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Review article | DOI: https://doi.org/10.31579/2639-4162/325
1Department of Biotechnology, Barkatullah University, Bhopal, M.P, India.
2Professor & Head, Department of Research & Training, ICMR- Bhopal Memorial Hospital & Research Centre, Bhopal M.P, India.
3Medical Director, Siddhanta Red Cross Hospital Bhopal, M.P, India.
4Assistant Professor, Gastrosurgery department, ICMR-Bhopal Memorial Hospital & Research Centre, Bhopal M.P, India.
*Corresponding Author: Puneet Gandhi, Professor & Head, Department of Research & Training, ICMR- Bhopal Memorial Hospital & Research Centre, Bhopal M.P, India.
Citation: Jyoti K. Bara, Puneet Gandhi, Subodh Varshney, Pramod Verma, Ragini Gothalwal, (2026), Unveiling the Deregulated Pathophysiology for Precision Diagnostics and Personalized Clinical Management of Acute on Chronic Pancreatitis: A Narrative Review, J. General Medicine and Clinical Practice, 9(2); DOI:10.31579/2639-4162/325
Copyright: © 2026, Puneet Gandhi. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 16 December 2025 | Accepted: 23 January 2026 | Published: 30 January 2026
Keywords: inflammation; oxidative stress; biomarkers; cytokines; pancreatitis
Acute on chronic pancreatitis (ACP) is a transitional condition between acute and chronic pancreatitis, which often gets missed due to overlapping clinical features with other pancreatitis states. The low sensitivity of standard tests like serum amylase and lipase, leading to underreported epidemiological data. This review examines the current knowledge on ACP’s pathophysiology, risk factors, and molecular diagnostic markers differentiating it as a separate entity. ACP clinically presents as ductal obstruction, premature enzyme activation, acinar cell injury, oxidative stress, or / and inflammation. Over the time, it can lead to complications like formation of pseudocyst(s) and type 3 pancreatogenic diabetes mellitus (T3cDM) which could be life threatening, if not treated properly. Sometimes, ACP might also progress to CP, thereby affecting the patients’ quality of life. Literature survey from 2007 to 2025, identifies sphincter of Oddi dysfunction, chronic alcohol consumption, smoking, and medications like hydrochlorothiazide and ACE inhibitors, as accountable factors. Limited studies available highlight a handful of molecular markers, like oxidative stress indicators and inflammatory cytokines as predictors of ACP events, having a potential for improving diagnostic accuracy, but more laboratory studies are needed to validate their utility for addressing the critical gaps. In context to the above scenario, a holistic approach needs to be adopted to deal with ACP inclusive of novel molecular markers for precision diagnosis of ACP events and risk prediction, followed by personalized therapeutic interventions to target inflammation, and other co-morbidities to improve outcomes in ACP patients
ACP: Acute on chronic pancreatitis
AP: Acute Pancreatitis
CP: Chronic Pancreatitis
SO: Sphincter of Oddi
MDA: Malondialdehyde
4-HNE: 4-hydroxynonenal
IL-6: Interleukin-6
IL-17: Interleukin-17
IFN-γ: Interferon- gamma
Acute pancreatitis (AP) and chronic pancreatitis (CP) are known as two distinct forms of pancreatic disorders caused by inflammation occurring in the pancreas [1,2]. Clinically, an intermediate state occurs between AP and CP that is Acute on Chronic Pancreatitis (ACP), a state generally associated with recurrent (≥2) episode of AP. ACP is known to mimic symptoms of AP, such as epigastric pain, nausea and vomiting but differs in the severity of the attack and clinically in the development of increased intra-pancreatic fat in the pancreas [3]. Globally, the exact incidence of ACP is not known but Shah et al. [4] estimated an annual incidence of ACP in the US is 8–10 per 100,000 persons, and its estimated prevalence is 110–140 per 100,000 persons per year. In a developing country like India, official data regarding the incidence of pancreatitis is still not available. In support, Krishnan et al. [5] conducted a multicenter study in India and observed that no specific data has been reported on incidence of ACP. However, the incidence is on the rise as information on sporadic cases is available at the gastroenterology departments of various healthcare centres they studied. Most likely, since there are no specific guidelines available in revised Atlanta classification (2012) for diagnosing ACP [6]; therefore, the incidence of ACP is not separately recorded in the literature and hence this entity is often overlooked. The conventional biomarkers, serum amylase and lipase, are used for pathological diagnosis of pancreatitis but they are not reliable diagnostic markers for differentiation of pancreatitis states. It has been observed that during episodes of ACP, the diagnostic performance of serum amylase and lipase deviates, that it decreases from the standard upper limit which is expected to be 3 times higher [7]. It has been also reported in a study conducted by Li and co-workers (2023) that in only 20% of cases of ACP, the levels of serum amylase and lipase were three times higher than the upper limit of the normal range [8]. Thus, failing in the accurate diagnosis of the state of ACP is responsible for missing incidence of such patients in epidemiological record. Hence, this review aims to define and highlight the clinical state of ACP and its deregulated pathophysiology. Additionally, it presents an overview of the factors that contribute to the development of this state and its related co-morbidities during the progression of ACP leading to diverse clinical outcomes, along with molecular markers that can aid in non-invasive early diagnosis of ACP.
