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Published in: Indian Journal of Gastroenterology 2/2018

01-03-2018 | Original Article

Rate of recurrence in Indian patients presenting with acute pancreatitis and identification of chronicity on follow up: Possible risk factors for progression

Authors: Rishikesh Kalaria, Philip Abraham, Devendra C. Desai, Anand Joshi, Tarun Gupta

Published in: Indian Journal of Gastroenterology | Issue 2/2018

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Abstract

Background

To study the profile and long-term outcome of Indian patients presenting with acute pancreatitis and the possible risk factors for progression.

Methods

Consecutive patients with acute or recurrent acute pancreatitis seen in our department during July 2013 to December 2014 were included. Details of past episodes were collected and patients were followed up till March 2015.

Results

In the 97 patients included (mean age 47.2 [SD 16.9] years; 74 men), gallstones (37 [38.1%]) and alcohol (19 [19.6%]) were the major identified etiologies; the idiopathic (31 [32%]) group constituted a third of patients. Recurrences were more common with idiopathic etiology (14 patients out of 30 had recurrences [46.7%]) as compared to alcoholic (5 out of 19 [26.3%]) and biliary (4 out of 37 [10.8%]) pancreatitis and with mild index episode. Following the episode of acute pancreatitis, identification of chronic pancreatitis was more common with alcoholic (6 out of 18 [33%]) and idiopathic (9 out of 30 [30%]) etiology as compared to other etiologies. Longer duration of follow up, but not number of recurrent episodes, was associated with identification of chronicity in patients presenting as acute pancreatitis.

