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Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
PCPs’ judgment, 38 patients had CP diagnosis. After reviewing
each patient data and disease characteristics, 11 resulted having a
definite diagnosis of CP according with M-ANNHEIM classification,
while 3 had a probable diagnosis, 15 a borderline diagnosis and 9
were uncertain, suggesting a prevalence of definite/probable CP
of 41/100.000. Of the 14 patients with definite/probable diagnosis
21% had a M-ANNHEIM stage 0, 15% had stage I, 50% stage II, 7%
stage III, 7% stage IV. Mean age at diagnosis was 50.2, 30% being
males; etiology was toxic-metabolic in 28%, idiopathic in 29%, post-
recurrent or severe acute pancreatitis in 36%, obstructive in 7%. All
the patients underwent radiologic imaging: 47.6% ultrasound only,
23.8% CT scan, 23.8% MRI. Mean BMI was 26.4 kg/m2, 35.7% of the
patients were reported having PEI, although fecal elastase was never
dosed, and 64% received PERT (mean dosage being 4.4 tablets per
day of 10.000 pancrelipase units). 28% of the patients had endocrine
insufficiency, 43% patients reported abdominal pain and 28% had
osteoporosis.
Conclusions:
This is the first study on the prevalence of chronic
pancreatitis in the general population. Our preliminary data suggest
that the prevalence of chronic pancreatitis is around 41/100.000, a
figure that is in line or higher to those of previous studies conducted
in specialist centres. Most cases are secondary to severe or recurrent
acute pancreatitis or toxic causes. This study is also highlighting the
lack in the investigation of PEI and frequent uncorrect prescription
of PERT (either suboptimal doses or wrong indication).
P.02.6
ACUTE PANCREATITIS IN CAMPANIA: PROPOSALS FOR A
RESOURCES SAVING REGIONAL ORGANIZATION
Sorrentini I.*
1
, Di Pietro A.G.
2
, Puglia V.
3
, Claar E.
4
, Balzano A.
5
1
Ospedale San Rocco, Sessa Aurunca, CE, Italy,
2
Regione Campania
Government, Napoli, Italy,
3
Consultant Regione Campania Government,
Napoli, Italy,
4
Ospedale Evangelico Villa Betania, Napoli, Italy,
5
AIGO
President, Napoli, Italy
Background and aim:
Acute Pancreatitis (AP) has an incidence
ranging from 13 to 45/100,000 persons and the moderate and severe
forms, representing the 15%, are characterized by larger mortality
and greater use of resources. AIGO Campania in collaboration with
experts from local health government, report data regarding AP
inferred from DRGs of the year 2013 in Campania to propose a more
efficient and cost saving regional organization in this field.
Material and methods:
DAFs (Discharge Abstract Forms) of the
year 2013 in Regione Campania were retrospectively analyzed
and the All-Patient-Refined-DRG system was applied to the DRG
204 (disease of the pancreas except malignancies). APR-DRG is
a validated program based on two sets of subclasses, severity of
illness and risk of mortality, able to correlate clinical severity to the
absorption of resources in the care process.
Results:
In Regione Campania G.I. diseases is the most frequent
cause of hospital discharge (12.7%) pooling both ordinary and day
hospital modality. AP has an incidence of 36.3 per 100.000 persons
and a mortality of 1.4%, figures comparable with data in western
world. APs were mainly hospitalized in Internal Medicine, Surgery,
or Gastroenterology Units (41%, 39% and 10.8% respectively). Seven
classes ranging from 1 (mild) to 7 (extremely severe) were identified
on the basis of APR-DRG. The moderate and severe forms (classes
from 4 to 7), represented the 12% and presented a double days in
hospital stay compared to less severe forms (17.3 vs 8.9 days). Milder
forms (classes from 1 to 3) were discharged in decreasing order from
the Units of Surgery, Internal Medicine, Gastroenterology (40.6%,
39.2%, 11.0% respectively).
