Impact of recurrent acute pancreatitis on the natural history and progression to chronic pancreatitis |
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| Affiliation: | 1. Division of Gastroenterology, Department of Internal Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA;2. Department of Internal Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA;3. Division of Gastroenterology, Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA;1. Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA;2. Family Medicine, Mercy Health, Toledo, OH, USA;1. Department of HPB Surgery and Transplantation, La Fe University Hospital and University of Valencia, Valencia, Spain;2. Department of General and Pancreatic Surgery, Verona Hospital Trust, University of Verona, Verona, Italy;3. Department of Nephrology and Kidney Transplantation, La Fe University Hospital and University of Valencia, Valencia, Spain;4. Department of Endocrinology, La Fe University Hospital and University of Valencia, Valencia, Spain;1. Department of Radiology, Cincinnati Children''s Hospital Medical Center, Cincinnati, OH, USA;2. Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA;3. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA;4. Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children''s Hospital Medical Center, Cincinnati, OH, USA;5. Division of Endocrinology, Cincinnati Children''s Hospital Medical Center, Cincinnati, OH, USA;6. Division of Pediatric General and Thoracic Surgery, Cincinnati Children''s Hospital Medical Center, Cincinnati, OH, USA;1. Division of Oncology and Hematology, Okinawa Chubu Hospital, Okinawa, Japan;2. Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan;3. Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan;4. Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan;5. Department of Biostatistics, Clinical Research Support Center, Shizuoka Cancer Center, Shizuoka, Japan;6. Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan;7. Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan;8. Division of Gastroenterology, Chiba Cancer Center, Chiba, Japan;9. Hepato-Biliary-Pancreatic Medicine Department, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan;10. Department of Medical Oncology, Kyorin University Faculty of Medicine, Tokyo, Japan;11. Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan;12. Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan;13. Division of Cancer Center, Hokkaido University Hospital, Sapporo, Japan;14. Department of Gastroenterology, Kanazawa University, Kanazawa, Japan;15. Department of Gastroenterological Oncology, Hyogo Cancer Center, Hyogo, Japan;p. Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan;q. Department of Internal Medicine, Niigata Cancer Center Hospital, Niigata, Japan;r. Department of Gastrointestinal Medical Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan;s. Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan;t. Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan;u. Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan;v. Department of Hepato-Biliary-Pancreatology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan;w. Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan;x. Department of Gastroenterology, Fukushima Medical University, School of Medicine, Fukushima, Japan;y. Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan;1. Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, USA;2. Department of Radiology, University of Minnesota, USA;3. Clinical and Translational Science Institute, Biostatistical Design and Analysis Center, University of Minnesota, USA |
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| Abstract: | Background and aimsIt is believed that acute pancreatitis (AP), recurrent AP (RAP) and chronic pancreatitis (CP) represent stages of the same disease spectrum. We aimed to identify risk factors, clinical presentation and outcomes in patients with prior RAP who develop CP.MethodsWe retrospectively reviewed patients with CP who were seen at our Pancreas Center during 2016–2021. We divided them into two groups: with and without RAP (≥2 episodes of AP). We compared demographics, clinical presentation and resource utilization between the two groups.ResultsWe identified 440 patients with CP, of which 283 (64%) patients had preceding RAP. These patients were younger (55.6 vs 63.1 years), active smokers (36% vs 20%) and had alcohol-related CP (49% vs 25%) compared to those without RAP and CP (p < 0.05). More patients with RAP had chronic abdominal pain (89% vs 67.9%), nausea (43.3% vs 27.1%) and exocrine pancreatic insufficiency (65.8% vs 46.5%) (p < 0.05). More patients with RAP used opioids (58.4% vs 32.3%) and gabapentinoids (56.6% vs 34.8%) (p < 0.05). They also had more ED visits resulting in an opioid prescription (9.68% vs 2%) and more CP flares requiring hospitalization (3.09 vs 0.87) (p < 0.05).ConclusionYoung age, smoking and alcohol use are seen in patients with RAP who progress to CP. These patients are highly symptomatic and use more healthcare resources, suggestive of an overall a more course compared to those patients who develop CP without preceding RAP. Early identification and counselling of these patients may slow down progression to CP. |
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| Keywords: | Recurrent acute pancreatitis Chronic pancreatitis Alcohol use disorder Opioid use disorder Smoking |
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