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Recurrent Acute Pancreatitis: International State-of-the-Science Conference With Recommendations

Guda, Nalini, M., MD*; Muddana, Venkata, MD*; Whitcomb, David, C., MD, PhD; Levy, Philippe, MD; Garg, Pramod, MD§; Cote, Gregory, MD; Uc, Aliye, MD; Varadarajulu, Shyam, MD#; Vege, Santhi, S., MD**; Chari, Suresh, T., MD**; Forsmark, Chris, E., MD††; Yadav, Dhiraj, MD, MPH; Reddy, D., Nageshwar, MD‡‡; Tenner, Scott, MD§§; Johnson, Colin, D., MChir, FRCS∥∥; Akisik, Fatih, MD¶¶; Saluja, Ashok, K., PhD##; Lerch, Markus, M., MD***; Mallery, J., Shawn, MD†††; Freeman, Martin, L., MD†††

doi: 10.1097/MPA.0000000000001053
Conference Report

Recurrent acute pancreatitis (RAP) is a clinically significant problem globally. The etiology remains unclear in approximately 10% to 15% of patients despite a thorough workup. Data on natural history and efficacy of treatments are limited. We aimed to establish criteria for diagnosis, evaluate the causative factors, and arrive at a consensus on the appropriate workup and management of patients with RAP. The organizing committee was formed, and a set of questions was developed based on the current evidence, controversies, and topics that needed further research. After a vetting process, these topics were assigned to a group of experts from around the world with special interest in RAP. Data were presented as part of a workshop on RAP organized as a part of the annual meeting of the America Pancreatic Association. Pretest and Posttest questions were administered, and the responses were tabulated by the current Grades of Recommendation Assessment, Development and Evaluation system. The consensus guidelines were established in the format of a diagnostic algorithm. Several deficiencies were identified with respect to data on etiology, treatment efficacies, and areas that need immediate research.

From the *Department of Gastroenterology, Aurora St Luke's Medical Center, Milwaukee, WI;

Department of Medicine, University of Pittsburgh, Pittsburgh, PA;

Pôle des Maladies de l'Appareil Digestif, Service de Gastroentérologie-Pancréatologie, APHP, Hôpital Beaujon, Clichy, France;

§Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India;

Department of Gastroenterology, Medical University of South Carolina, Charleston, SC;

University of Iowa Stead Family Children's Hospital, Iowa City, IA;

#Center for Interventional Endoscopy, Florida Hospital, Orlando, FL;

**Department of Gastroenterology, Mayo Clinic, Rochester, MN;

††Department of Gastroenterology, University of South Florida, Gainesville, FL;

‡‡Asian Institute of Gastroenterology, Hyderabad, India;

§§Department of Gastroenterology, State University of New York, Brooklyn, NY;

∥∥Department of Surgery, University of Southampton, Southampton, United Kingdom;

¶¶Department of Radiology, Indiana University School of Medicine, Indianapolis, IN;

##Department of Surgery, University of Miami, Miami, FL;

***Department of Medicine A, University Medicine Greifswald, Greifswald, Germany; and

†††Division of Gastroenterology, University of Minnesota, Minneapolis, MN.

Received for publication December 17, 2017; accepted March 2, 2018.

Address correspondence to: Martin L. Freeman, MD, University of Minnesota, MMC 36, 420 Delaware St SE, Minneapolis, MN 55455 (e-mail: freem020@umn.edu).

This meeting was conducted as a part of the annual meeting of the American Pancreatic Association.

Conflicts of interest: DCW: Consultant for Ariel Precision Medicine, Pittsburgh, PA.

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