The importance of metabolic factors and P22PHOX gene expression in the devolopment of the post ERCP pancreatitis

Pancreatitis is the most common complication of ERCP. The recent studies have indicated that the risk factors associated with patients and ERCP procedure increase the devolopment of pancreatitis and affect the course of pancreatitis. In this study, we aimed to analyse the relationship between metabolic conditions (diabetes mellitus, obesity, dyslipidemia), genetic factors (p22phox) and the devolopment of the post ERCP pancreatitis.The patients, underwent a diagnostic or therapeutic ERCP between 2009-2010 at the University Hospital of Gaziantep University were enrolled in the study. The definition and the classification of the post ERCP pancreatitis were made according to ASGE (American Society of Gastrointestinal Endoscopy) criteria. During the study period, 1329 patients included and 51 (% 3,8) of them developed post ERCP pancreatitis. The patients with a fasting blood glucose higher than 126 mg/dl were defined as diabetes mellitus (DM). Sixteen of patients with DM (% 7,5) and 35 of patients without DM (% 3) has developed post ERCP pancreatitis with a statistical significance (p=0.002). The patients were divided into two groups according to lipid profile. Twenty two patients with dyslipidemia (% 5,4) and 29 patients (% 3,2) without dyslipidemia has developed post ERCP pancreatitis. Although the group with dyslipidemia had more post ERCP pancreatitis, a statistical significance was not determined (p=0.08). The patients were also analysed according to body mass index (BMI) status. The post ERCP pancreatitis rate was higher in obese patients (BMI > 30) than those non-obese (BMI < 30) however, the result was not statistically significant (% 5,5 and % 3,4 p=0.46).In the genetic part of the study, we compared the p22phox gene expression levels among the healthy people and the patients with or without post ERCP pancreatitis. The statical analysis indicated a significant relationship of p22phox gene expression among the groups (p=0.003). In the subgroup analysis, the p22phox gene expression was lower in post ERCP pancreatitis group than the group without pancreatitis but result was not statistically significant (p=0.98). The p22phox gene expression was also lower in healthy group than the group with or without pancreatitis and result was statistically significant (p=0.009, p=0.006).This is the first study investigating the role of metabolic and genetic factors for devolopment of the post ERCP pancreatıtıs. The study showed a close relationship between diabetes mellitus and post ERCP pancreatitis. In addition, dyslipidemia and obesity also increased the risk of the post ERCP pancratitis to some degree, but more studies are needed. The p22phox gene expression does not take part in the development of the post ERCP pancreatitis. In conclusion, the patients with diabetes mellitus, dyslipidemia and obesity should followed up more closely after the ERCP procedure for post ERCP pancreatitis.Key words: Pancreatitis, Diabetes, Dislipidemia, Obesity, P22phox