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Risk of Recurrent Pancreatitis and Progression to Chronic Pancreatitis After a First Episode of Acute Pancreatitis.
Clin Gastroenterol Hepatol 2016; 14(5):738-46CG

Abstract

BACKGROUND & AIMS

Patients with a first episode of acute pancreatitis can develop recurrent or chronic pancreatitis (CP). However, little is known about the incidence or risk factors for these events.

METHODS

We performed a cross-sectional study of 669 patients with a first episode of acute pancreatitis admitted to 15 Dutch hospitals from December 2003 through March 2007. We collected information on disease course, outpatient visits, and hospital readmissions, as well as results from imaging, laboratory, and histology studies. Standardized follow-up questionnaires were sent to all available patients to collect information on hospitalizations and interventions for pancreatic disease, abdominal pain, steatorrhea, diabetes mellitus, medications, and alcohol and tobacco use. Patients were followed up for a median time period of 57 months. Primary end points were recurrent pancreatitis and CP. Risk factors were evaluated using regression analysis. The cumulative risk was assessed using Kaplan-Meier analysis.

RESULTS

Recurrent pancreatitis developed in 117 patients (17%), and CP occurred in 51 patients (7.6%). Recurrent pancreatitis developed in 12% of patients with biliary disease, 24% of patients with alcoholic etiology, and 25% of patients with disease of idiopathic or other etiologies; CP occurred in 3%, 16%, and 10% of these patients, respectively. Etiology, smoking, and necrotizing pancreatitis were independent risk factors for recurrent pancreatitis and CP. Acute Physiology and Chronic Health Evaluation II scores at admission also were associated independently with recurrent pancreatitis. The cumulative risk for recurrent pancreatitis over 5 years was highest among smokers at 40% (compared with 13% for nonsmokers). For alcohol abusers and current smokers, the cumulative risks for CP were similar-approximately 18%. In contrast, the cumulative risk of CP increased to 30% in patients who smoked and abused alcohol.

CONCLUSIONS

Based on a retrospective analysis of patients admitted to Dutch hospitals, a first episode of acute pancreatitis leads to recurrent pancreatitis in 17% of patients, and almost 8% of patients progress to CP within 5 years. Progression was associated independently with alcoholic etiology, smoking, and a history of pancreatic necrosis. Smoking is the predominant risk factor for recurrent disease, whereas the combination of alcohol abuse and smoking produces the highest cumulative risk for chronic pancreatitis.

Authors+Show Affiliations

Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.Department of Surgery, Isala Clinics, Zwolle, The Netherlands.Department of Radiology, St Antonius Hospital, Nieuwegein, The Netherlands.Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.Department of Gastroenterology, Gelderse Vallei Hospital, Ede, The Netherlands.Department of Gastroenterology, Meander Medical Center, Amersfoort, The Netherlands.Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.Department of Surgery and NUTRIM, University Hospital Maastricht, Maastricht, The Netherlands.Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands.Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands.Department of Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands.Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.Department of Evidence Based Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: m.a.boermeester@amc.uva.nl.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

