Research progress of diagnosis and treatment in hypertriglyceridemia pancreatitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Xiaojia , ZHAO Kailiang ,  WANG Weixing

Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, P. R. China;

Corresponding author：

WANG Weixing, Email: sate.llite@163.com

Keywords：

hypertriglyceridemia pancreatitis; triglyceride level; recent advance; review

DOI：

10.7507/1007-9424.201904058

Video：

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Objective To summarize the research progress of diagnosis and treatment in hypertriglyceridemia pancreatitis in recent years.Methods Through the retrieval of relevant literatures, the progress of diagnosis and treatment in hypertriglyceridemia pancreatitis were reviewed.Results Hypertriglyceridemia pancreatitis is a rare acute pancreatitis, but with the improvement of living standard and the change of diet structure, the incidence of this disease in recent years was increasing, and more likely to lead to complications, causing serious consequences. The treatment of hypertriglyceridemia pancreatitis in addition to the routine treatment of pancreatitis, attention should also be paid to the rapid reduction of blood triglyceride levels, including plasma exchange, the use of low molecular weight heparin and insulin, and the use of lipid-lowering drugs.Conclusions Hypertriglyceridemia pancreatitis is more severe than acute pancreatitis caused by other causes, and the incidence of complications is higher. Maintaining a lower level of blood triglycerides is of great significance for the improvement of this pancreatitis and the prevention of the recurrence of pancreatitis.

Citation： YANG Xiaojia, ZHAO Kailiang, WANG Weixing. Research progress of diagnosis and treatment in hypertriglyceridemia pancreatitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(12): 1485-1489. doi: 10.7507/1007-9424.201904058 Copy

