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Introduction

The bidirectional interplay of the brain-gut axis alongside manifestations of anxiety and depression has already been demonstrated. Despite this fact, routine mental health assessments and interventions are not well-established in the treatment of acute (AP) and chronic pancreatitis (CP), potentially worsening clinical outcomes. Our objective is to achieve a comprehensive understanding of the mind-body connection within the context of pancreatitis by assessing the prevalence of depression and anxiety in patients with AP and CP.

Aims & Methods

Our protocol was registered on PROSPERO (CRD42023481739). We conducted a systematic search on 10 November 2023 in three databases (MEDLINE, Embase, and CENTRAL) to identify studies reporting the occurrence of depressive and anxiety-related symptoms in pancreatitis. The pooled proportion rate with 95% confidence intervals (CI) was calculated using a random-effects model.

Results

The prevalence of depressive symptoms was 16% in AP (CI 0.06; 0.39), while it was 34% in CP (CI 0.27; 0.43). The prevalence of anxiety symptoms in AP and CP was 15% (CI 0.07; 0.32) and 35% (CI 0.26; 0.45), respectively.

Conclusion

Anxiety and depression are significantly more frequently observed among individuals with pancreatitis compared to the general population. These conditions occur twice as often in CP compared to AP. Thus, we underscore the significance of psychological interventions in this patient population.

INVESTIGATING THE PREVALENCE OF ANXIETY AND DEPRESSION IN PATIENTS WITH PANCREATITIS

Tibor Feher 1, Mahmoud Obediat 2, Ádám Zolcsák 1, Renáta Papp 1, Brigitta Teutsch 3, Marie Anne Engh 2, Réka Csaba 2, Lilla Réthy 2, Peter Hegyi 3, Rita Nagy 4

1 Semmelweis University, Budapest, Hungary|||Semmelweis University, Budapest, Hungary

2 Semmelweis University, Budapest, Hungary

3 Semmelweis University, Budapest, Hungary|||Semmelweis University, Budapest, Hungary|||Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary, Pécs, Hungary

4 Semmelweis University, Budapest, Hungary|||Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary, Pécs, Hungary|||Heim Pál National Pediatric Institute, Budapest, Hungary

Conference

UEG Week Vienna 2024

Topics

Pancreas

Submission format

Abstract

Session

PANCREAS (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Introduction

Depressive and anxiety symptoms may influence the severity of acute pancreatitis episodes; however, their impact, particularly in pancreatic units, remains poorly understood.

Aims & Methods

Our study aimed to identify risk factors associated with poorer psychological assessment scores in patients with acute and chronic pancreatitis (AP, CP) and their impact on clinical outcomes.
Patients admitted to a tertiary pancreatic unit were assessed for depressive and anxiety symptoms upon admission, with follow-ups every seven days during hospitalization. Psychological states were measured using the Hospital Anxiety and Depression Scale (HADS).

Results

Of the 1,397 admitted patients (median = 54, range = 17–97), 1,237 completed the questionnaire (42.98% female). At admission, 56.5% of patients had normal scores (0-7 points), 23.4% had borderline abnormal scores (8-10 points), and 20.3% had abnormal scores (11-21 points). The prevalence of abnormal cases at intervention, i.e. before intervention, was 20.15% in AP, 23.15% in early chronic pancreatitis (ECP), and 24.15% in acute-on-chronic pancreatitis (ACP). Borderline abnormal cases were observed in 22.25%, 24.15%, and 19.15% of cases, respectively. Abnormal cases varied by etiology: hypertriglyceridemia (13.9%), biliary (16.9%), alcohol-related (26.3%), and tumor-related pancreatitis (26.6%). The prevalence also differed by AP severity: mild AP (17.76%), moderate AP (23.94%), and severe AP (35.05%). Following psychological intervention, the number of patients with abnormal scores decreased (67.6%, 19.6%, and 12.8%, respectively).

Conclusion

Depressive and anxiety symptoms are common in patients with acute and chronic pancreatitis, with more severe AP already associated with worse psychological scores at admission. Psychological interventions are essential to improve clinical outcomes.

