Giulia Martina Cavestro1, Gioacchino Leandro2, Milena Di Leo3, Raffaella Alessia Zuppardo3, Olivia B Morrow4, Chiara Notaristefano5, Gemma Rossi3, Sabrina Gloria Giulia Testoni3, Giorgia Mazzoleni3, Matteo Alessandri3, Elisabetta Goni4, Satish K Singh6, Aurore Giliberti2, Margherita Bianco2, Lorella Fanti5, Edi Viale5, Paolo Giorgio Arcidiacono5, Alberto Mariani5, Maria Chiara Petrone5, Pier Alberto Testoni3. 1. Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, Milan, Italy. Electronic address: cavestro.giuliamartina@hsr.it. 2. Gastroenterology Unit 1, Gastroenterological Hospital 'S. De Bellis' IRCCS, Castellana Grotte, Italy. 3. Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, Milan, Italy. 4. Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, Milan, Italy. 5. Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy. 6. Boston University School of Medicine and Boston Medical Center, Section of Gastroenterology, United States.
Abstract
BACKGROUND: The natural history of acute pancreatitis is based on clinical studies that aim to elucidate the course of disease on the basis of predicted risk factors. AIMS: To evaluate the long-term occurrence of recurrent acute pancreatitis and chronic pancreatitis in a cohort of patients following an initial episode of acute pancreatitis. METHODS: 196 patients were enrolled consecutively and studied prospectively. Clinical characteristics, exogenously/endogenously-associated factors, and evolution to recurrent acute pancreatitis and chronic pancreatitis were analyzed. RESULTS: 40 patients developed recurrent acute pancreatitis 13 of whom developed chronic pancreatitis. In a univariate analysis, recurrent acute pancreatitis was associated with an idiopathic aetiology (p<0.001), pancreas divisum (p=0.001), and higher usage of cigarettes and alcohol (p<0.001; p=0.023). Chronic pancreatitis was associated with a severe first episode of acute pancreatitis (p=0.048), PD (p=0.03), and cigarette smoking (p=0.038). By multivariate analysis, pancreas divisum was an independent risk factor for recurrent acute pancreatitis (OR 11.5, 95% CI 1.6-83.3). A severe first-episode of acute pancreatitis increased the risk of progressing to chronic pancreatitis by nine-fold. CONCLUSIONS: Special attention should be given to patients who experience a severe first attack of acute pancreatitis as there appears to be an increased risk of developing chronic pancreatitis over the long term.
BACKGROUND: The natural history of acute pancreatitis is based on clinical studies that aim to elucidate the course of disease on the basis of predicted risk factors. AIMS: To evaluate the long-term occurrence of recurrent acute pancreatitis and chronic pancreatitis in a cohort of patients following an initial episode of acute pancreatitis. METHODS: 196 patients were enrolled consecutively and studied prospectively. Clinical characteristics, exogenously/endogenously-associated factors, and evolution to recurrent acute pancreatitis and chronic pancreatitis were analyzed. RESULTS: 40 patients developed recurrent acute pancreatitis 13 of whom developed chronic pancreatitis. In a univariate analysis, recurrent acute pancreatitis was associated with an idiopathic aetiology (p<0.001), pancreas divisum (p=0.001), and higher usage of cigarettes and alcohol (p<0.001; p=0.023). Chronic pancreatitis was associated with a severe first episode of acute pancreatitis (p=0.048), PD (p=0.03), and cigarette smoking (p=0.038). By multivariate analysis, pancreas divisum was an independent risk factor for recurrent acute pancreatitis (OR 11.5, 95% CI 1.6-83.3). A severe first-episode of acute pancreatitis increased the risk of progressing to chronic pancreatitis by nine-fold. CONCLUSIONS: Special attention should be given to patients who experience a severe first attack of acute pancreatitis as there appears to be an increased risk of developing chronic pancreatitis over the long term.
Authors: Haq Nawaz; Efstratios Koutroumpakis; Jeffrey Easler; Adam Slivka; David C Whitcomb; Vijay P Singh; Dhiraj Yadav; Georgios I Papachristou Journal: Am J Gastroenterol Date: 2015-09-01 Impact factor: 10.864