Conclusions

Out of 97 patients with acute pancreatitis, 27 (27.8%) developed recurrences with risk factors being idiopathic etiology and mild index episode. Eighteen of 97 (18.6%) patients had evidence of chronic pancreatitis on follow up, risk factors being the alcoholic and idiopathic varieties, and longer duration of follow up.
Literature
3.
go back to reference Unnikrishnan AG, Kalra S, Garg MK. Preventing obesity in India: weighing the options. Indian J Endocrinol Metab. 2012;16:4–6. Unnikrishnan AG, Kalra S, Garg MK. Preventing obesity in India: weighing the options. Indian J Endocrinol Metab. 2012;16:4–6.
4.
go back to reference Thomson SR, Hendry WS, McFarlane GA, Davidson AI. Epidemiology and outcome of acute pancreatitis. Br J Surg. 1987;74:398–401. Thomson SR, Hendry WS, McFarlane GA, Davidson AI. Epidemiology and outcome of acute pancreatitis. Br J Surg. 1987;74:398–401.
5.
go back to reference Yadav D, O’Connell M, Papachristou GI. Natural history following the first attack of acute pancreatitis. Am J Gastroenterol. 2012;107:1096–103. Yadav D, O’Connell M, Papachristou GI. Natural history following the first attack of acute pancreatitis. Am J Gastroenterol. 2012;107:1096–103.
6.
go back to reference Xu H, Li Y, Yan J, et al. Severity analysis of acute pancreatitis based on etiology. Zhonghua Yi Xue Za Zhi. 2014;94:3220–3. Xu H, Li Y, Yan J, et al. Severity analysis of acute pancreatitis based on etiology. Zhonghua Yi Xue Za Zhi. 2014;94:3220–3.
7.
go back to reference Zheng Y, Zhou Z, Li H, et al. A multicenter study on etiology of acute pancreatitis in Beijing during 5 years. Pancreas. 2015;44:409–14. Zheng Y, Zhou Z, Li H, et al. A multicenter study on etiology of acute pancreatitis in Beijing during 5 years. Pancreas. 2015;44:409–14.
8.
go back to reference Halonen KI, Pettilä V, Leppäniemi AK, Kemppainen EA, Puolakkainen PA, Haapiainen RK. Long-term health-related quality of life in survivors of severe acute pancreatitis. Intensive Care Med. 2003;29:782–6. Halonen KI, Pettilä V, Leppäniemi AK, Kemppainen EA, Puolakkainen PA, Haapiainen RK. Long-term health-related quality of life in survivors of severe acute pancreatitis. Intensive Care Med. 2003;29:782–6.
9.
go back to reference Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis—2012 revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–11. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis—2012 revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–11.
10.
go back to reference Al-Haddad M, Wallace MB. Diagnostic approach to patients with acute idiopathic and recurrent pancreatitis: what should be done? World J Gastroenterol. 2008;21:1007–10. Al-Haddad M, Wallace MB. Diagnostic approach to patients with acute idiopathic and recurrent pancreatitis: what should be done? World J Gastroenterol. 2008;21:1007–10.
11.
go back to reference Mayerle J, Hoffmeister A, Werner J, Witt H, Lerch MM, Mössner J. Chronic pancreatitis—definition, etiology, investigation and treatment. Dtsch Arztebl Int. 2013;110:387–93. Mayerle J, Hoffmeister A, Werner J, Witt H, Lerch MM, Mössner J. Chronic pancreatitis—definition, etiology, investigation and treatment. Dtsch Arztebl Int. 2013;110:387–93.
12.
go back to reference Wu BU, Johannes RS, Sun X, Tabak Y, Conwell DL, Banks PA. The early prediction of mortality in acute pancreatitis: a large population-based study. Gut. 2008;57:1698–703.CrossRefPubMed Wu BU, Johannes RS, Sun X, Tabak Y, Conwell DL, Banks PA. The early prediction of mortality in acute pancreatitis: a large population-based study. Gut. 2008;57:1698–703.CrossRefPubMed
13.
go back to reference Balthazar EJ, Ranson JH, Naidich DP, Megibow AJ, Caccavale R, Cooper MM. Acute pancreatitis: prognostic value of CT. Radiology. 1985;156:767–72. Balthazar EJ, Ranson JH, Naidich DP, Megibow AJ, Caccavale R, Cooper MM. Acute pancreatitis: prognostic value of CT. Radiology. 1985;156:767–72.
14.
go back to reference Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23:1638–52. Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23:1638–52.
15.
go back to reference Senapati D, Debata PK, Jenasamant SS, Nayak AK, Gowda SM, Swain NN. A prospective study of the bedside index for severity in acute pancreatitis (BISAP) score in acute pancreatitis: an Indian perspective. Pancreatology. 2014;14:335–9. Senapati D, Debata PK, Jenasamant SS, Nayak AK, Gowda SM, Swain NN. A prospective study of the bedside index for severity in acute pancreatitis (BISAP) score in acute pancreatitis: an Indian perspective. Pancreatology. 2014;14:335–9.
16.
go back to reference Talukdar R, Bhattacharrya A, Rao B, Sharma M, Nageshwar Reddy D. Clinical utility of the revised Atlanta classification of acute pancreatitis in a prospective cohort: have all loose ends been tied? Pancreatology. 2014;14:257–62. Talukdar R, Bhattacharrya A, Rao B, Sharma M, Nageshwar Reddy D. Clinical utility of the revised Atlanta classification of acute pancreatitis in a prospective cohort: have all loose ends been tied? Pancreatology. 2014;14:257–62.
17.
go back to reference Lankisch PG, Breuer N, Bruns A, Weber-Dany B, Lowenfels AB, Maisonneuve P. Natural history of acute pancreatitis: a long-term population-based study. Am J Gastroenterol. 2009;104:2797–805. Lankisch PG, Breuer N, Bruns A, Weber-Dany B, Lowenfels AB, Maisonneuve P. Natural history of acute pancreatitis: a long-term population-based study. Am J Gastroenterol. 2009;104:2797–805.
18.