PREVALENCE AND IMPACT OF PSYCHOLOGICAL DISTURBANCES ON DISEASE SEVERITY IN PANCREATITIS: A COHORT ANALYSIS

Tibor Feher 1, Mahmoud Obeidat 2, Boglárka Szentes 2, Renáta Papp 3, Brigitta Teutsch 4, Marie Anne Engh 2, Szilárd Váncsa 5, Réka Csaba 2, Lilla Réthy 2, Peter Hegyi 5, Rita Nagy 6

1 Semmelweis University, Budapest, Hungary|||Károli Gáspár University, Budapest, Hungary|||Semmelweis University, Budapest, Hungary

2 Semmelweis University, Budapest, Hungary

3 Semmelweis University, Budapest, Hungary|||Semmelweis University, Budapest, Hungary

4 Semmelweis University, Budapest, Hungary|||University of Pécs, Budapest, Hungary|||Semmelweis University, Budapest, Hungary

5 Semmelweis University, Budapest, Hungary|||Semmelweis University, Budapest, Hungary|||University of Pécs, Budapest, Hungary

6 Heim Pál National Pediatric Institute, Budapest, Hungary|||Semmelweis University, Budapest, Hungary

Conference

UEG Week Berlin 2025

Topics

Pancreas

Submission format

Abstract

Session

PANCREAS (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Introduction

Depression and anxiety are common yet underrecognized comorbidities in patients with pancreatitis. While evidence suggests a significant psychological burden in these patients, the underlying mechanisms remain unclear, and psychological management is not routinely implemented in clinical care. This study aims to assess the prevalence of these conditions and highlight the need for their integration into pancreatitis treatment.

Aims & Methods

Our protocol was registered on PROSPERO (CRD42023481739). We conducted a comprehensive search on November 10, 2023, across three databases - MEDLINE, Embase, and CENTRAL - to identify studies reporting on the prevalence of depression and anxiety symptoms in patients with pancreatitis. We used a random-effects model to calculate the pooled proportion rate and mean differences (MD) with 95% confidence intervals (CI), as well as a pooled single-mean analysis of the psychological questionnaire data.

Results

In total, 43 studies were included in our meta-analysis. Among patients with acute pancreatitis (AP), anxiety was reported in approximately 23% of cases (CI: 7-54), whereas in chronic pancreatitis (CP), the prevalence was higher at 31% (CI: 23-39). Depressive symptoms were identified in approximately 29% of AP patients (CI: 14-51) and 39% of CP patients (CI: 30-48). The pooled single-mean analysis of questionnaire data further underscored the severity of these psychological symptoms, with scores exceeding established clinical cut-off points. For depressive symptoms, mean scores were as follows: CESD-10 (14.30 [CI: 6.69-21.92]), HADS (8.23 [CI: 4.53-11.94]), and SES (49.29 [CI: 44.01-54.57]). Similarly, anxiety symptom severity was reflected in the following measures: HADS (8.67 [CI: 4.53-11.94]) and SAS (47.75 [CI: 35.05-60.45])

Conclusion

There is a significant prevalence of both anxiety and depression in patients with pancreatitis. There is a need to integrate psychological interventions into the treatment of pancreatitis to potentially improve clinical outcomes.

BIDIRECTIONAL ASSOCIATIONS BETWEEN PANCREATITIS AND PSYCHOLOGICAL DISORDERS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Tibor Feher 1, Mahmoud Obeidat 2, Boglárka Szentes 2, Renáta Papp 3, Brigitta Teutsch 4, Marie Anne Engh 2, Szilárd Váncsa 4, Réka Csaba 2, Lilla Réthy 2, Peter Hegyi 4, Rita Nagy 5

1 Semmelweis University, Budapest, Hungary|||Semmelweis University, Budapest, Hungary|||Károli Gáspár University, Budapest, Hungary

2 Semmelweis University, Budapest, Hungary

3 Semmelweis University, Budapest, Hungary|||Semmelweis University, Budapest, Hungary

4 Semmelweis University, Budapest, Hungary|||Semmelweis University, Budapest, Hungary|||University of Pécs, Budapesthun, Hungary

5 Semmelweis University, Budapest, Hungary|||Heim Pál National Pediatric Institute, Budapest, Hungary

Conference

UEG Week Berlin 2025

Topics

Pancreas

Submission format

Abstract

Session

PANCREAS (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Introduction

Malnutrition has been shown to worsen the course and outcome of many diseases. However, the Malnutrition Universal Screening Tool (MUST), an internationally accepted nutritional score, has not been widely studied in acute pancreatitis, despite the known fact that the dietary habits of patients with pancreatitis of different etiologies vary.