Identifying Key Factors as Triggers
The appropriate clinical intervention received by the patients with AP often result in the resolution of their diseased state. However, when AP does not resolve, there are specific triggers, such as sphincter oddi (SO) dysfunction, alcohol, smoking, and certain medications, that lead to recurrent episodes of ACP. There are case reports and small cohort studies to show the association of risk factors with the recurrent episodes of ACP. A case study conducted by Shayesteh and group [9], involved a 42-year old female suffering from acute pancreatitis with a SO dysfunction who experienced multiple episodes of ACP after she underwent sphincterectomy. In another case study conducted by Raut and his colleagues [10], the detrimental effects of chronic alcoholism on the pancreas was highlighted that lead to episodes of ACP. This study was on a 28-year-old patient with a 12-year history of chronic alcoholism and recurrent episodes of ACP, between 2022-23. The recurrent ACP episodes led to the development of chronic calcified pancreatitis and a pseudocyst. Way back in 2009, Yadav and his colleagues [11] assessed 460 ACP patients with a habit of smoking a pack of cigarette per day and found that these patients had an increased risk for the recurrence of ACP were increased to 13.6%. In a retrospective study conducted by Sun et al. [12], considered 81 ACP patients, they found that smoking 10 cigarettes daily was associated with a 32.2% increased risk of recurrent ACP episodes. A recent case report by Linkous and his colleagues [13] reported a case of a 58-year-old African female patient admitted with a previous history of pancreatitis. The healthcare providers discontinued the drug hydrochlorothiazide (HCTZ) being used by her for urinary complications. However, after 16 months, the patient had another episode of ACP, due to HCTZ, which she kept consuming without medical consultation.
The studies mentioned above demonstrate the role of triggers in initiating a recurrent episode of ACP. However, comprehensive understanding of the underlying pathophysiology is critical for the accurate diagnosis of patients with ACP.
Deregulated pathophysiology of ACP
The trigger(s) associated with ACP lead to obstruction in the pancreatic duct and hypertension in the intraductal region of the pancreas. The SO dysfunction is mainly due to narrowing of the sphincter or an abnormal spasm (dyskinesia) [14]. The inflammation generated during an episode of ACP, is primarily due to the release of pancreatic juices that flow into the duodenum and induce bile reflux. This further, ushers to oxidative stress and inflammation which increases the release of inflammatory cytokines and leads to three different types of SO dysfunction [15]. Type 1 dysfunction patients suffer from severe abdominal pain. Due to the dilation of the common bile and/or main (central) pancreatic duct, prolonged drainage of higher levels of serum pancreatic enzymes takes place. Type II dysfunction occurs in patients having symptoms like upper abdominal pain, which radiates to the back along with elevated liver enzymes. Patients with type III dysfunction present only abdominal pain with no rise in serum pancreatic enzymes [16], and therefore, an episode of ACP might be overlooked when it recurs.
