A single-centre prospective, cohort study of the natural history of acute pancreatitis. Issue 3 (March 2015) - Cavestro, Giulia Martina
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.