Acute pancreatitis in acute viral hepatitis

AIM: To elucidate the frequency and characteristics of pancreatic involvement in the course of acute (nonfulminant) viral hepatitis. METHODS: We prospectively assessed the pancreatic involvement in patients with acute viral hepatitis who presented with severe abdomimanl pain. RESULTS: We studied 124 patients with acute viral hepatitis, of whom 24 presented with severe abdominal pain. Seven patients (5.65%) were diagnosed to have acute pancreatitis. All were young males. Five patients had pancreatitis in the first week and two in the fourth week after the onset of jaundice. The pancreatitis was mild and all had uneventful recovery from both pancreatitis and hepatitis on conservative treatment. The etiology of pancreatitis was hepatitis E virus in 4, hepatitis A virus in 2, and hepatitis B virus in 1 patient. One patient had biliary sludge along with HEV infection. The abdominal pain of remaining seventeen patients was attributed to stretching of Glisson's capsule. CONCLUSION: Acute pancreatitis occurs in 5.65% of patients with acute viral hepatitis, it is mild and recovers with conservative management.

Insulin and heparin in treatment of hypertriglyceridemia-induced pancreatitis

TO THE EDITOR We read with great interest the case report, “Hypertriglyceridernia -induced pancreatitis： A case-based review” by Gan eta]11 in the November 2006 issue of World Journal of Gastroenterology. We agree that in acute setting, pancreatitis due to hyper- triglyceridemia （HTG） should be ruled out as it is a treat-able and preventable condition. It needs to be treated conservatively along with measures to lower the triglyceride level. The various modalities to treat hypertriglyceridemia are plasmapheresis, insulin and heparin, purified apo C Ⅱ, and fibric acid derivatives^[2-5]. Plasmapheresis and purified apo C Ⅱ infusion are not easily available. There is limited literature about the efficacy of intravenous insulin and heparin, both of which can enhance lipoprotein lipase activity.

Barium meal follow through with pneumocolon:Screening test for chronic bowel pain

AIM： To study the sensitivity, specificity and cost effectiveness of barium meal follow through with pneumocolon （BMFTP） used as a screening modality for patients with chronic abdominal pain of luminal origin in developing countries. METHODS： Fifty patients attending the Gastroenterology Unit, SMS Hospital, whose clinical evaluation revealed chronic abdominal pain of bowel origin were included in the study. After routine testing, BMFT, BMFTP, contrast enhanced computed tomography （CECT） of the abdomen, barium enema and colonoscopy were performed. The sensitivity, specificity and cost effectiveness of these imaging modalities in the detection of small and/or large bowel lesions were compared. RESULTS： Out of fifty patients, structural pathology was found in ten. Nine out of these ten patients had small bowel involvement while seven had colonic involvement alone or in combination with small bowel involvement. The sensitivity of BMFTP was 100% compared to 88.89% with BMFT when detecting small bowel involvement （BMFTP detected one additional patient with ileocecal involvement）. The sensitivity and specificity of BMFTP for the detection of colonic pathology were 85.71% and 95.35% （41/43）, respectively. Screening a patient with chronic abdominal pain （bowel origin） using a combination of BMFT and barium enema cost significantly more than BMFTP while their sensitivity was almost comparable. CONCLUSION： BMFTP should be included in the investigative workup of patients with chronic abdominal pain of luminal origin, where either multiple sites （small and large intestine） of involvement are suspected or the site is unclear on clinical grounds. BMFTP is an economical, quick and comfortable procedure which obviates the need for colonoscopy in the majority of patients.