The Nardi test is considered as gold standard examination to assess dysfunction of the SO. This test involves administering morphine and neostigmine simultaneously. Morphine causes contractions in the bile ducts, while neostigmine tightens the Sphincter of Oddi. If a patient's symptoms are related to SO dysfunction, the increased pressure from the bile being pushed into the contracted sphincter will replicate the symptoms [17]. But this test is generally not undertaken because post examination it raises the risk of an episode of ACP in 27% of the patients [18].
The above discussed triggers of ACP also lead to abnormal calcium signaling which results in elevated levels of intracellular calcium in the acinar cells along with oxidative stress. Consequently, the higher calcium levels trigger a premature activation and conversion of trypsinogen into trypsin within the pancreatic acini and not in the pancreatic duct lumen as in a canonical pathway. This abnormal activation of trypsin within the acinar cells leads to acinar injury or damage along with inflammation during ACP episode [19]. The role of trypsin in ACP pathophysiology is significant, as it is a key enzyme involved in protein digestion, and its premature activation can lead to tissue damage and inflammation [20]. Furthermore, the inflammation exacerbates complications such as pancreatic fluid accumulation during the second episode of ACP and the formation of a pseudocyst in the third episode of ACP [21]. Moreover, when the pancreatic tissue (acinar cells) gets damaged, enzymes drain out from the damaged acinar cells and get collected in the surrounding tissue, leading to peri-pancreatic fluid collection. When the accumulated fluid is not drained through surgical intervention, it results in a pancreatic pseudocyst (Fig1). The unresolved pseudocysts can rupture into the peritoneum (abdominal cavity) and cause pancreatic ascites or haemorrhagic shock, which may result mortality in 40% of ACP patients [22].
Molecular markers for diagnosis of ACP
The conventional biomarkers, serum amylase and lipase, are not considered sensitive enough for monitoring complications or organ damage occurring during ACP. Also, the invasive Nardi test is troublesome during the examination of SO dysfunction and may result in recurrence of ACP. Therefore, to address the pathophysiology involving oxidative stress and inflammation the biomarkers for monitoring these phases can be of use during an episode of ACP. In literature, few studies have been conducted on the markers associated with oxidative stress and inflammation which could aid in governing the plausible event of ACP to occur. In a study conducted by Bhopana et al. [23], ACP patients and controls were assessed for their oxidative stress and antioxidant levels. It was reported that during recurrence of an episode of ACP the reduced levels of malondialdehyde (MDA) and 4-hydroxynoneal (HNE) in serum samples of ACP patients corresponded to their increased oxidative stress and decreased antioxidant levels.
The release of cytokines marks as a sign for an inflammation occurring during ACP. Pendharkar et al., [24] examined ACP patients with and without hyperglycemia for their inflammatory cytokines and incretin levels. His group found that IL-6 levels were increased in serum whereas GIP (glucose-dependent insulinotropic polypeptide), an incretin marker was decreased in ACP patients with hyperglycemia. Park and his colleagues [25] conducted a study in which the circulating cytokine levels of IFN-gamma, IL-13, IL-1 beta IL-27 and IL-31 showed higher levels in ACP patients when compared with the controls. Similarly, Lee et al. [26] also assessed IL-17 levels in the serum of ACP patients, which were higher in ACP patients than in the controls. A comprehensive overview of the study cohort, methodology adopted and salient findings are provided in (Table 1).
