review of literature on clinical pancreatology - The Pancreapedia

diagnostic and treatment strategy can not improve without a thorough knowledge <strong>of</strong> thephysiology and patophysiology <strong>of</strong> acute pancreatitis [148].Epidemiology and demographyAn increased incidenceThe pathophysiology and treatment <strong>of</strong> acute pancreatitis has been intensely studied duringthe last century and our aim is to <strong>review</strong> recent evidence and achievements in the diagnosisand treatment as pancreatitis is a growing problem in Europe, posing significant medical,surgical and financial sequelae. The mean age <strong>of</strong> the first attack is in the 6th decade whichcan be explained by an increasing incidence <strong>of</strong> gallstone pancreatitis among white womenover the age <strong>of</strong> 60 years. The incidence <strong>of</strong> acute pancreatitis has been reported to bemarkedly increasing. The explanation <strong>of</strong> this increased incidence could be explained by theroutine testing <strong>of</strong> pancreatic enzymes in patients presenting with abdominal pain atemergency departments, and in over-diagnosis in cases <strong>of</strong> non-specific increases inenzymes due to other causes. Another explanation is an increase in the incidence <strong>of</strong>gallstone disease and obesity in the population [022].Risk factors in the USKnowledge <strong>of</strong> the number <strong>of</strong> deaths caused by risk factors is needed for health policy andpriority setting. The aim <strong>of</strong> one study was to estimate the mortality effects <strong>of</strong> the following 12modifiable dietary, lifestyle, and metabolic risk factors in the United States (US) usingconsistent and comparable methods: high blood glucose, low-density lipoprotein (LDL)cholesterol, and blood pressure; overweight-obesity; high dietary trans fatty acids and salt;low dietary polyunsaturated fatty acids, omega-3 fatty acids (seafood), and fruits andvegetables; physical inactivity; alcohol use; and tobacco smoking. It was used data on riskfactor exposures in the US population from nationally representative health surveys anddisease-specific mortality statistics from the National Center for Health Statistics. In 2005,tobacco smoking and high blood pressure were responsible for an estimated 467,000 (95 %confidence interval 436,000 to 500,000) and 395,000 (372,000 to 414,000) deaths,respectively, accounting for about one in five or six deaths in US adults. Overweight-obesity(216,000; 188,000 to 237,000) and physical inactivity (191,000; 164,000 to 222,000) wereeach responsible for nearly 1 in 10 deaths. High dietary salt (102,000; 97,000 to 107,000),low dietary omega-3 fatty acids (84,000; 72,000 to 96,000), and high dietary trans fatty acids(82,000; 63,000 to 97,000) were the dietary risks with the largest mortality effects. Although26,000 (23,000 to 40,000) deaths from ischemic heart disease, ischemic stroke, anddiabetes were averted by current alcohol use, they were outweighed by 90,000 (88,000 to94,000) deaths from other cardiovascular diseases, cancers, liver cirrhosis, pancreatitis,alcohol use disorders, road traffic and other injuries, and violence [149].GermanySeveral European studies have reported an increase in acute pancreatitis. Therefore, it wasdecided to investigate whether acute pancreatitis in one area <strong>of</strong> Germany also displayschanges in frequency, etiology, and severity over time. The study included 608 patients witha first attack <strong>of</strong> acute pancreatitis, all from Lüneburg County, northern Germany, admitted toone municipal hospital between 1987 and 2006. The age-standardized rate (world) per100,000 inhabitants/year was 16.0 for men and 10.2 for women. Division <strong>of</strong> the study periodinto four 5-year segments revealed no increase or decrease in the frequency <strong>of</strong> acutepancreatitis nor did the etiology change. The severity <strong>of</strong> disease, however, decreased overthe course <strong>of</strong> time, as shown by lower Ranson scores, a lower proportion <strong>of</strong> cases with