Hypertriglyceridemia-induced pancreatitis: updated review of current treatment and preventive strategies
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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.
KeywordsHypertriglyceridemia Acute pancreatitis Insulin Heparin Plasmapheresis Recurrent pancreatitis
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.
No funding to disclose.
Compliance with ethical standards
Conflict of interest
Prashanth Rawla, Tagore Sunkara, Krishna Chaitanya Thandra, and Vinaya Gaduputi declare that they have no conflict of interest.
This study does not include any data about human subjects.
This study does not involve human subjects and does not apply to giving Informed Consent.
- 14.Lebenson J, Oliver T. Hypertriglyceride induced acute pancreatitis. Prof. Luis Rodrigo (Ed.), ISBN: 978-953-307-984-4, InTech, Available from: http://www.intechopen.com/books/acute-pancreatitis/hypertriglyceride-induced-acute-pancreatitis. 2012. Accessed 3 Apr 2018.
- 17.Coskun A, Erkan N, Yakan S, et al. Treatment of hypertriglyceridemia-induced acute pancreatitis with insulin. Przeglad Gastroenterol. 2015;10:18–22.Google Scholar
- 18.Toskes PP. Hyperlipidemic pancreatitis. Gastroenterol Clin N Am. 1990;19:783–91.Google Scholar
- 22.Afari ME, Shafqat H, Shafi M, et al. Hypertriglyceridemia-induced pancreatitis: a decade of experience in a community-based teaching hospital. Rhode Island Med J. 2015;98:40–3.Google Scholar
- 29.Gray E, Hogwood J, Mulloy B. The anticoagulant and antithrombotic mechanisms of heparin. Handb Exp Pharmacol 2012:43–61.Google Scholar
- 30.Maccia M. Mechanism for Heparin’s ability to lower TGs in hypertriglyceridemia. 2015. https://www.ebmconsult.com/articles/heparin-mechanism-reduce-triglycerides-hypertriglyceridemia-treatment. Accessed on 02 April 2018.
- 38.Gavva C, Sarode R, Agrawal D, et al. Therapeutic plasma exchange for hypertriglyceridemia induced pancreatitis: a rapid and practical approach. Transfus Apheresis Sci Off J World Apheresis Assoc Off J Eur Soc Haemapheresis. 2016;54:99–102.Google Scholar
- 42.Chait A, Brunzell JD. Chylomicronemia syndrome. Adv Int Med. 1992;37:249–73.Google Scholar
- 45.He WH, Yu M, Zhu Y, et al. Emergent triglyceride-lowering therapy with early high-volume hemofiltration against low-molecular-weight heparin combined with insulin in hypertriglyceridemic pancreatitis: a prospective randomized controlled trial. J Clin Gastroenterol. 2016;50:772–8.CrossRefGoogle Scholar
- 56.Nasa P, Alexander G, Kulkarni A, et al. Early plasmapheresis in patients with severe hypertriglyceridemia induced acute pancreatitis. Indian J Crit Care Med Peer Rev Off Publ Indian Soc Crit Care Med. 2015;19:487–9.Google Scholar
- 60.Expert Panel on Detection E, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP). Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA 2001;285:2486–97.CrossRefGoogle Scholar