Skip to main content

Advertisement

SpringerLink
Log in

Recurrent Acute Pancreatitis: Clinical Profile and an Approach to Diagnosis

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background and Aims

Though recurrent acute pancreatitis is often seen in clinical practice, there are few comprehensive articles on this entity. The aim of this study therefore was to assess the etiological and clinical profile as well as diagnostic yield of non-invasive and invasive tests in this group of patients.

Methods

All patients with recurrent acute pancreatitis seen from 2002 to 2007 were included in the study, retrospectively. Clinical information, investigation, and treatment data were collected for all patients by a standardized review of medical charts. Diagnostic tests were grouped into level one (non-invasive) and level two (invasive) tests and their yield was assessed. Comparison was made between the group with known etiology and idiopathic group to look for significant differences.

Results

A total of 188 patients with recurrent acute pancreatitis were seen during the study period. Common etiological factors were biliary disease (37%), pancreas divisum (8.5%) and alcohol (6.4%). Multiple etiologies were seen in 7% of cases, and no cause was found in 32.4%. The diagnostic yield of level-one investigation (non-invasive) was 29.3%. Level-two tests (invasive) identified presumptive etiologies in 38.3% of cases. Complications developed in 12.2% and there was no mortality. Clinical features and complications were similar in the idiopathic group and those with known etiology.

Conclusions

Etiological diagnosis was obtained in 67.6% of patients after comprehensive diagnostic work up. Diagnosis in the majority of patients could only be reached after invasive tests (bile crystal analysis, EUS, ERCP). Early diagnosis and etiology-based therapy is the key to optimum patient outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Bradley EL. 3rd. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, GA, September 11 through 13, 1992. Arch Surg. 1993;128:586–590.

    PubMed  Google Scholar 

  2. Lankisch PG, Blum T, Maisonneuve P, Lowenfels AB. Severe acute pancreatitis: when to be concerned? Pancreatology. 2003;3:102–110.

    Article  PubMed  Google Scholar 

  3. Gao YJ, Li YQ, Wang Q, et al. Analysis of the clinical features of recurrent acute pancreatitis in China. J Gastroenterol. 2006;41:681–685.

    Article  PubMed  Google Scholar 

  4. Zhang W, Shan HC, Gu Y. Recurrent acute pancreatitis and its relative factors. World J Gastroenterol. 2005;11:3002–3004.

    PubMed  Google Scholar 

  5. Gullo L, Migliori M, Pezzilli R, et al. An update on recurrent acute pancreatitis: Data from five European countries. Am J Gastroenterol. 2002;97:1959–1962.

    Article  PubMed  Google Scholar 

  6. Kaw M, Brodmerkel GJ Jr. ERCP, biliary crystal analysis, and sphincter of Oddi manometry in idiopathic recurrent pancreatitis. Gastrointest Endosc. 2002;55:157–162.

    Article  PubMed  Google Scholar 

  7. Testoni PA, Caporuscio S, Bagnolo F, Lella F. Idiopathic recurrent pancreatitis: long-term results after ERCP, endoscopic sphincterotomy, or ursodeoxycholic acid treatment. Am J Gastroenterol. 2000;95:1702–1707.

    Article  CAS  PubMed  Google Scholar 

  8. Katsinelos P, Dimiropoulos S, Katsiba D, et al. Acute recurrent pancreatitis associated with anomalous pancreaticobiliary ductal union and choledochal cyst of mixed type I plus II. Surg Endosc. 2003;17:162.

    CAS  PubMed  Google Scholar 

  9. Kim BK, Kim MJ, Chang WC, Yoo KH, Shin YG, Chung CH. Recurrent acute pancreatitis in a patient with type IIb hyperlipoproteinemia: a case report and review of the literature in Korea. Yonsei Med J. 2006;47:144–147.

    Article  PubMed  Google Scholar 

  10. Moreno Gonzalez E, Ibanez Aguirre J, Rico Selas P, et al. Recurrent acute pancreatitis as a complication of cystic fibrosis: report of one case treated surgically. Ann Ital Chir. 1991;62:345–347. discussion 347–348.

