title: Frequency and prognosis of acute pancreatitis associated with acute hepatitis E: A systematic review.
abstract: BACKGROUND
  The association of acute pancreatitis (AP) with viral hepatitis is well known, and is usually attributed to HAV, HBV, or HCV. AP related to acute hepatitis E (AHE) has been rarely described, and the typical profile is that of a young male, residing in an endemic area, presenting with mild to moderate pancreatitis, and improving with conservative management.
  
  
  BACKGROUND
  An increasing number of reports describe AP associated with AHE. Some life-threatening complications related to AP may occur, and death has been reported. In addition, it is possible that early diagnosis of these cases may help in reducing the morbidity and mortality.
  
  
  OBJECTIVE
  Perform a systematic review to study cases of AP associated with AHE and to assess their prognosis.
  
  
  METHODS
  PubMed, EMBASE, Scopus, and the Cochrane library.
  
  
  METHODS
  All available studies discussing AP associated with AHE.
  Two blinded independent observers extracted and assessed the studies for diagnosis of AHE based on serological and/or molecular techniques, diagnosis of fulminant hepatitis based on the American Association for the study of Liver Diseases (AASLD) position paper, diagnosis of AP based on the American College of Gastroenterology (ACG) guidelines, diagnosis of AP associated with AHE based on Makharia's association, and diagnosis of AP severity based on the Revision of the Atlanta Classification (RAC).
  
  
  RESULTS
  Thirteen case reports and 4 case series were found with 55 patients meeting the inclusion criteria. All patients originated from Southern Asia or had a recent travel to that area. The mean age at diagnosis was 28 years with a male to female ratio of 18:1. The mean interval between the onset of jaundice and the onset of AP pain was 10 days. AP was mild or moderately severe in 45 patients (82%), and severe in 10 patients (18%). Mortality was reported in 2 patients (3.6%).
  
  
  CONCLUSIONS
  Fifty-five cases of acute pancreatitis associated with AHE are reported in the literature. Acute pancreatitis in this setting is severe in approximately one fifth of patients with an overall mortality rate similar to all other causes of AP.
authors.affiliation: Department of Gastroenterology, Al-Mouassat University Hospital, Damascus, Syria. Electronic address: shaffar75@gmail.com.
authors.forename: Samir
authors.initials: S
authors.lastname: Haffar
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, United States.
authors.forename: Fateh
authors.initials: F
authors.lastname: Bazerbachi
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, United States.
authors.forename: Sushil
authors.initials: S
authors.lastname: Garg
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, United States.
authors.forename: John R
authors.initials: JR
authors.lastname: Lake
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, United States. Electronic address: freem020@umn.edu.
authors.forename: Martin L
authors.initials: ML
authors.lastname: Freeman
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D005260:Female; D016751:Hepatitis E / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D011379:Prognosis; D055815:Young Adult
keywords: Hepatitis; Hepatitis E virus; Humans; Pancreatitis; Systematic review; Virology