Pancreatitis. Journal of Clinical Gastroenterology, 51, 77-85. https://doi.org/10.1097/MCG.0000000000000579
[12]
Preiss, D., Tikkanen, M.J., Welsh, P., Ford, I., Lovato, L.C., et al. (2012) Lipid-Modifying Therapies and Risk of Pancreatitis: A Meta-Analysis. The Journal of the American Medical Association, 308, 804-811. https://doi.org/10.1001/jama.2012.8439
[13]
Padmanabhan, A., Connelly-Smith, L., Aqui, N., Balogun, R.A., Klingel, R., Meyer, E., et al. (2019) Guidelines on the Use of Therapeutic Apheresis in Clinical Practice Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. Journal of Clinical Apheresis, 34, 171-354. https://doi.org/10.1002/jca.21705
[14]
Jain, P., Rai, R.R., Udawat, H., Nijhawan, S. and Mathur, A. (2007) Insulin and Heparin in Treatment of Hypertriglyceridemia-Induced Pancreatitis. World Journal of Gastroenterology, 13, 2642-2643.
[15]
Boyarinov, G.A., Zubeyev, P.S., Mokrov, K.V. and Voyennov, O.V. (2020) Hemofiltration in Patients with Severe Acute Pancreatitis (Review). SovremennyeTekhnologii V Medicine (Modern Technologies in Medicine), 12, 105-121. https://doi.org/10.17691/stm2020.12.1.14
[16]
Gouni-Berthold., I., Schwarz, J. and Berthold, H.K. (2023) Updates in Drug Treatment of Severe Hypertriglyceridemia. Current Atherosclerosis Report, 25, 701-709. https://doi.org/10.1007/s11883-023-01140-z
[17]
Yadav, D. and Pitchumoni, C.S. (2003) Issues in Hyperlipidemic Pancreatitis. Journal of Clinical Gastroenterology, 36, 54-62. https://doi.org/10.1097/00004836-200301000-00016
