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THE NATURAL COURSE OF ACUTE IDIOPATHIC PANCREATITIS

Lankisch, P. G.1; Breuer, N.1; Bruns, A.1; Weber-Dany, B.1; Maisonneuve, P.2; Lowenfels, A. B.3

Abstracts: Abstracts of Papers Submitted to the 37th Annual Meeting of the American Pancreatic Association and 13th Meeting of the International Association of Pancreatology; November 1-4, 2006, Chicago, Illinois
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1Department of Internal Medicine, Municipal Clinic of Lueneburg, Lueneburg, Germany; 2European Institute of Oncology, Milan, Italy; 3New York Medical College, Valhalla, NY

The aim of our study was to determine the natural course of acute idiopathic pancreatitis (AIP).

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Patients and Methods:

We identified 106 patients with a first attack of AIP admitted to our hospital from 1987-2004. All living patients were interviewed by telephone and questionnaire. For patients who died the cause of death was obtained from their general practitioners.

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Results:

The etiology was not idiopathic in two patients in whom a pancreatic carcinoma (PCA) diagnosed during follow-up was responsible for the first attack.

Thirty-eight (37%) patients died, 9 (9%) during the first attack and 29 (28%) from unrelated causes. None of the latter group experienced any relapse. Sixty-four of the 66 living patients could be contacted, and 8 of these had had recurrent attacks (4: 1 attack, 3: 2 attacks, 1: 3 attacks). With the exception of one relapse which occurred following alcohol abuse the etiology of the others were unknown. In none of the patients did relapsing pancreatitis progress to chronic pancreatitis. One patient developed a PCA 15 years after a single attack of AIP.

Among living patients, recurrence was more frequent in those with a family history of pancreatic disease (AP, PCA, or diabetes mellitus; p = 0.047) and in smokers, although the latter association was not statistically significant (p = 0.17). However, 3 of the 4 patients, who had multiple relapses, were smokers. Neither the prognostic scores (APACHE II, Ranson, Imrie) nor the result of a contrast-enhanced computed tomography (Balthazar score) correlated with the recurrence rate.

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Conclusion:

The relapse rate in patients with AIP is low. A change of etiology is very unlikely. There is no progression from acute to chronic pancreatitis. Patients are advised to stop smoking and to undergo appropriate imaging procedures 3 months after the attack in order to identify the eventual presence of a PCA.

© 2006 Lippincott Williams & Wilkins, Inc.