CLINICAL REVIEWSHypertriglyceridemic Pancreatitis Presentation and ManagementTsuang, Wayne MD1; Navaneethan, Udayakumar MD1; Ruiz, Luis MD2; Palascak, Joseph B. MD3; Gelrud, Andres MD, MMSc4 Author Information 1Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio, USA; 2Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Chicago Medical Center, Chicago, Illinois, USA; 3Department of Gastroenterology, Sutter Medical Group, Palo Alto Medical Foundation, Santa Cruz, California, USA; 4Division of Gastroenterology, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. published online 17 March 2009 Correspondence: Andres Gelrud, MD, MMSc, Therapeutic Endoscopy, Division of Gastroenterology, Hepatology, and Nutrition, UPMC Shadyside Medical Building, Suite 409, 5200 Centre Avenue, Pittsburgh, Pennsylvania 15232, USA. E-mail: [email protected] Received 23 June 2008; accepted 28 November 2008 American Journal of Gastroenterology 104(4):p 984-991, April 2009. Buy Abstract Hypertriglyceridemia (HTG) is reported to cause 1-4% of acute pancreatitis (AP) episodes. HTG is also implicated in more than half of gestational pancreatitis cases. Disorders of lipoprotein metabolism are conventionally divided into primary (genetic) and secondary causes, including diabetes, hypothyroidism, and obesity. Serum triglyceride (TG) levels above 1,000 mg/dl are usually considered necessary to ascribe causation for AP. The mechanism for hypertriglyceridemic pancreatitis (HTGP) is postulated to involve hydrolysis of TG by pancreatic lipase and release of free fatty acids that induce free radical damage. Multiple small studies on HTGP management have evaluated the use of insulin, heparin, or both. Many series have also reported use of apheresis to reduce TG levels. Subsequent control of HTG with dietary restrictions, antihyperlipidemic agents, and even regular apheresis has been shown anecdotally in case series to prevent future episodes of AP. However, large multicenter studies are needed to optimize future management guidelines for patients with HTGP. © The American College of Gastroenterology 2009. All Rights Reserved.