Aims & Methods

Our objective was to examine the MUST score in pancreatitis.
All patients were assessed for MUST on admission at Semmelweis University Institute of Pancreatic Diseases between 04.10.2021 and 21.02.2024. The MUST score was compared with the etiology and outcome of the disease.

Results

Of the 1148 patients admitted to the unit 994 patients had complete data on MUST score and severity and 992 patients had data on etiology. Most patients were at low risk of malnutrition (MUST 0) 76,3% (n=760), 10,7% (n=107) had a moderate risk (MUST 1) and 12,9% (n=129) had a high risk (MUST score greater than 1). In patients with a MUST score over two alcoholic etiology was the most common (44,4%), while in patients at low risk of malnutrition biliary etiology was predominant (51,3%). Overweight and obese patients (BMI 25+) typically had biliary AP (47,9%, 61,3%), while normal and underweight patients most often had alcoholic AP (46,4%, 41,3%). The largest proportion of obese patients (BMI 30+) were seen in hypertriglyceridemic AP (72,2%) compared to other etiologies. The proportion of non-mild AP severity was similar in patients with MUST scores of 0, 1, and 2 (32,7%, 35,5%, and 30,1%, respectively), rising to 50% in patients with MUST scores over two. The largest proportion of severe cases (19,4%) was seen in patients with MUST scores over two.

Conclusion

Patients with higher BMI and lower malnutrition risk tend to have more often biliary etiology, while higher MUST score and lower BMI is characteristic of alcoholic AP. Malnutrition is a risk factor for severe AP.

NUTRITIONAL STATUS OF ACUTE PANCREATITIS PATIENTS

Olga Julia Zahariev 1, Klára Lara Vámossy 2, Bettina Csilla Budai 1, Luca Havelda 1, Balint Eross 3, Peter Jeno Hegyi 1, Fruzsina Hedvig Petlickij 2, Peter Hegyi 4

1 Semmelweis University, Budapest, Hungary|||Semmelweis University, Budapest, Hungary

2 Semmelweis University, Budapest, Hungary

3 Semmelweis University, Budapest, Hungary|||Semmelweis University, Budapest, Hungary|||University of Pécs, Pécs, Hungary

4 Semmelweis University, Budapest, Hungary|||Semmelweis University, Budapest, Hungary|||University of Pécs, Pécs, Hungary|||University of Szeged, Szeged, Hungary

Conference

UEG Week Vienna 2024

Topics

Pancreas

Submission format

Abstract

Session

PANCREAS (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Introduction

Sarcopenia is a progressive skeletal muscle disorder characterized by a loss of muscle mass, as well as strength and function. The presence of sarcopenia in acute pancreatitis (AP), a disease with potentially marked catabolism and impaired food intake, could further affect the course and outcome of the disease.

Aims & Methods

The aim of our study is to determine the prevalence of sarcopenia in patients with AP based on computed tomography (CT) and its association with disease severity and clinical outcomes. We retrospectively analyzed patients hospitalized for AP in 2020, regardless of etiology. Predictors of disease severity, the APACHE II index, and the BISAP index were determined on admission. To assess pancreatic necrosis and local complications, contrast-enhanced CT of the abdomen with CT Severity Index (CTSI) was performed between days 3 and 5. Assessment of sarcopenia was recorded by determining the psoas muscle index (PMI) and the Hounsfield Unit average calculation (HUAC) at the level of the L3 vertebra. Thresholds for PMI were set at 6.36 cm2/m2 for men and 3.92 cm2/m2 for women, whereas HUAC values were determined at the level of the 25% quartile of values measured in our patients. Local and systemic complications of AP were defined using the revised Atlanta criteria, whereas the impact of comorbidities was assessed by determining the Charlson comorbidity index (CCI).

