Review
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2022; 28(19): 2034-2056
Published online May 21, 2022. doi: 10.3748/wjg.v28.i19.2034
Review on acute pancreatitis attributed to COVID-19 infection
Takumi Onoyama, Hiroki Koda, Wataru Hamamoto, Shiho Kawahara, Yuri Sakamoto, Taro Yamashita, Hiroki Kurumi, Soichiro Kawata, Yohei Takeda, Kazuya Matsumoto, Hajime Isomoto
Takumi Onoyama, Hiroki Koda, Wataru Hamamoto, Shiho Kawahara, Yuri Sakamoto, Taro Yamashita, Hiroki Kurumi, Soichiro Kawata, Yohei Takeda, Kazuya Matsumoto, Hajime Isomoto, Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Tottori Prefecture, Japan
Kazuya Matsumoto, Department of Internal Medicine, Irisawa Medical Clinic, Matsue 690-0025, Shimane Prefecture, Japan
Author contributions: Isomoto H and Onoyama T conceptualized and designed the review; all authors contributed to the conception and design of the study; Onoyama T, Koda H, Hamamoto W, Kawahara S, Sakamoto Y, Yamashita T, Kurumi H, Kawata S, Takeda Y, and Matsumoto K performed material preparation, data collection, and analysis; Onoyama T drafted the initial manuscript; all authors reviewed and approved the final manuscript as submitted.
Conflict-of-interest statement: The authors declare that they have no conflict of interest associated with the study.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Takumi Onoyama, MD, PhD, Doctor, Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago 683-8504, Tottori Prefecture, Japan. golf4to@yahoo.co.jp
Received: December 29, 2021
Peer-review started: January 4, 2022
First decision: March 10, 2022
Revised: March 20, 2022
Accepted: April 4, 2022
Article in press: April 4, 2022
Published online: May 21, 2022
Abstract

The coronavirus disease 2019 (COVID-19) is known to cause gastrointestinal symptoms. Recent studies have revealed COVID-19-attributed acute pancreatitis (AP). However, clinical characteristics of COVID-19-attributed AP remain unclear. We performed a narrative review to elucidate relation between COVID-19 and AP using the PubMed database. Some basic and pathological reports revealed expression of angiotensin-converting enzyme 2 and transmembrane protease serine 2, key proteins that aid in the entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) into the pancreas. The experimental and pathological evaluation suggested that SARS-CoV-2 infects human endocrine and exocrine pancreas cells, and thus, SARS-CoV-2 may have a direct involvement in pancreatic disorders. Additionally, systemic inflammation, especially in children, may cause AP. Levels of immune mediators associated with AP, including interleukin (IL)-1β, IL-10, interferon-γ, monocyte chemotactic protein 1, and tumor necrosis factor-α are higher in the plasma of patients with COVID-19, that suggests an indirect involvement of the pancreas. In real-world settings, some clinical features of AP complicate COVID-19, such as a high complication rate of pancreatic necrosis, severe AP, and high mortality. However, clinical features of COVID-19-attributed AP remain uncertain due to insufficient research on etiologies of AP. Therefore, high-quality clinical studies and case reports that specify methods for differential diagnoses of other etiologies of AP are needed.

Keywords: COVID-19, SARS-CoV-2, Pancreatitis, Revised atlanta classification, Prognosis, Etiology

Core Tip: Several review articles have explored the relationship between coronavirus disease 2019 (COVID-19) and acute pancreatitis (AP). However, due to various etiologies associated with AP, COVID-19-attributed AP is controversially defined. Therefore, this narrative review attempted to reveal clinical features of COVID-19-attributed AP focused on surveillance of the other etiologies of AP. The clinical features of COVID-19-attributed AP remain uncertain due to insufficient data on etiologies of AP. Therefore, prospective cohort studies focused on patients with COVID-19 with idiopathic AP are required, especially to clearly exclude other etiologies of AP.