1.	Valdivielso P, Ramírez-Bueno A, Ewald N. Current knowledge of hypertriglyceridemic pancreatitis. Eur J Intern Med, 2014, 25(8): 689-694.
2.	Ewald N, Hardt PD, Kloer HU. Severe hypertriglyceridemia and pancreatitis: presentation and management. Curr Opin Lipidol, 2009, 20(6): 497-504.
3.	Papachristou GI, Machicado JD, 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, 30(1): 106-113.
4.	Scherer J, Singh VP, Pitchumoni CS, et al. Issues in hyper-triglyceridemic pancreatitis: an update. J Clin Gastroenterol, 2014, 48(3): 195-203.
5.	Kota SK, Kota SK, Jammula S, et al. Hypertriglyceridemia-induced recurrent acute pancreatitis: a case-based review. Indian J Endocrinol Metab, 2012, 16(1): 141-143.
6.	Tsuang W, Navaneethan U, Ruiz L, et al. Hypertriglyceridemic pancreatitis: presentation and management. Am J Gastroenterol, 2009, 104(4): 984-991.
7.	Adiamah A, Psaltis E, Crook M, et al. A systematic review of the epidemiology, pathophysiology and current management of hyperlipidaemic pancreatitis. Clin Nutr, 2018, 37(6 Pt A): 1810-1822.
8.	Anderson F, Thomson SR, Clarke DL, et al. Dyslipidaemic pancreatitis clinical assessment and analysis of disease severity and outcomes. Pancreatology, 2009, 9(3): 252-257.
9.	Ewald N. Hypertriglyceridemia-induced acute pancreatitis. Clin Lipidol, 2013, 8(5): 587-594.
10.	陈厚斌, 黄伟. 高脂血症急性胰腺炎临床特点回顾性分析. 中国普外基础与临床杂志, 2015, 22(7): 867-869.
11.	Guo YY, Li HX, Zhang Y, et al. Hypertriglyceridemia-induced acute pancreatitis: progress on disease mechanisms and treatment modalities. Discov Med, 2019, 27(147): 101-109.
12.	Yadav D, Pitchumoni CS. Issues in hyperlipidemic pancreatitis. J Clin Gastroenterol, 2003, 36(1): 54-62.
13.	Yadav D, Lowenfels AB. Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review. Pancreas, 2006, 33(4): 323-330.
14.	Christian JB, Arondekar B, Buysman EK, et al. Determining triglyceride reductions needed for clinical impact in severe hypertriglyceridemia. Am J Med, 2014, 127(1): 36-44.
15.	Zarnescu NO, Barbu ST, Zarnescu Vasiliu EC, et al. Management of acute pancreatitis in the early stage. Maedica (Buchar), 2015, 10(3): 257-263.
16.	Tenner S, Baillie J, DeWitt J, et al. American College of Gastro-enterology guideline: management of acute pancreatitis. Am J Gastroenterol, 2013, 108(9): 1400-1415, 1416.
17.	龚海军, 贺菊芳, 卢存存, 等. 重症急性胰腺炎预防性应用抗生素效果的 meta 分析. 中国普外基础与临床杂志, 2018, 25(10): 1218-1226.
18.	Coskun A, Erkan N, Yakan S, et al. Treatment of hyper-triglyceridemia-induced acute pancreatitis with insulin. Prz Gastroenterol, 2015, 10(1): 18-22.
19.	Hooper L, Thompson RL, Harrison RA, et al. Risks and benefits of omega 3 fats for mortality, cardiovascular disease, and cancer: systematic review. BMJ, 2006, 332(7544): 752-760.
20.	Eckel RH. Lipoprotein lipase. A multifunctional enzyme relevant to common metabolic diseases. N Engl J Med, 1989, 320(16): 1060-1068.
21.	Inayat F, Zafar F, Riaz I, et al. Hypertriglyceridemic pancreatitis: is insulin monotherapy a feasible therapeutic option? Cureus, 2018, 10(10): e3461.
22.	Mikhail N, Trivedi K, Page C, et al. Treatment of severe hypertriglyceridemia in nondiabetic patients with insulin. Am J Emerg Med, 2005, 23(3): 415-417.
23.	Twilla JD, Mancell J. Hypertriglyceridemia-induced acute pancreatitis treated with insulin and heparin. Am J Health Syst Pharm, 2012, 69(3): 213-216.
24.	Jin M, Peng JM, Zhu HD, et al. Continuous intravenous infusion of insulin and heparin vs plasma exchange in hypertriglyceridemia-induced acute pancreatitis. J Dig Dis, 2018, 19(12): 766-772.
25.	Näsström B, Olivecrona G, Olivecrona T, et al. Lipoprotein lipase during continuous heparin infusion: tissue stores become partially depleted. J Lab Clin Med, 2001, 138(3): 206-213.
26.	Watts GF, Cameron J, Henderson A, et al. Lipoprotein lipase deficiency due to long-term heparinization presenting as severe hypertriglyceridaemia in pregnancy. Postgrad Med J, 1991, 67(794): 1062-1064.