Results

We analyzed 50 patients, of whom 32% were women. The mean age was 67 years (IQR 52-73), and the mean body mass index (BMI) was 27.88 ± 4.72 kg/m2. The mean length of hospital stay was 11.82 ± 7.68 days. The prevalence of sarcopenia was 16% by PMI and 26% by HUAC. There was no difference in the prevalence of sarcopenia between the sexes. We found significant negative correlations of PMI with APACHE II (r=-0.38; P=0.006), BISAP (r=-0.32; P=0.02), CCI (r=-0.43; P=0.002), and age (r=-0.35 ; P=0.01) but no significant correlation with CTSI, BMI, and length of hospital stay. HUAC is significantly negatively correlated with APACHE II (r=-0.73; P<0.0001), BISAP (r=-0.58; P<0.0001), BMI (r=-0.39; P=0.005), CCI (r=-0.68; P<0.0001), age (r=-0.58; P<0.0001) and length of hospital stay (r=-0.32; P=0.02) but with no correlation with CTSI.
According to the PMI criteria, no significant difference was found between the group of subjects with marked sarcopenia and the group without sarcopenia in all analyzed outcomes. Using HUAC criteria, patients with sarcopenia were significantly older (76±7.23 vs 59.22±14.12; P=0.0001) and had significantly higher BMI (30.85±3.77 vs 26.84±4.62; P=0.007). The same group had significantly higher values of APACHE II (10.92±20.74 vs 6.32±8.28; P=0.0001) and CCI index (5±2.48 vs 2.19±1.81; P=0.0001). No differences were observed in other outcomes. Mortality analysis was not possible because no deaths occurred.

Conclusion

Sarcopenia is quite common in patients with AP already on admission. As expected, sarcopenia in this group is also associated with older age and a greater number of concomitant diseases, but it also seems to be associated with higher BMI values. There are indications that sarcopenia is associated with potentially more severe forms of the disease, but this has not been confirmed in terms of the frequency of specific clinical outcomes. This is likely a consequence of the relatively small number of patients studied with a rather limited number of observed complications and a very low proportion of patients with a severe AP. Further studies in a larger number of subjects with a higher proportion of severe forms of AP are needed for more reliable results.

PREVALENCE OF SARCOPENIA AND ITS INFLUENCE ON CLINICAL OUTCOMES IN PATIENTS WITH ACUTE PANCREATITIS

Goran Poropat 1, Tin Nadarevic 2, Alojzije Lackovic 1, Vedra Gurdon 1, Goran Hauser 1

1 Clinical Hospital Center Rijeka, Rijeka, Croatia

2 University Hospital Centre Rijeka, Rijeka, Croatia

Conference

UEG Week Copenhagen 2023

Topics

Pancreas

Submission format

Abstract

Session

PP 08 Pancreas (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Introduction

96-98% of patients survive acute pancreatitis (AP), but in the post-AP phase, patients are at high risk of morbidity and mortality. It has been shown that pancreatic exocrine insufficiency can occur after AP.

Aims & Methods

We aimed to investigate the rate, risk factors, and the effect of pancreatic enzyme replacement therapy (PERT) for PEI in patients with AP. The study protocol was registered on PROSPERO (CRD42024516403). We conducted a systematic search on 5 February 2024 in three databases (PubMed, EMBASE, and CENTRAL). We included in the analysis studies reporting on risk factors and PERT efficacy in PEI associated with AP. Pooled proportion and odds ratios (OR) with a 95% confidence interval (CI) were calculated using a random effect model.

Results

Fifty-six articles were included in our meta-analysis. Among 17896 patients with AP, the pooled proportion of PEI was 20 % ([CI]: 15–26). The odds of PEI development were two-fold higher in severe acute pancreatitis (OR=2.44, [CI]: 0.98–6.11) compared with mild or moderate AP and three times higher after necrosectomy compared to patients without necrosectomy (OR=3.26, [CI]: 1.6–6.64). There was no significant difference between the odds of PEI among AP patients with necrosis (OR=1.43, [CI]: 0.32–6.45) and those without necrosis. However, the odds of PEI were twice as high in patients with infected necrosis (OR=2.13, [CI]: 0.93–4.87) than in patients with sterile necrosis. Pancreatic enzyme replacement therapy was prescribed for 22% ([CI]: 16–30) of patients after AP.