| S. No. | Assessment of Markers | Cohort | Study region | Method | Findings | References | |
| Oxidative stress markers | |||||||
| 1. | 4-hydroxynonenol (4-HNE), malondialdehyde (MDA) Antioxidant levels- Ferric reducing ability of plasma, glutathione peroxidase, Vitamin C | 50 ACP patients 50 controls | INDIA | Enzyme linked immunosorbent assay | Higher plasma levels of 4-HNE and MDA; lower antioxidant levels suggested that oxidative stress plays a key role in causing recurrent episodes of ACP in patients. | [23] | |
| Inflammatory markers | |||||||
| 2. | 3 Pro-inflammatory markers and 9 incretin hormone | ACP with hyperglycemia-19 patients ACP without hyperglycemia- 64 patients | New Zealand
| Enzyme linked immunosorbent assay | Increased IL-6 levels and decreased GIP levels in ACP patients with hyperglycemia. | [24] | |
| 3. | 62 analytes inclusive of cytokines/ chemokines and adhesion molecules | ACP- 20 patients, CP patients-20 Controls- 41individuals | USA | Multiplex immunoassay | IFNγ, IL-13, IL-1b, IL-27, IL-31, and FASL were expressed in ACP patients. The biomarker levels were higher than CP and controls. | [25] | |
| 4. | 92 analytes inclusive of cytokines and chemokines | ACP- 56 patients Controls - 56 | USA | Multiplex immunoassay | IL-7 levels in serum of ACP patients were higher when compared with controls | [26] | |
Table 1: Studies on biomarkers available in the literature for assessment and diagnosis of an ACP event.
These studies on ACP reveal the key biomarkers that can be developed clinically for a non-invasive diagnosis. Elevated oxidative stress markers (4-HNE, MDA) and reduced antioxidant levels in Indian cohorts indicate that oxidative stress drives recurrent ACP episodes [23]. The increased IL-6 levels and decreased GIP in ACP with hyperglycemia suggest inflammatory and metabolic dysregulation [24]. Multiplex immunoassays in US studies show elevated IFNγ, IL-13, IL-1b, IL-27, IL-31, FASL, and IL-7 in ACP than CP [25,26], highlighting distinct cytokine/chemokine profiles as identifiers. Hence, these biomarkers could enhance non-invasive ACP diagnosis and monitoring.
Varied Physiological and Clinical Outcomes of ACP
Recurrent episodes of ACP lead to loss of endocrine and exocrine function of the pancreas and may result in the development of type 3c diabetes (T3cDM), pancreatic pseudocysts or progression to CP.
Loss of endocrine function
Patients with ACP may gradually develop loss of the endocrine function due to the insults caused during an episode of ACP, resulting in damage to the endocrine cells and may lead to pancreatic cancer also. Specifically, it is the loss of β-cells in the pancreas that regulate the production and release of insulin and glucose, facilitating glucose metabolism in the body. This β-cell loss initiates an inflammatory response and releases IL-6 [27], which impairs the phosphorylation of insulin receptors and insulin receptor substrate. This results in pancreatogenic or type 3c diabetes (T3cDM), characterized by insulin resistance and its deficiency. In a study conducted by Das et al. [28] it has been reported that there was a 40% prevalence of T3cDM after ACP. Another study conducted by Shen et al. [29] concluded that the overall risk of T3cDM increases two-fold after the second episode of ACP. During T3cDM, there is a loss of secretion of the glucoregulatory hormones produced by the islets (insulin, glucagon, and pancreatic polypeptide). It also contributes to abnormal secretion of the incretin hormones glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) which are adversely affected by the loss of exocrine function as well, because exocrine cells also get damaged during ACP episode [30] (Fig.2). This can result in fluctuations of glycemic levels in patients that can be fatal, if not addressed immediately [31].
Figure 1: Triggers causing injury and inflammation in the pancreas, leading to aberrant calcium signaling during an episode of acute on chronic pancreatitis (ACP)
Loss of exocrine function
Exocrine insufficiency in ACP occurs when there is damage to exocrine cells due to inadequate secretion of pancreatic enzymes to maintain normal digestion. Progressive exocrine dysfunction results in the generation of inflammation that disrupts the digestion of fats due to lipase deficiency. This results in impaired absorption of the fat-soluble vitamins A, D, E, and K [32]. Vitamin D deficiency additionally leads to a loss of bone density, ultimately resulting in osteoporosis (Fig 2). The sequel to loss of fat digestion is an impaired incretin-mediated insulin release due to altered GLP-1 secretion from the proximal and distal small bowel in ACP patients [33]. The loss of endocrine and exocrine functions, further add to burden of disease in ACP. The other clinical scenario of exocrine dysfunction is the formation of fluid filled pseudocyst. The repeated episodes of ACP lead to collection of digestive enzymes into a sac walled off by fibrous tissue. A spontaneous resolution of pseudocyst can occur in patients who are given conservative management, such as low-fat diet and treatment through analgesics and antiemetics. But the unresolved pseudocyst can lead to the complications like rupture of the pseudocyst and flow of its fluid into the peritoneal cavity causing increased intra-abdominal pressure, abdominal pain leading to a new organ failure or even death [34].
