INTERNATIONAL JOURNAL OF ARTIFICIAL INTELLIGENCE
ISSN: 2692-5206, Impact Factor: 12,23
American Academic publishers, volume 05, issue 06,2025
Journal:
https://www.academicpublishers.org/journals/index.php/ijai
page 2179
POST-COVID VIRAL ETIOLOGY PANCREATITIS: DIAGNOSTIC AND
THERAPEUTIC
Tilavova Feruza Sobir qizi
1st-year PhD student, Bukhara State Medical Institute
Abstract:
Post-COVID viral etiology pancreatitis has emerged as a significant clinical concern
in recent years. This article analyzes cases of pancreatitis associated with COVID-19 and other
viral pathogens such as CMV, EBV, and hepatitis viruses, focusing on clinical presentation,
diagnostic challenges, and therapeutic strategies. A comprehensive literature review was
performed utilizing the latest scientific publications, clinical case studies, and international
treatment guidelines. Results indicate that pancreatitis in COVID-19 patients may present
atypically or with a delay, complicating the diagnostic process despite advancements in
laboratory and imaging modalities. Treatment is primarily symptomatic, antiviral when
indicated, and often minimally invasive. The study concludes that due to its complex
presentation and potentially severe course, viral pancreatitis should remain a focus for
clinicians, particularly in the post-COVID era, to improve timely diagnosis and patient
outcomes.
Keywords:
COVID-19, viral pancreatitis, diagnostics, CMV, EBV, hepatitis viruses, ACE2,
treatment challenges
Introduction
Acute pancreatitis is an inflammatory condition of the pancreas that ranks among the leading
gastrointestinal emergencies globally. While common etiologies include gallstones, alcohol use,
and hypertriglyceridemia, infections—particularly viral—also contribute to disease onset.
During the COVID-19 pandemic, growing clinical and scientific interest emerged regarding the
direct and indirect effects of SARS-CoV-2 on pancreatic tissue. Research has identified the
expression of ACE2 receptors on pancreatic cells, suggesting a potential viral tropism for the
pancreas and establishing a link between COVID-19 and pancreatic damage.
Materials and Methods
This study conducted a structured literature review focusing on the pathogenesis, clinical
manifestations, diagnostic tools, and treatment modalities for post-COVID viral pancreatitis.
Scientific databases including PubMed, Scopus, and Google Scholar were searched using
keywords such as “COVID-19 and pancreatitis,” “viral pancreatitis,” “ACE2 expression in
pancreas,” “CMV, EBV, hepatitis and pancreatitis.” Inclusion criteria encompassed English-
language publications from 2019 to 2024 featuring clinical trials, case series with more than
five patients, systematic reviews, and official guidelines. Data were analyzed thematically and
organized through comparative tabulation to highlight similarities and differences across viral
etiologies. Special focus was placed on distinguishing SARS-CoV-2-associated pancreatitis
from CMV, EBV, and HEV-associated cases.
Results
INTERNATIONAL JOURNAL OF ARTIFICIAL INTELLIGENCE
ISSN: 2692-5206, Impact Factor: 12,23
American Academic publishers, volume 05, issue 06,2025
Journal:
https://www.academicpublishers.org/journals/index.php/ijai
page 2180
Elevated pancreatic enzymes (amylase/lipase) have been observed in approximately 17–19% of
COVID-19 patients, with a subset exhibiting clinical features of acute pancreatitis. Diagnosis
was confirmed when at least two of the following criteria were met: (1) serum amylase/lipase
levels exceeding three times the normal limit, (2) imaging findings suggestive of pancreatitis
via computed tomography (CT) or ultrasound (US), and (3) typical abdominal symptoms. The
following table summarizes the clinical associations and treatment approaches for different
viral causes of pancreatitis.
Table 1. Clinical characteristics of viral-associated pancreatitis
Clinical Features of Viral Pancreatitis (Illustrative Table)
Virus type
Association
with
pancreatitis
Treatment approach
SARS-CoV-2 (COVID-19) Direct damage via ACE2
receptors
Symptomatic,
antiviral
therapy
specific
to
COVID-19
CMV
Necrotizing pancreatitis in
immunocompromised
patients
Ganciclovir
EBV
Rare, usually mild
Symptomatic
Hepatitis B/E
Observed in clinical cases
Antiviral therapy targeting
the primary virus
As shown in Table 1, each virus exhibits a distinct pathogenic mechanism and clinical impact
on the pancreas. SARS-CoV-2 primarily affects pancreatic cells via ACE2 receptors and
requires antiviral and supportive care. CMV-related pancreatitis presents severely in
immunocompromised patients and warrants targeted antiviral therapy with ganciclovir. EBV
typically results in self-limited disease, while hepatitis B and E viruses may be associated with
pancreatitis in select clinical scenarios, warranting antiviral treatment specific to the causative
virus.
Discussion
Viral pancreatitis, particularly in the context of COVID-19, presents significant diagnostic and
therapeutic challenges. Elevated pancreatic enzymes do not always indicate clinical pancreatitis,
and symptoms may be masked by concurrent respiratory complications such as ARDS. In
severe COVID-19-associated pancreatitis cases, multi-organ failure has been documented.
Although pancreatitis caused by other viruses such as CMV, EBV, and HEV tends to be milder,
immunosuppressed patients remain at increased risk. The current therapeutic approach
prioritizes conservative management, but accurate etiological identification allows for targeted
antiviral therapies that can significantly improve outcomes.
Conclusion
INTERNATIONAL JOURNAL OF ARTIFICIAL INTELLIGENCE
ISSN: 2692-5206, Impact Factor: 12,23
American Academic publishers, volume 05, issue 06,2025
Journal:
https://www.academicpublishers.org/journals/index.php/ijai
page 2181
Though relatively rare, pancreatitis of viral origin—especially post-COVID—requires
heightened clinical awareness. Early detection based on standardized diagnostic criteria and
individualized therapeutic strategies can enhance prognosis and reduce complications. Given
the potential for atypical presentation, clinicians must remain vigilant for pancreatic
involvement in patients with recent or concurrent viral infections.
References:
1. Dirweesh, A., et al. (2021). Clinical characteristics of COVID-19–associated pancreatitis.
Pancreatology, 21(3), 615–620.
2. Liu, F., et al. (2020). ACE2 expression in pancreas may cause pancreatic damage after
SARS-CoV-2 infection. Clinical Gastroenterology and Hepatology, 18(9), 2128–2130.
3. Mao, R., et al. (2020). Manifestations and prognosis of gastrointestinal and liver involvement
in patients with COVID-19: a systematic review and meta-analysis. The Lancet
Gastroenterology & Hepatology, 5(7), 667–678.
4. McNabb-Baltar, J., et al. (2020). Lipase elevation in patients with COVID-19. The American
Journal of Gastroenterology, 115(8), 1286–1288.
5. Tenner, S., et al. (2013). American College of Gastroenterology guideline: management of
acute pancreatitis. The American Journal of Gastroenterology, 108(9), 1400–1415.
6. Wang, F., et al. (2020). Pancreatic injury patterns in patients with coronavirus disease 19
pneumonia. Gastroenterology, 159(1), 367–370.
