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Hypertriglyceridemia-induced pancreatitis: updated review of current treatment and preventive strategies

Abstract

Hypertriglyceridemia (HTG) is an uncommon but well-established cause of acute pancreatitis (AP) comprising up to 7% of the cases. The clinical course of HTG-induced pancreatitis (HTGP) is highly similar to that of AP of other etiologies with HTG being the only distinguishing clinical feature. However, HTGP is often correlated with higher severity and elevated complication rate. At present, no approved treatment guideline for the management of HTGP is available, although different treatment modalities such as insulin, heparin, fibric acids, and omega 3 fatty acids have been successfully implemented to reduce serum triglycerides (TG). Plasmapheresis has also been used to counteract elevated TG levels in HTGP patients. However, it has been associated with complications. Following the management of acute phase, lifestyle modifications including dietary adjustments and drug therapy are essential in the long-term management of HTGP and the prevention of its relapse. Results from studies of small patient groups describing treatment and prevention of HTGP are not sufficient to draw solid conclusions resulting in no treatment algorithm being available for effective management of HTGP. Therefore, prospective randomized, active-controlled clinical studies are required to find a better treatment regimen for the management of HTGP. Until date, one randomized clinical trial has been performed to compare clinical outcomes of different treatment approaches for HTGP. However, further studies are required to outline a generalized and efficient treatment regimen for the management of HTGP.

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Author information

Conception and design: PR, M.D; TS, M.D. Analysis and interpretation: PR, M.D; TS, M.D; KCT, M.D, VG, M.D. Drafting of the article: PR, M.D; TS, M.D; KCT, M.D, VG, M.D. Critical revision of the article: PR, M.D; TS, M.D; KCT, M.D, VG, M.D. Final approval of the article: PR, M.D; TS, M.D; KCT, M.D, VG, M.D.

Correspondence to Prashanth Rawla.

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Prashanth Rawla, Tagore Sunkara, Krishna Chaitanya Thandra, and Vinaya Gaduputi declare that they have no conflict of interest.

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Rawla, P., Sunkara, T., Thandra, K.C. et al. Hypertriglyceridemia-induced pancreatitis: updated review of current treatment and preventive strategies. Clin J Gastroenterol 11, 441–448 (2018) doi:10.1007/s12328-018-0881-1

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Keywords

  • Hypertriglyceridemia
  • Acute pancreatitis
  • Insulin
  • Heparin
  • Plasmapheresis
  • Recurrent pancreatitis