Duality of the association between COVID-19 and acute pancreatitis

Correspondence to Dr Jin-Lin Yang, Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China; yangjinlin@wchscu.cn We read with great interest the study by Pandanaboyana et al.1 The COVID-19 PAN collaborative study was a large international study that provided updated clinical evidence that has deepened our understanding of the relationship between COVID-19 and acute pancreatitis (AP). To explore the relationship between the two diseases, the definition of AP needs to be relatively strict, including a combination of enzymatic changes, imaging changes and typical symptoms, as enzymatic changes alone in patients with COVID-19 appear to be unreliable for the definition of pancreatitis.3 4 Furthermore, this study did not further analyse the reasons for the high mortality rate in patients with both AP and COVID-19. Existing studies have confirmed that concomitant SARS-CoV-2 infection in patients with AP leads to further disease deterioration, leading to more severe disease and mortality.1 5 This may be attributed to the exaggerated immune dysfunction, subsequent cytokine storms and endothelial damage that occur under proinflammatory conditions.1 6 However, it remains unclear whether SARS-CoV-2 infection directly leads to pancreatitis.