    CAS  PubMed  Google Scholar 

  11. Venu RP, Geenen JE, Hogan W, Stone J, Johnson GK, Soergel K. Idiopathic recurrent pancreatitis. An approach to diagnosis and treatment. Dig Dis Sci. 1989;34:56–60.

    Article  CAS  PubMed  Google Scholar 

  12. Thomson SR, Hendry WS, McFarlane GA, Davidson AI. Epidemiology and outcome of acute pancreatitis. Br J Surg. 1987;74:398–401.

    Article  CAS  PubMed  Google Scholar 

  13. Yadav Dhiraj, Albert Lowenfels B. Trends in the epidemiology of the first attack of acute pancreatitis. A systematic review. Pancreas. 2006;33:323–330.

    Article  PubMed  Google Scholar 

  14. Trapnell JE, Duncan EH. Patterns of incidence in acute pancreatitis. Br Med J. 1975;2:179–183.

    Article  CAS  PubMed  Google Scholar 

  15. Li ZS. Progress in endoscopic management of pancreas diseases. World J Gastroenterol. 1998;4:178–180.

    PubMed  Google Scholar 

  16. Axon AT, Classen M, Cotton PB, Cremer M, Freeny PC, Lees WR. Pancreatography in chronic pancreatitis: international definitions. Gut. 1984;25:1107–1112.

    Article  CAS  PubMed  Google Scholar 

  17. Fortson MR, Freedman SN, Webster PD 3rd. Clinical assessment of hyperlipidemic pancreatitis. Am J Gastroenterol. 1995;90:2134–2139.

    CAS  PubMed  Google Scholar 

  18. Toniato A, Boschin IM, Piotto A, Pelizzo M, Sartori P. Thyroidectomy and parathyroid hormone: tracing hypocalcemia-prone patients. Am J Surg. 2008;196:285–288.

    Article  CAS  PubMed  Google Scholar 

  19. Guelrud M, Morera C, Rodriguez M, Prados JG, Jaen D. Normal and anomalous pancreaticobiliary union in children and adolescents. Gastrointest Endosc. 1999;50:189–193.

    Article  CAS  PubMed  Google Scholar 

  20. Somogyi L, Martin SP, Venkatesan T, Ulrich CD 2nd. Recurrent acute pancreatitis: an algorithmic approach to identification and elimination of inciting factors. Gastroenterology. 2001;120:708–717.

    Article  CAS  PubMed  Google Scholar 

  21. Billi P, Barakat B, D’Imperio N, Pezzilli R. Relapses of biliary acute pancreatitis in patients with previous attack of biliary pancreatitis and gallbladder in situ. Dig Liver Dis. 2003;35:653–655.

    Article  CAS  PubMed  Google Scholar 

  22. Jungst C, Kullak-Ublick GA, Jungst D. Gallstone disease: microlithiasis and sludge. Best Pract Res Clin Gastroenterol. 2006;20:1053–1062.

    Article  PubMed  Google Scholar 

  23. Negro P, Flati G, Flati D, Porowska B, Tuscano D, Carboni M. Occult gallbladder microlithiasis causing acute recurrent pancreatitis. A report of three cases. Acta Chir Scand. 1984;150:503–506.

    CAS  PubMed  Google Scholar 

  24. Levy MJ, Geenen JE. Idiopathic acute recurrent pancreatitis. Am J Gastroenterol. 2001;96:2540–2555.

    Article  CAS  PubMed  Google Scholar 

  25. Garg PK, Tandon RK, Madan K. Is biliary microlithiasis a significant cause of idiopathic recurrent acute pancreatitis? a long-term follow-up study. Clin Gastroenterol Hepatol. 2007;5:75–79.

    Article  PubMed  Google Scholar 

  26. Ros E, Navarro S, Bru C, Garcia-Puges A, Valderrama R. Occult microlithiasis in ‘idiopathic’ acute pancreatitis: prevention of relapses by cholecystectomy or ursodeoxycholic acid therapy. Gastroenterology. 1991;101:1701–1709.