go back to reference Singh VK, Wu BU, Bollen TL, et al. A prospective evaluation of the bedside index for severity in acute pancreatitis score in assessing mortality and intermediate markers of severity in acute pancreatitis. Am J Gastroenterol. 2009;104:966–71. Singh VK, Wu BU, Bollen TL, et al. A prospective evaluation of the bedside index for severity in acute pancreatitis score in assessing mortality and intermediate markers of severity in acute pancreatitis. Am J Gastroenterol. 2009;104:966–71.
19.
go back to reference Khanna AK, Meher S, Prakash S, et al. Comparison of Ranson, Glasgow, MOSS, SIRS, BISAP, APACHE-II, CTSI scores, IL-6, CRP, and procalcitonin in predicting severity, organ failure, pancreatic necrosis, and mortality in acute pancreatitis. HPB Surg. 2013, 2013:367581. Khanna AK, Meher S, Prakash S, et al. Comparison of Ranson, Glasgow, MOSS, SIRS, BISAP, APACHE-II, CTSI scores, IL-6, CRP, and procalcitonin in predicting severity, organ failure, pancreatic necrosis, and mortality in acute pancreatitis. HPB Surg. 2013, 2013:367581.
20.
go back to reference Vipperla K, Papachristou GI, Easler J, et al. Risk of and factors associated with readmission after a sentinel attack of acute pancreatitis. Clin Gastroenterol Hepatol. 2014;12:1911–9. Vipperla K, Papachristou GI, Easler J, et al. Risk of and factors associated with readmission after a sentinel attack of acute pancreatitis. Clin Gastroenterol Hepatol. 2014;12:1911–9.
21.
go back to reference Frey CF, Zhou H, Harvey DJ, White RH. The incidence and case-fatality rates of acute biliary, alcoholic, and idiopathic pancreatitis in California, 1994-2001. Pancreas. 2006;33:336–44. Frey CF, Zhou H, Harvey DJ, White RH. The incidence and case-fatality rates of acute biliary, alcoholic, and idiopathic pancreatitis in California, 1994-2001. Pancreas. 2006;33:336–44.
22.
go back to reference Choi JH, Kim MH, Oh D, et al. Clinical relevance of the revised Atlanta classification focusing on severity stratification system. Pancreatology. 2014;14:324–9. Choi JH, Kim MH, Oh D, et al. Clinical relevance of the revised Atlanta classification focusing on severity stratification system. Pancreatology. 2014;14:324–9.
23.
go back to reference Zhang W, Shan H, Gu Y. Recurrent acute pancreatitis and its relative factors. World J Gastroenterol. 2005;11:3002–4. Zhang W, Shan H, Gu Y. Recurrent acute pancreatitis and its relative factors. World J Gastroenterol. 2005;11:3002–4.
24.
go back to reference Gullo L, Migliori M, Pezzilli R, et al. An update on recurrent acute pancreatitis: data from five European countries. Am J Gastroenterol. 2002;97:1959–62. Gullo L, Migliori M, Pezzilli R, et al. An update on recurrent acute pancreatitis: data from five European countries. Am J Gastroenterol. 2002;97:1959–62.
25.
go back to reference Gao YJ, Li YQ, Wang Q, et al. Analysis of the clinical features of recurrent acute pancreatitis in China. J Gastroenterol. 2006;41:681–5. Gao YJ, Li YQ, Wang Q, et al. Analysis of the clinical features of recurrent acute pancreatitis in China. J Gastroenterol. 2006;41:681–5.
26.
go back to reference Nøjgaard C. Prognosis of acute and chronic pancreatitis—a 30-year follow-up of a Danish cohort. Dan Med Bull. 2010;57:B4228.PubMed Nøjgaard C. Prognosis of acute and chronic pancreatitis—a 30-year follow-up of a Danish cohort. Dan Med Bull. 2010;57:B4228.PubMed
27.
go back to reference Nøjgaard C, Becker U, Matzen P, Andersen JR, Holst C, Bendtsen F. Progression from acute to chronic pancreatitis: prognostic factors, mortality, and natural course. Pancreas. 2011;40:1195–200. Nøjgaard C, Becker U, Matzen P, Andersen JR, Holst C, Bendtsen F. Progression from acute to chronic pancreatitis: prognostic factors, mortality, and natural course. Pancreas. 2011;40:1195–200.
28.
go back to reference Skinazi F, Lévy P, Bernades P. Does acute alcoholic pancreatitis always reveal chronic pancreatitis? Gastroenterol Clin Biol. 1995;19:266–9.PubMed Skinazi F, Lévy P, Bernades P. Does acute alcoholic pancreatitis always reveal chronic pancreatitis? Gastroenterol Clin Biol. 1995;19:266–9.PubMed
29.
go back to reference Ammann RW, Buehler H, Bruehlmann W, Kehl O, Muench R, Stamm B. Acute (nonprogressive) alcoholic pancreatitis: prospective longitudinal study of 144 patients with recurrent alcoholic pancreatitis. Pancreas. 1986;1:195–203. Ammann RW, Buehler H, Bruehlmann W, Kehl O, Muench R, Stamm B. Acute (nonprogressive) alcoholic pancreatitis: prospective longitudinal study of 144 patients with recurrent alcoholic pancreatitis. Pancreas. 1986;1:195–203.
30.
go back to reference Poddar U, Yachha SK, Borkar V, Srivastava A. Is acute recurrent pancreatitis in children a precursor of chronic pancreatitis? A long-term follow-up study of 93 cases. Dig Liver Dis. 2017;49:796–801. Poddar U, Yachha SK, Borkar V, Srivastava A. Is acute recurrent pancreatitis in children a precursor of chronic pancreatitis? A long-term follow-up study of 93 cases. Dig Liver Dis. 2017;49:796–801.
Metadata
Title
Rate of recurrence in Indian patients presenting with acute pancreatitis and identification of chronicity on follow up: Possible risk factors for progression
Authors
Rishikesh Kalaria
Philip Abraham
Devendra C. Desai
Anand Joshi
Tarun Gupta
Publication date
01-03-2018
Publisher
Springer India
Published in
Indian Journal of Gastroenterology / Issue 2/2018
Print ISSN: 0254-8860
Electronic ISSN: 0975-0711
DOI
https://doi.org/10.1007/s12664-018-0818-0

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