Conclusions:
On the light of the APR-DRGs system only 12% of APs
could be considered moderate-severe needing a multidisciplinary
approach in specialist center equipped with sophisticated
endoscopic and radiologic technologies while milder forms require
minor supportive and cheaper measures. Actually more than 40% of
the latest were discharged by Surgery Units so that these admissions
could look improper. We suggest that Regione Campania, in order
to save resources, needs a territorial hub-spoke organization with
only few advanced Gastroenterology Units able to handle moderate
and severe APs connected in a network with a sufficient number of
territorial Gastroenterology or Medicine Units for a more efficient
management of milder AP forms.
P.02.7
FREQUENCY AND CLINICAL-INSTRUMENTAL CHARACTERIZATION
OF ACUTE PANCREATITIS FROM HYPERTRIGLYCERIDEMIA IN A
CONSECUTIVE SERIES OF 105 PATIENTS
Amodio A., Campagnola P.*, Sartori A., Bernardoni L., Breoni I.,
De Pretis N., Carestiato F., De Marchi G., Gabbrielli A., Frulloni L.
Gastroenterologia AOUI Verona Detp Medicine, Verona, Italy
Background and aim:
Hypertriglyceridemia (HyperTG) severe,
definedas levels of triglyceride (TG) in serum>1000mg/dl, it is a cause
of acute pancreatitis (AP) in 1-10% of cases, but its aetiopathogenetic
role is unknown. Moreover IperTG mild to moderate (TG 150-
999 mg/dl) seems to correlate with increased severity of the AP,
independent of the cause of disease. The causes of HyperTG are
divided into primary (genetic, eg. Deficit of lipoproteinlipase - LPL)
and secondary ones. It was recently approved by European Medicine
Agency a gene therapy for LPL deficiency. The aims of this study
are an epidemiological and clinical-instrumental characterization
of AP hypertriglyceridemia-correlated and the description of the
relationship between mild to moderate HyperTG and the severity
of AP.
Material and methods:
We reviewed the patients observed in
the period 2010-2015 with a diagnosis of first episode of PA, with
a dosage of TG within 72 hours and abdominal CT performed at
least 48-72 hours. We were collected clinical-instrumental data of
patients.
Results:
The average age of patients with AP HyperTG-correlated
was lower than in controls (40.3 ± 7.3 vs 55.1 ± 19.2 years, p = 0.002).
Patients with HyperTG have higher frequency of family history of
dyslipidemia (67% vs 21%; p = 0.009) and smoking status (73% vs 34%,
p = 0.019), with the highest number of cigarettes /day in smokers
(27.1 ± 12.2 vs 15.9 ± 10.7, p = 0.027). The AP for HyperTG was more
severe than the AP from other causes, with greater occurrence of
organ failure (50% vs 17%, p = 0.025) and need for hospitalization in
Intensive Care Unit (ICU) (50% vs. 11%, p = 0.006). Patients, regardless
of the cause of disease, are increasing severity in the three groups
of serum triglycerides (<150, 150-999, ≥1000 mg / dl) with increase
in average length of stay (18.6 ± 16.3, 22.6 ± 15, 30.7 ± 34 days, p =
0.0001), organ failure (14%, 29%, 50%, p = 0.015), ICU (8%, 23%, 50%,
p = 0.0001).
Conclusions:
The AP HyperTG-correlated is not uncommon and TG
levels correlate with the severity of the disease regardless of the
cause.
P.02.8
CAN SERUM AMYLASE AND LIPASE LEVELS BE USED AS
DIAGNOSTIC MARKERS TO DISTINGUISH BETWEEN PATIENTS
WITH MUCINOUS CYSTIC LESIONS OF THE PANCREAS, CHRONIC
PANCREATITIS AND PANCREATIC DUCTAL ADENOCARCINOMA?
Pezzilli R.*
1
, Melzi D’Eril G.
2
, Barassi A.
2
1
Sant’Orsola-Malpighi Hospital, Bologna, Italy,
2
San Paolo Hospital,
Milan, Italy