27.	Berger Z, Quera R, Poniachik J, et al. Heparin and insulin treatment of acute pancreatitis caused by hypertriglyceridemia. Experience of 5 cases. Rev Med Chil, 2001, 129(12): 1373-1378.
28.	Henzen C, Röck M, Schnieper C, et al. Heparin and insulin in the treatment of acute hypertriglyceridemia-induced pancreatitis. Schweiz Med Wochenschr, 1999, 129(35): 1242-1248.
29.	Kuchay MS, Farooqui KJ, Bano T, et al. Heparin and insulin in the management of hypertriglyceridemia-associated pancreatitis: case series and literature review. Arch Endocrinol Metab, 2017, 61(2): 198-201.
30.	Gavva C, Sarode R, Agrawal D, et al. Therapeutic plasma exchange for hypertriglyceridemia induced pancreatitis: a rapid and practical approach. Transfus Apher Sci, 2016, 54(1): 99-102.
31.	Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut, 2013, 62(1): 102-111.
32.	Ewald N, Kloer HU. Severe hypertriglyceridemia: an indication for apheresis? Atheroscler Suppl, 2009, 10(5): 49-52.
33.	Yeh JH, Chen JH, Chiu HC. Plasmapheresis for hyperlipidemic pancreatitis. J Clin Apher, 2003, 18(4): 181-185.
34.	Syed H, Bilusic M, Rhondla C, et al. Plasmapheresis in the treatment of hypertriglyceridemia-induced pancreatitis: a community hospital’s experience. J Clin Apher, 2010, 25(4): 229-234.
35.	Chait A, Brunzell JD. Chylomicronemia syndrome. Adv Intern Med, 1992, 37: 249-273.
36.	Lennertz A, Parhofer KG, Samtleben W, et al. Therapeutic plasma exchange in patients with chylomicronemia syndrome complicated by acute pancreatitis. Ther Apher, 1999, 3(3): 227-233.
37.	Piolot A, Nadler F, Cavallero E, et al. Prevention of recurrent acute pancreatitis in patients with severe hypertriglyceridemia: value of regular plasmapheresis. Pancreas, 1996, 13(1): 96-99.
38.	Rawla P, Sunkara T, Thandra KC, et al. Hypertriglyceridemia-induced pancreatitis: updated review of current treatment and preventive strategies. Clin J Gastroenterol, 2018, 11(6): 441-448.
39.	He WH, Yu M, Zhu Y, et al. Emergent triglyceride-lowering therapy with early high-volume hemofiltration against low-molecular-weight heparin combined with insulin in hypertriglyceridemic pancreatitis: a prospective randomized controlled trial. J Clin Gastroenterol, 2016, 50(9): 772-778.
40.	Miyamoto K, Horibe M, Sanui M, et al. Plasmapheresis therapy has no triglyceride-lowering effect in patients with hyper-triglyceridemic pancreatitis. Intensive Care Med, 2017, 43(6): 949-951.
41.	Bosscha K, Hulstaert PF, Hennipman A, et al. Fulminant acute pancreatitis and infected necrosis: results of open management of the abdomen and " planned” reoperations. J Am Coll Surg, 1998, 187(3): 255-262.
42.	Kris-Etherton PM, Pearson TA, Wan Y, et al. High-monounsaturated fatty acid diets lower both plasma cholesterol and triacylglycerol concentrations. Am J Clin Nutr, 1999, 70(6): 1009-1015.
43.	Song X, Shi D, Cui Q, et al. Intensive insulin therapy versus plasmapheresis in the management of hypertriglyceridemia-induced acute pancreatitis (Bi-TPAI trial): study protocol for a randomized controlled trial. Trials, 2019, 20(1): 365.
44.	Biberci Keskin E, Koçhan K, Köker İH, et al. The role of plasma exchange in hypertriglyceridemia-induced acute pancreatitis. Eur J Gastroenterol Hepatol, 2019, 31(6): 674-677.
45.	Huang SP, Toh DE, Sue YM, et al. Double filtration plasmapheresis in treatment of acute pancreatitis associated with severe hypertriglyceridemia: three case reports. Medicine (Baltimore), 2018, 97(44): e12987.
46.	Michalova R, Mankova A, Vnucak M, et al. Therapeutic plasma exchange in secondary prevention of acute pancreatitis in pregnant patient with familial hyperchylomicronemia. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2019, 163(1): 90-94.
47.	Kandemir A, Coşkun A, Yavaşoğlu İ, et al. Therapeutic plasma exchange for hypertriglyceridemia induced acut pancreatitis: the 33 cases experience from a tertiary reference center in Turkey. Turk J Gastroenterol, 2018, 29(6): 676-683.

