P0039 - COVID-19 in Association With Pancreatitis: A Retrospective Study

Sunday, October 24, 2021

3:30 PM – 7:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Kristen L. Moulton, DO

University of Massachusetts Medical Center
Worcester, MA, United States

Kristen Moulton, DO¹, Yurima Guilarte-Walker, MS², Wahid Wassef, MD, MPH, FACG³
¹University of Massachusetts Medical Center, Worcester, MA; ²Population and Quantitative Health Sciences, Worcester, MA; ³University of Arizona Medical Center, Phoenix, AZ

Introduction: COVID-19 is a multi-faceted virus affecting many systems, including the gastrointestinal tract. COVID-19 is thought to enter host cells through angiotensin-converting-enzyme-2 (ACE2) receptors, which happen to be highly concentrated within the islet cells of the pancreas. Small studies suggest an association between COVID-19 infection and pancreatitis (1) or pancreatic inflammation (2). Our study sought to determine whether COVID-19 is associated with the development of pancreatitis, while accounting for the more common causes of pancreatic inflammation, such as alcohol or gallstones.

Methods: Our study was conducted through retrospective chart review, looking at patients found to have both COVID-19 and acute pancreatitis at a large university hospital between March 2020 and March 2021. Among 15,549 COVID-positive patients and 2,542 patients with acute pancreatitis, 115 patients showed evidence of both pancreatic injury and COVID-19. We further analyzed 10 patients who met diagnostic criteria for acute pancreatitis within 30 days after COVID-19 diagnosis.

Results: The incidence of COVID-19 with coincident pancreatitis was rare, with 10 patients meeting full criteria. Seven cases of COVID-19-associated pancreatitis were confounded by alcohol abuse, cholelithiasis, initiation of pancreatitis-associated medication, and tobacco abuse. One patient left against medical advice before further work-up. Two COVID-19 positive patients were found to have idiopathic pancreatitis after extensive work-up, with COVID-19 and pancreatitis diagnosed an average of 3 days apart.

Discussion: Based on our data and prior research findings, there may be a small correlation between COVID-19 infection and acute pancreatitis. Our research indicates that COVID-19 may rarely cause pancreatitis, as suggested by the 2 idiopathic cases. COVID-19 may also contribute to pancreatic inflammation in the setting of a preexisting pancreatic stressor, such as alcohol abuse, cholelithiasis, or certain medications. Wang et al (2020) showed that COVID-19 may cause a lower level of pancreatic inflammation that goes undetected in many patients. Further research is needed to elucidate the effect of this unpredictable and multi-faceted virus on the pancreas.

References:
1. Szatmary P et al (2020). Emerging phenotype of SARS-CoV2 associated pancreatitis, Gastroenterology, 159(4), 1551-1554.
2. Wang, F et al (2020). Pancreatic Injury Patterns in Patients with Coronavirus Disease 19 Pneumonia. Gastroenterology, 159(1), 367-370.

Etiology	Incidence (# of patients)	Average Time between diagnoses (days)
Alcohol abuse	3	1.0
Cholelithiasis	2	6.5
Idiopathic	2	3.0
Pancreatitis-associated medication	1	8.0
Tobacco abuse	1	1.0

Table: COVID-19-Associated Pancreatitis Cases:
All patients had a diagnosis of pancreatitis within 8 days of their COVID-19 diagnosis, suggesting that COVID-19 likely contributed to the onset of pancreatic inflammation. Two patients were found to have idiopathic pancreatitis, consistent with possible viral-induced pancreatitis from COVID-19. The other seven patients were found to have another etiology of pancreatitis. However, the close proximity of the COVID-19 and pancreatitis diagnoses lends further evidence to suggest that COVID-19 may serve as a stressor to the pancreas, resulting in an increased risk of acute pancreatitis.

Disclosures:
Kristen Moulton indicated no relevant financial relationships.
Yurima Guilarte-Walker indicated no relevant financial relationships.
Wahid Wassef indicated no relevant financial relationships.

Kristen Moulton, DO¹, Yurima Guilarte-Walker, MS², Wahid Wassef, MD, MPH, FACG³. P0039 - COVID-19 in Association With Pancreatitis: A Retrospective Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.