Frequency and prognosis of acute pancreatitis associated with acute hepatitis E: A systematic review

Samir Haffar, Fateh Bazerbachi, Sushil Garg, John R. Lake, Martin L. Freeman

Research output: Contribution to journalReview articlepeer-review

28 Scopus citations


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. Rationale 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. Data sources PubMed, EMBASE, Scopus, and the Cochrane library. Study selection All available studies discussing AP associated with AHE. Data extraction and assessment 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%). Conclusion 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.

Original languageEnglish (US)
Pages (from-to)321-326
Number of pages6
Issue number4
StatePublished - Jul 1 2015


  • Hepatitis
  • Hepatitis E virus
  • Humans
  • Pancreatitis
  • Systematic review
  • Virology


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