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Acute-on-chronic pancreatitis less severe with presence of fibrosis
Fibrosis was associated with less severe acute attacks among patients with chronic pancreatitis in a recent study.
Researchers evaluated records and pancreatic histology samples of 23 patients with acute pancreatitis (AP), 35 with chronic pancreatitis (CP) and 15 with both (AP-on-CP). Data collection from the University of Pittsburgh Medical Center/Presbyterian Hospital Autopsy Database occurred between 1998 and 2008. Fat necrosis (FN), peri-fat acinar necrosis (PFAN) fibrotic area and intrapancreatic fat (IPF) were compared between samples from these patients and from 50 random controls.
IPF was correlated with BMI among patients with AP (r=0.506; P=.014) and AP-on-CP (r=0.729; P=.002), plus controls (r=0.592; P<.001), but not among those with CP (r=0.168; P=.334). Significantly more IPF was observed among nonobese patients with CP than nonobese controls.
FN was significantly more prominent among patients with AP than controls or CP patients (P<.001 for both comparisons). PFAN also was significantly greater in patients with AP (P<.001 vs. CP or controls, and P=.025 vs. AP-on-CP), as was total necrosis (P<.001 for all groups).
IPF was surrounded by significantly more fibrosis among patients with CP or AP-on-CP than among controls or those with AP. Those with CP or AP-on-CP also had significantly less PFAN and total necrosis. Investigators said fibrosis appeared to wall off the IPF from FN and limit the presence of PFAN. In vitro analysis replicating AP pathophysiology indicated that collagen I, prominent in CP among humans, limited lipolytic flux between adipocytes and acinar cells, resulting in the protective effect of fibrosis against AP-on-CP severity.
Vijay P. Singh
“Intrapancreatic of chronic pancreatitis is different from that of obesity since it is walled off by fibrosis,” researcher Vijay P. Singh, MD, assistant professor in the gastroenterology, hepatology and nutrition division at the University of Pittsburgh School of Medicine, told Healio.com. “This fibrosis acts as a barrier between fat and the parenchyma, reducing the fat mediated damage during pancreatitis. Therefore, fibrosis is protective in acute-on-chronic pancreatitis, and in the absence of this fibrosis, obese patients have worse attacks of AP.”
Disclosure: The researchers report no relevant financial disclosures.