1. Valdivielso P, Ramírez-Bueno A, Ewald N. Current knowledge of hypertriglyceridemic pancreatitis. Eur J Intern Med, 2014, 25(8): 689-694.
2. Ewald N, Hardt PD, Kloer HU. Severe hypertriglyceridemia and pancreatitis: presentation and management. Curr Opin Lipidol, 2009, 20(6): 497-504.
3. Papachristou GI, Machicado JD, 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, 30(1): 106-113.
4. Scherer J, Singh VP, Pitchumoni CS, et al. Issues in hyper-triglyceridemic pancreatitis: an update. J Clin Gastroenterol, 2014, 48(3): 195-203.
5. Kota SK, Kota SK, Jammula S, et al. Hypertriglyceridemia-induced recurrent acute pancreatitis: a case-based review. Indian J Endocrinol Metab, 2012, 16(1): 141-143.
6. Tsuang W, Navaneethan U, Ruiz L, et al. Hypertriglyceridemic pancreatitis: presentation and management. Am J Gastroenterol, 2009, 104(4): 984-991.
7. Adiamah A, Psaltis E, Crook M, et al. A systematic review of the epidemiology, pathophysiology and current management of hyperlipidaemic pancreatitis. Clin Nutr, 2018, 37(6 Pt A): 1810-1822.
8. Anderson F, Thomson SR, Clarke DL, et al. Dyslipidaemic pancreatitis clinical assessment and analysis of disease severity and outcomes. Pancreatology, 2009, 9(3): 252-257.
9. Ewald N. Hypertriglyceridemia-induced acute pancreatitis. Clin Lipidol, 2013, 8(5): 587-594.
10. 陈厚斌, 黄伟. 高脂血症急性胰腺炎临床特点回顾性分析. 中国普外基础与临床杂志, 2015, 22(7): 867-869.
11. Guo YY, Li HX, Zhang Y, et al. Hypertriglyceridemia-induced acute pancreatitis: progress on disease mechanisms and treatment modalities. Discov Med, 2019, 27(147): 101-109.
12. Yadav D, Pitchumoni CS. Issues in hyperlipidemic pancreatitis. J Clin Gastroenterol, 2003, 36(1): 54-62.
13. Yadav D, Lowenfels AB. Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review. Pancreas, 2006, 33(4): 323-330.
14. Christian JB, Arondekar B, Buysman EK, et al. Determining triglyceride reductions needed for clinical impact in severe hypertriglyceridemia. Am J Med, 2014, 127(1): 36-44.
15. Zarnescu NO, Barbu ST, Zarnescu Vasiliu EC, et al. Management of acute pancreatitis in the early stage. Maedica (Buchar), 2015, 10(3): 257-263.
16. Tenner S, Baillie J, DeWitt J, et al. American College of Gastro-enterology guideline: management of acute pancreatitis. Am J Gastroenterol, 2013, 108(9): 1400-1415, 1416.
17. 龚海军, 贺菊芳, 卢存存, 等. 重症急性胰腺炎预防性应用抗生素效果的 meta 分析. 中国普外基础与临床杂志, 2018, 25(10): 1218-1226.
18. Coskun A, Erkan N, Yakan S, et al. Treatment of hyper-triglyceridemia-induced acute pancreatitis with insulin. Prz Gastroenterol, 2015, 10(1): 18-22.
19. Hooper L, Thompson RL, Harrison RA, et al. Risks and benefits of omega 3 fats for mortality, cardiovascular disease, and cancer: systematic review. BMJ, 2006, 332(7544): 752-760.
20. Eckel RH. Lipoprotein lipase. A multifunctional enzyme relevant to common metabolic diseases. N Engl J Med, 1989, 320(16): 1060-1068.
21. Inayat F, Zafar F, Riaz I, et al. Hypertriglyceridemic pancreatitis: is insulin monotherapy a feasible therapeutic option? Cureus, 2018, 10(10): e3461.
22. Mikhail N, Trivedi K, Page C, et al. Treatment of severe hypertriglyceridemia in nondiabetic patients with insulin. Am J Emerg Med, 2005, 23(3): 415-417.
23. Twilla JD, Mancell J. Hypertriglyceridemia-induced acute pancreatitis treated with insulin and heparin. Am J Health Syst Pharm, 2012, 69(3): 213-216.
24. Jin M, Peng JM, Zhu HD, et al. Continuous intravenous infusion of insulin and heparin vs plasma exchange in hypertriglyceridemia-induced acute pancreatitis. J Dig Dis, 2018, 19(12): 766-772.
25. Näsström B, Olivecrona G, Olivecrona T, et al. Lipoprotein lipase during continuous heparin infusion: tissue stores become partially depleted. J Lab Clin Med, 2001, 138(3): 206-213.
26. Watts GF, Cameron J, Henderson A, et al. Lipoprotein lipase deficiency due to long-term heparinization presenting as severe hypertriglyceridaemia in pregnancy. Postgrad Med J, 1991, 67(794): 1062-1064.
27. Berger Z, Quera R, Poniachik J, et al. Heparin and insulin treatment of acute pancreatitis caused by hypertriglyceridemia. Experience of 5 cases. Rev Med Chil, 2001, 129(12): 1373-1378.