Conclusion

One in five patients with AP develops PEI. The rate is higher in patients with severe AP, infected necrosis, or who need necrosectomy. Patients with AP should be screened for PEI to allow timely PERT administration.

RISK FACTORS OF PANCREATIC EXOCRINE INSUFFICIENCY ASSOCIATED AFTER ACUTE PANCREATITIS – A SYSTEMATIC REVIEW AND META-ANALYSIS

Orsolya Eperjesi 1, Maria Bucur 2, Anett Rancz 2, Ádám Zolcsák 3, Marie Anne Engh 2, Mahmoud Obediat 2, Balint Eross 4, Peter Banovcin 5, Andrea Szentesi 6, Peter Hegyi 7, Stefania Bunduc 8

1 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary|||Department of Internal Medicine, Toldy Ferenc Hospital, Cegléd, Hungary

2 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary

3 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary|||Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary

4 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary|||Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary|||Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary

5 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary|||Department of Pharmacology and Pharmacotherapy, Medical Faculty, Semmelweis University, Budapest, Hungary

6 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary|||Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary

7 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary|||Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary

8 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary|||Carol Davila University of Medicine and Pharmacy, Bucharest, Romania|||Digestive Disease and Liver Transplant Center, Fundeni Clinical Institute, Bucharest, Romania

Conference

UEG Week Vienna 2024

Topics

Pancreas

Submission format

Abstract

Session

PANCREAS (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Introduction

The transition from acute pancreatitis (AP) to recurrent (RAP) and chronic (CP) pancreatitis poses significant clinical challenges.

Aims & Methods

This systematic review and meta-analysis aimed to identify risk factors associated with this progression. Following the protocol registration on PROSPERO (CRD42022368931), we searched Medline, Embase, and Cochrane databases up to December 19th, 2023, for studies examining risk factors for the evolution of AP into RAP or CP. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using the random effects model. Heterogeneity was evaluated using the I² statistic. The risk of bias assessment was performed using the Quality in Prognostic Studies (QUIPS) tool.

Results

A total of 124 articles were included in the meta–analysis, and several risk factors were identified for the progression of AP into RAP and CP. We found the following risk factors of AP recurrence: male gender, smoking, alcoholic etiology, hypertriglyceridemia, diabetes mellitus, pseudocyst, etc. The pooled OR for the male gender was 1.49 (95% CI: 1.31-1.62, I²=25%), for smoking was 1.47 (95% CI: 1.22-1.71, I²=57%), for alcoholic etiology was 1.78 (95% CI: 1.45-2.14, I²=78%), for hypertriglyceridemia was 2.48 (95% CI: 2.16-2.83, I²=9%), for diabetes mellitus was 1.51 (95% CI: 1.21-1.75, I²=0%), for pseudocyst was 2.23 (95% CI: 1.61-3.12, I²=0%). We also found risk factors of RAP progression into CP. The risk of bias was moderate in the majority of the included studies.

Conclusion

These findings suggest that addressing modifiable risk factors might be key in preventing the progression of pancreatitis

IDENTIFYING PREDICTORS FOR THE EVOLUTION OF ACUTE PANCREATITIS INTO RECURRENT AND CHRONIC FORMS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Endre-Botond Gagyi 1, Mahmoud Obediat 2, Edina Tari 3, Szilárd Váncsa 4, Ádám Zolcsák 2, Peter Banovcin 5, Peter Jeno Hegyi 6, Peter Hegyi 4, Balint Eross 4

1 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary|||Selye János Doctoral College for Advanced Studies, Semmelweis University, Budapest, Hungary

2 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary

3 Semmelweis University, Budapest, Hungary

4 Semmelweis University, Budapest, Hungary|||Centre for Translational Medicine, Semmelweis University, Budapest, Hungary

5 JESSENIUS FACULTY OF MEDICINE, COMENIUS UNIVERSITY, Martin, Slovakia

6 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary|||Semmelweis University, Budapest, Hungary

Conference

UEG Week Vienna 2024

Topics

Pancreas

Submission format

Abstract

Session

PANCREAS (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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