Roberto Simons-Linares, MD: How a Hepatitis Viral Infection Causes Acute Pancreatitis

The outcomes for patients suffering from the different forms of the hepatitis virus with acute pancreatitis can vary drastically.

While patients suffering from hepatitis A and hepatitis E have relatively good outcomes, those suffering from hepatitis B do not.

In research presented at the American College of Gastroenterology’s Annual Scientific Meeting (ACG 2019) in San Antonio, Texas, Roberto Simons-Linares, MD, a gastrointestinal fellow with the Cleveland Clinic, explained in an interview with MD Magazine® the results from a new literature review on the association between hepatitis and acute pancreatitis.

MD Magazine: What is your takeaway from the study on hepatitis causing acute pancreatitis?

Simons-Linares: We also have a study, a systematic review of the literature on patients who develop hepatitis from a viral cause that also had a hepatitis inflammation of the liver infection at the same time. So, they have acute hepatitis with acute pancreatitis. We found around 71 cases and the most common cause was acute hepatitis A and then acute hepatitis B and then E.

Those were the 3 most common and only 1 case of acute hepatitis C with acute pancreatitis. What we found, these cases of acute pancreatitis were thought to be from the virus. So, other etiologies were excluded.

We found that patients with hepatitis A and E had relatively good outcomes. They had mild inflammation of the pancreas. However, patients with hepatitis B had really more severe outcomes. About 80 percent of them had severe acute pancreatitis as classified by the revised Atlanta classification. They had a very high mortality, they had around 50% mortality, which is very high for acute pancreatitis.

I thought this is an interesting project that may help all healthcare providers not only gastroenterologist to be aware that if you encounter a patient that has both acute hepatitis and acute pancreatitis from a viral etiology those patients with hepatitis B will have very high mortality.

MD Magazine: In the study, you said viral hepatitis causing concomitant acute pancreatitis is rare, but what is the optimal way to treat this condition?

Simons-Linares: The optimal way to treat a patient with acute viral hepatitis and acute viral pancreatitis would be supportive care in most cases.

In the case of hepatitis B there is also antiviral medication that we can use. In the case of hepatitis C, it was only 1 case and it was thought to be more supportive care that the patient received and did well rather than other antivirals.

So, I think the home the take-home point is to treat these patients with supportive care.

Also, if they develop hepatitis B, if they are immunosuppressed they may have poorer outcomes. They may need a nice intensive care unit to receive the appropriate supportive care for the viral infection.