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Issues in Hypertriglyceridemic Pancreatitis: An Update

Scherer, John MD*; Singh, Vijay P. MD*; Pitchumoni, C.S. MD; Yadav, Dhiraj MD, MPH*

Journal of Clinical Gastroenterology: March 2014 - Volume 48 - Issue 3 - p 195–203
doi: 10.1097/01.mcg.0000436438.60145.5a
Clinical Review

Hypertriglyceridemia (HTG) is a well-established but underestimated cause of acute pancreatitis and recurrent acute pancreatitis. The clinical presentation of HTG-induced pancreatitis (HTG pancreatitis) is similar to other causes. Pancreatitis secondary to HTG is typically seen in the presence of one or more secondary factors (uncontrolled diabetes, alcoholism, medications, pregnancy) in a patient with an underlying common genetic abnormality of lipoprotein metabolism (familial combined hyperlipidemia or familial HTG). Less commonly, a patient with rare genetic abnormality (familial chylomicronemic syndrome) with or without an additional secondary factor is encountered. The risk of acute pancreatitis in patients with serum triglycerides >1000 and >2000 mg/dL is ∼5% and 10% to 20%, respectively. It is not clear whether HTG pancreatitis is more severe than when it is due to other causes. Clinical management of HTG pancreatitis is similar to that of other causes. Insulin infusion in diabetic patients with HTG can rapidly reduce triglyceride (TG) levels. Use of apheresis is still experimental and better designed studies are needed to clarify its role in the management of HTG pancreatitis. Diet, lifestyle changes, and control of secondary factors are key to the treatment, and medications are useful adjuncts to the long-term management of TG levels. Control of TG levels to 500 mg/dL or less can effectively prevent recurrences of pancreatitis.

*Department of Medicine, Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA

Division of Gastroenterology, St. Peters University Hospital, New Brunswick, NJ

Supported in part by NIH—RO1DK 077906 (D.Y.), Department of Army (DOA—PR110417) (V.P.S.), and NIH—R01DK 092460 (V.P.S.).

The authors declare that they have nothing to disclose.

Reprints: Dhiraj Yadav, MD, MPH, Department of Medicine, Division of Gastroenterology & Hepatology, University of Pittsburgh Medical Center, 200 Lothrop Street, M2, C-wing, Pittsburgh, PA 15213 (e-mail: yadavd@upmc.edu).

© 2014 by Lippincott Williams & Wilkins