Viral hepatitis causing concomitant acute pancreatitis (AP) is rare and outcomes vary depending on the type of hepatitis virus, according to a systemic review on viral hepatitis-induced AP published in The American Journal of Gastroenterology. The abstract was presented at the American College of Gastroenterology Annual Meeting 2019, held October 25 to 30, in San Antonio, Texas.

Viral hepatitis-induced AP has been reported but not extensively studied; therefore, researchers investigated the frequency of viral hepatitis that concomitantly causes AP, its impact on AP, and the clinical features of this disease by performing a comprehensive review of the PubMed database using all relevant medical subject headings keywords.

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They found 71 cases of viral hepatitis causing concomitant AP; 20 AP cases were attributed to hepatitis A virus (HAV), 16 AP cases to hepatitis B virus (HBV), and 35 cases to hepatitis E virus (HEV). Men to women ratios were 2.25:1, 4.33:1, and 8:1 for HAV, HBV, and HEV cases respectively, indicating that HEV AP appears to have a predominance in men. Interestingly, more than one-third (37.5%) of HBV-attributed AP cases occurred in patients who had immunocompromise.

Mild and moderately severe AP were reported in 80% of HAV-attributed cases, 31.3% of HBV-attributed cases, and 82.9% of HEV-attributed cases; severe AP was reported in 20%, 66.7%, and 14.3% of cases, respectively.

In addition, mortality was reported in 25% of HAV-attributed cases, 56.3% of HBV-attributed cases, and 11.8% of HEV-attributed cases. Only one case of HCV-attributed AP was reported.

The authors concluded that, “Viral hepatitis causing concomitant AP is a rare entity and outcomes vary depending on the type of hepatitis virus.” They have suggested that direct acinar injury by active viral replication may be the mechanism of injury.

Reference

Imam Z, Simons-Linares R, Chahal P. Systematic review on viral hepatitis-induced acute pancreatitis. Am J Gastroenterol. 2019;114(2019 ACG Annual Meeting Abstracts):S18-S19.