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Trends in the Epidemiology of the First Attack of Acute Pancreatitis: A Systematic Review

Yadav, Dhiraj MD, MPH*; Lowenfels, Albert B. MD

doi: 10.1097/01.mpa.0000236733.31617.52

Objective: To systematically review trends in the epidemiology of the first attack of acute pancreatitis (AP) based on reported population-based studies.

Methods: From Medline, we retrieved 18 full-length English language peer-reviewed original articles published from 1966 to June 2005 with population-based information on the epidemiology of first-attack AP. Trends over time were analyzed based on study- and country-specific data and the study site (UK vs non-UK).

Results: Eight studies were from the UK and 10 from other European centers. An increase in the annual incidence per 100,000 for first-attack AP was reported in 10 of 12 studies with longitudinal data from 4 countries (UK, Sweden, Denmark, and Netherlands). The overall AP incidence seems to be higher in non-UK studies compared with that of UK, partly explained by a higher incidence of alcoholic pancreatitis in non-UK studies. A linear trend for increase in gallstone pancreatitis incidence over time was observed irrespective of the study site (UK or non-UK). The AP incidence and mortality increased with age. Gallstone pancreatitis was more common in female subjects, and alcoholic pancreatitis was more common in middle-aged male subjects. The AP case fatality (%) has decreased over time, but the overall population mortality rate per 100,000 has remained unchanged. Recurrence after the first attack is milder with a substantially lower mortality.

Conclusions: The incidence of AP seems to be increasing. Differences in the incidence and etiology between and within countries reflect differences in the risk factor prevalence. Case-fatality rate, but not the population-based mortality rate, decreased over time.

From the *Division of Gastroenterology and Hepatology, John L. McClellan Memorial Veterans Hospital & University of Arkansas for Medical Sciences, Little Rock, Arkansas; and †Department of Surgery, New York Medical College, Valhalla, New York.

Received for publication March 24, 2006; accepted July 11, 2006.

Disclosure: Dr. Lowenfels is supported in part by the C. D. Smithers Foundation.

Part of this article was presented as a poster at the 2006 American Gastroenterological Association meeting in Los Angeles, California.

This study was supported by a grant-in-aid from Solvay Pharmaceuticals.

Reprints: Dhiraj Yadav, MD, MPH, Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh School of Medicine, 200 Lothrop Street PUH, M2, C-wing, Pittsburgh, PA 15213 (e-mail:

© 2006 Lippincott Williams & Wilkins, Inc.