| Theme |
Management of Acute Pancreatitis Based on the Revised JPN Guidelines |
| Title |
Diagnostic Criteria of Acute Pancreatitis |
| Author |
Junichi Sakagami |
Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine / Division of Medical Information, Kyoto Prefectural University Hospital |
| Author |
Keisho Kataoka |
Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine / Otsu Municipal Hospital |
| Author |
Hiroaki Yasuda |
Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine |
| Author |
Yoshio Sogame |
Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine / Department of Diagnostic Medicine, Kyoto Prefectural University Hospital |
| Author |
Ryusuke Kato |
Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine |
| Author |
Hayato Miyake |
Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine |
| Author |
Toshifumi Doi |
Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine |
| Author |
Yoshito Itoh |
Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine |
| [ Summary ] |
According to the JPN criteria (2008), the diagnosis of acute pancreatitis (AP) can be confirmed if the patient fulfills 2 of the following 3 criteria after exclusion of other illnesses : (1) shows symptoms of AP, (2) has pancreatic enzyme elevation, and (3) imaging studies confirm the diagnosis. The diagnostic criteria in other countries, including the revised Atlanta classification (2012), resemble the JPN criteria ; however, they differ on the point that pancreatic enzyme elevation should be at least 3 times greater than the upper limit of normal. Out of 1137 patients diagnosed with AP as per the JPN criteria, 30 (2.6 %) cannot be considered as having AP as per the revised Atlanta classification (2012). More than 90% of AP patients have abdominal pain ; however, the remaining patients have painless AP. As stated in the recent reports of multi-kinase inhibitor (MKI)-induced AP, 50 % of the cases have painless AP. Future investigation regarding MKI-induced AP is required. Although measurement of serum lipase activity is strongly recommended at the initial diagnosis of AP, only 7 (0.9 %) out of 798 AP patients are diagnosed by a single measurement of serum lipase. Etiological assessment of AP is very important, especially in treating biliary AP. The JPN guidelines insist that we should take utmost efforts to reduce the diagnosis of idiopathic AP, whereas the criteria of other countries recommend that no more than 20 % cases should be classified as idiopathic. Once the diagnosis of AP is confirmed, repeated severity assessments based on the JPN criteria (2008) are necessary. The area under the receiver operating characteristic curve of the disseminated intravascular coagulopathy (DIC) score defined by the Japanese Association for Acute Medicine (JAAM) for predicting severe AP based on the JPN criteria (2008) is as high as 0.77, and the severe AP patients have a significantly higher JAAM-DIC score (P<0.0001). We should elucidate a link between DIC and the AP criteria in the future. |