28. Henzen C, Röck M, Schnieper C, et al. Heparin and insulin in the treatment of acute hypertriglyceridemia-induced pancreatitis. Schweiz Med Wochenschr, 1999, 129(35): 1242-1248.
29. Kuchay MS, Farooqui KJ, Bano T, et al. Heparin and insulin in the management of hypertriglyceridemia-associated pancreatitis: case series and literature review. Arch Endocrinol Metab, 2017, 61(2): 198-201.
30. Gavva C, Sarode R, Agrawal D, et al. Therapeutic plasma exchange for hypertriglyceridemia induced pancreatitis: a rapid and practical approach. Transfus Apher Sci, 2016, 54(1): 99-102.
31. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut, 2013, 62(1): 102-111.
32. Ewald N, Kloer HU. Severe hypertriglyceridemia: an indication for apheresis? Atheroscler Suppl, 2009, 10(5): 49-52.
33. Yeh JH, Chen JH, Chiu HC. Plasmapheresis for hyperlipidemic pancreatitis. J Clin Apher, 2003, 18(4): 181-185.
34. Syed H, Bilusic M, Rhondla C, et al. Plasmapheresis in the treatment of hypertriglyceridemia-induced pancreatitis: a community hospital’s experience. J Clin Apher, 2010, 25(4): 229-234.
35. Chait A, Brunzell JD. Chylomicronemia syndrome. Adv Intern Med, 1992, 37: 249-273.
36. Lennertz A, Parhofer KG, Samtleben W, et al. Therapeutic plasma exchange in patients with chylomicronemia syndrome complicated by acute pancreatitis. Ther Apher, 1999, 3(3): 227-233.
37. Piolot A, Nadler F, Cavallero E, et al. Prevention of recurrent acute pancreatitis in patients with severe hypertriglyceridemia: value of regular plasmapheresis. Pancreas, 1996, 13(1): 96-99.
38. Rawla P, Sunkara T, Thandra KC, et al. Hypertriglyceridemia-induced pancreatitis: updated review of current treatment and preventive strategies. Clin J Gastroenterol, 2018, 11(6): 441-448.
39. He WH, Yu M, Zhu Y, et al. Emergent triglyceride-lowering therapy with early high-volume hemofiltration against low-molecular-weight heparin combined with insulin in hypertriglyceridemic pancreatitis: a prospective randomized controlled trial. J Clin Gastroenterol, 2016, 50(9): 772-778.
40. Miyamoto K, Horibe M, Sanui M, et al. Plasmapheresis therapy has no triglyceride-lowering effect in patients with hyper-triglyceridemic pancreatitis. Intensive Care Med, 2017, 43(6): 949-951.
41. Bosscha K, Hulstaert PF, Hennipman A, et al. Fulminant acute pancreatitis and infected necrosis: results of open management of the abdomen and " planned” reoperations. J Am Coll Surg, 1998, 187(3): 255-262.
42. Kris-Etherton PM, Pearson TA, Wan Y, et al. High-monounsaturated fatty acid diets lower both plasma cholesterol and triacylglycerol concentrations. Am J Clin Nutr, 1999, 70(6): 1009-1015.
43. Song X, Shi D, Cui Q, et al. Intensive insulin therapy versus plasmapheresis in the management of hypertriglyceridemia-induced acute pancreatitis (Bi-TPAI trial): study protocol for a randomized controlled trial. Trials, 2019, 20(1): 365.
44. Biberci Keskin E, Koçhan K, Köker İH, et al. The role of plasma exchange in hypertriglyceridemia-induced acute pancreatitis. Eur J Gastroenterol Hepatol, 2019, 31(6): 674-677.
45. Huang SP, Toh DE, Sue YM, et al. Double filtration plasmapheresis in treatment of acute pancreatitis associated with severe hypertriglyceridemia: three case reports. Medicine (Baltimore), 2018, 97(44): e12987.
46. Michalova R, Mankova A, Vnucak M, et al. Therapeutic plasma exchange in secondary prevention of acute pancreatitis in pregnant patient with familial hyperchylomicronemia. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2019, 163(1): 90-94.
47. Kandemir A, Coşkun A, Yavaşoğlu İ, et al. Therapeutic plasma exchange for hypertriglyceridemia induced acut pancreatitis: the 33 cases experience from a tertiary reference center in Turkey. Turk J Gastroenterol, 2018, 29(6): 676-683.

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Research progress of diagnosis and treatment in hypertriglyceridemia pancreatitis

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