26772149

Citation

Ahmed Ali, Usama, et al. "Risk of Recurrent Pancreatitis and Progression to Chronic Pancreatitis After a First Episode of Acute Pancreatitis." Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, vol. 14, no. 5, 2016, pp. 738-46.
Ahmed Ali U, Issa Y, Hagenaars JC, et al. Risk of Recurrent Pancreatitis and Progression to Chronic Pancreatitis After a First Episode of Acute Pancreatitis. Clin Gastroenterol Hepatol. 2016;14(5):738-46.
Ahmed Ali, U., Issa, Y., Hagenaars, J. C., Bakker, O. J., van Goor, H., Nieuwenhuijs, V. B., ... Boermeester, M. A. (2016). Risk of Recurrent Pancreatitis and Progression to Chronic Pancreatitis After a First Episode of Acute Pancreatitis. Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, 14(5), pp. 738-46. doi:10.1016/j.cgh.2015.12.040.
Ahmed Ali U, et al. Risk of Recurrent Pancreatitis and Progression to Chronic Pancreatitis After a First Episode of Acute Pancreatitis. Clin Gastroenterol Hepatol. 2016;14(5):738-46. PubMed PMID: 26772149.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk of Recurrent Pancreatitis and Progression to Chronic Pancreatitis After a First Episode of Acute Pancreatitis. AU - Ahmed Ali,Usama, AU - Issa,Yama, AU - Hagenaars,Julia C, AU - Bakker,Olaf J, AU - van Goor,Harry, AU - Nieuwenhuijs,Vincent B, AU - Bollen,Thomas L, AU - van Ramshorst,Bert, AU - Witteman,Ben J, AU - Brink,Menno A, AU - Schaapherder,Alexander F, AU - Dejong,Cornelis H, AU - Spanier,B W Marcel, AU - Heisterkamp,Joos, AU - van der Harst,Erwin, AU - van Eijck,Casper H, AU - Besselink,Marc G, AU - Gooszen,Hein G, AU - van Santvoort,Hjalmar C, AU - Boermeester,Marja A, AU - ,, Y1 - 2016/01/06/ PY - 2015/11/10/received PY - 2015/12/09/accepted PY - 2016/1/17/entrez PY - 2016/1/17/pubmed PY - 2016/12/24/medline KW - Chronic Pancreatitis KW - Longitudinal Study KW - Pancreatitis Progression KW - Risk Factors SP - 738 EP - 46 JF - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association JO - Clin. Gastroenterol. Hepatol. VL - 14 IS - 5 N2 - BACKGROUND & AIMS: Patients with a first episode of acute pancreatitis can develop recurrent or chronic pancreatitis (CP). However, little is known about the incidence or risk factors for these events. METHODS: We performed a cross-sectional study of 669 patients with a first episode of acute pancreatitis admitted to 15 Dutch hospitals from December 2003 through March 2007. We collected information on disease course, outpatient visits, and hospital readmissions, as well as results from imaging, laboratory, and histology studies. Standardized follow-up questionnaires were sent to all available patients to collect information on hospitalizations and interventions for pancreatic disease, abdominal pain, steatorrhea, diabetes mellitus, medications, and alcohol and tobacco use. Patients were followed up for a median time period of 57 months. Primary end points were recurrent pancreatitis and CP. Risk factors were evaluated using regression analysis. The cumulative risk was assessed using Kaplan-Meier analysis. RESULTS: Recurrent pancreatitis developed in 117 patients (17%), and CP occurred in 51 patients (7.6%). Recurrent pancreatitis developed in 12% of patients with biliary disease, 24% of patients with alcoholic etiology, and 25% of patients with disease of idiopathic or other etiologies; CP occurred in 3%, 16%, and 10% of these patients, respectively. Etiology, smoking, and necrotizing pancreatitis were independent risk factors for recurrent pancreatitis and CP. Acute Physiology and Chronic Health Evaluation II scores at admission also were associated independently with recurrent pancreatitis. The cumulative risk for recurrent pancreatitis over 5 years was highest among smokers at 40% (compared with 13% for nonsmokers). For alcohol abusers and current smokers, the cumulative risks for CP were similar-approximately 18%. In contrast, the cumulative risk of CP increased to 30% in patients who smoked and abused alcohol. CONCLUSIONS: Based on a retrospective analysis of patients admitted to Dutch hospitals, a first episode of acute pancreatitis leads to recurrent pancreatitis in 17% of patients, and almost 8% of patients progress to CP within 5 years. Progression was associated independently with alcoholic etiology, smoking, and a history of pancreatic necrosis. Smoking is the predominant risk factor for recurrent disease, whereas the combination of alcohol abuse and smoking produces the highest cumulative risk for chronic pancreatitis. SN - 1542-7714 UR - https://www.unboundmedicine.com/medline/citation/26772149/Risk_of_Recurrent_Pancreatitis_and_Progression_to_Chronic_Pancreatitis_After_a_First_Episode_of_Acute_Pancreatitis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1542-3565(16)00004-5 DB - PRIME DP - Unbound Medicine ER -