Figure 2: Flowchart showing complications arising after repeated episodes of ACP
Personalized intervention for management of ACP
Diagnosis of ACP based on molecular markers is precise and can enable targeted therapeutic interventions to halt the inflammatory flares and prevent progression to CP [35]. The management includes surgical and/or endoscopic interventions for patients with unresolved pancreatic fluid pseudocysts using lumen opposing metal stent to prevent rupture of the fluid to mitigate systemic inflammation and to maintain gut barrier function [22]. Pancreatic enzyme replacement therapy (PERT) is used to address emerging exocrine insufficiency during T3cDM and improve glycemic control [36, 37]. Biomarker-guided immunomodulation using drugs such as tocilizumab for lowering high IL-6 levels or Anakinra for targeting elevated IL-1β and
NLRP3 inflammasome activation, can dampen cytokine storms and pyroptosis to avert fibrosis escalation. Emerging anti-fibrotic agents like pirfenidone or TLY012, alongside lifestyle modifications such as alcohol and smoking cessation, can further retard progression by controlling oxidative stress and irreversible pancreatic damage due to ACP [38].
To summarize, ACP, an often-missed clinical entity, is characterized by repeated episodes of pancreatic inflammation and injury, with significant implications for increased morbidity and poor quality of life. The risk of developing ACP is influenced by factors like SO dysfunction, smoking, alcohol consumption and certain medications and therefore, understanding the underlying patho-physiology is essential since recurrent episodes can cause pancreatic tissue damage. Conventional biochemical tests fail to diagnose the onset of an episode of ACP or predict its complications. Our analysis of gaps in research suggests that a diagnostic panel of molecular markers should be established for early intervention. Since limited studies are available on molecular markers, more multi-centric validations are also advocated for instituting their clinical utility. The holistic approach for clinically addressing ACP should include identification of etiology & pathophysiology of the patient using molecular precision diagnosis and risk prediction of possible complications followed by personalized intervention for better management of ACP.
Statement & Declarations
Conflict of interest: The authors declare that they have no conflicts of interest, financial or any other.
Funding: The authors declare that no funds, grants or other support were received during the preparation of this manuscript.
Data availability: Not applicable
Ethics approval: Not applicablea
Consent to participate: Not applicable
Consent to publish: Not applicable
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My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.
Dear Maria Emerson, Editorial Coordinator of International Journal of Clinical Case Reports and Reviews, What distinguishes International Journal of Clinical Case Report and Review is not only the scientific rigor of its publications, but the intellectual climate in which research is evaluated. The submission process is refreshingly free of unnecessary formal barriers and bureaucratic rituals that often complicate academic publishing without adding real value. The peer-review system is demanding yet constructive, guided by genuine scientific dialogue rather than hierarchical or authoritarian attitudes. Reviewers act as collaborators in improving the manuscript, not as gatekeepers imposing arbitrary standards. This journal offers a rare balance: high methodological standards combined with a respectful, transparent, and supportive editorial approach. In an era where publishing can feel more burdensome than research itself, this platform restores the original purpose of peer review — to refine ideas, not to obstruct them Prof. Perlat Kapisyzi, FCCP PULMONOLOGIST AND THORACIC IMAGING.
Dear Grace Pierce, International Journal of Clinical Case Reports and Reviews I appreciate the opportunity to review for Auctore Journal, as the overall editorial process was smooth, transparent and professionally managed. This journal maintains high scientific standards and ensures timely communications with authors, which is truly commendable. I would like to express my special thanks to editor Grace Pierce for his constant guidance, promt responses, and supportive coordination throughout the review process. I am also greatful to Eleanor Bailey from the finance department for her clear communication and efficient handling of all administrative matters. Overall, my experience with Auctore Journal has been highly positive and rewarding. Best regards, Sabita sinha
Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.