    CAS  PubMed  Google Scholar 

  27. Delhaye M, Engelholm L, Cremer M. Pancreas divisum: congenital anatomic variant or anomaly? contribution of endoscopic retrograde dorsal pancreatography. Gastroenterology. 1985;89:951–958.

    CAS  PubMed  Google Scholar 

  28. Morgan DE, Logan K, Baron TH, Koehler RE, Smith JK. Pancreas divisum: implications for diagnostic and therapeutic pancreatography. AJR Am J Roentgenol. 1999;173:193–198.

    CAS  PubMed  Google Scholar 

  29. Bernard JP, Sahel J, Giovannini M, Sarles H. Pancreas divisum is a probable cause of acute pancreatitis: a report of 137 cases. Pancreas. 1990;5:248–254.

    Article  CAS  PubMed  Google Scholar 

  30. Brenner P, Duncombe V, Ham JM. Pancreatitis and pancreas divisum: aetiological and surgical considerations. Aust N Z J Surg. 1990;60:899–903.

    Article  CAS  PubMed  Google Scholar 

  31. Lans JI, Geenen JE, Johanson JF, Hogan WJ. Endoscopic therapy in patients with pancreas divisum and acute pancreatitis: a prospective, randomized, controlled clinical trial. Gastrointest Endosc. 1992;38:430–434.

    Article  CAS  PubMed  Google Scholar 

  32. Lehman GA, Sherman S, Nisi R, Hawes RH. Pancreas divisum: results of papilla sphincterotomy. Gastrointest Endosc. 1993;39:1–8.

    Article  CAS  PubMed  Google Scholar 

  33. Ertan A. Long-term results after endoscopic pancreatic stent placement without pancreatic papillotomy in acute recurrent pancreatitis due to pancreas divisum. Gastrointest Endosc. 2000;52:9–14.

    Article  CAS  PubMed  Google Scholar 

  34. Gerke H, Byrne MF, Stiffler HL, et al. Outcome of endoscopic minor papillotomy in patients with symptomatic pancreas divisum. Jop. 2004;5:122–131.

    PubMed  Google Scholar 

  35. Aoun E, Slivka A, Papachristou DJ, Gleeson FC, Whitcomb DC, Papachristou GI. Rapid evolution from the first episode of acute pancreatitis to chronic pancreatitis in human subjects. Jop. 2007;8:573–578.

    PubMed  Google Scholar 

  36. Coyle WJ, Pineau BC, Tarnasky PR, et al. Evaluation of unexplained acute and acute recurrent pancreatitis using endoscopic retrograde cholangiopancreatography, sphincter of Oddi manometry and endoscopic ultrasound. Endoscopy. 2002;34:617–623.

    Article  CAS  PubMed  Google Scholar 

  37. Feller ER. Endoscopic retrograde cholangiopancreatography in the diagnosis of unexplained pancreatitis. Arch Intern Med. 1984;144:1797–1799.

    Article  CAS  PubMed  Google Scholar 

  38. Aliperti G. Complications related to diagnostic and therapeutic endoscopic retrograde cholangiopancreatography. Gastrointest Endosc Clin N Am. 1996;6:379–407.

    CAS  PubMed  Google Scholar 

  39. Yusoff IF, Raymond G, Sahai AV. A prospective comparison of the yield of EUS in primary vs. recurrent idiopathic acute pancreatitis. Gastrointest Endosc. 2004;60:673–678.

    Article  PubMed  Google Scholar 

  40. Rocca R, De Angelis C, Castellino F, et al. EUS diagnosis and simultaneous endoscopic retrograde cholangiography treatment of common bile duct stones by using an oblique-viewing echoendoscope. Gastrointest Endosc. 2006;63:479–484.

    Article  PubMed  Google Scholar 

  41. Varghese JC, Liddell RP, Farrell MA, Murray FE, Osborne H, Lee MJ. The diagnostic accuracy of magnetic resonance cholangiopancreatography and ultrasound compared with direct cholangiography in the detection of choledocholithiasis. Clin Radiol. 1999;54:604–614.

    Article  CAS  PubMed  Google Scholar 

  42. Toouli J, Roberts-Thomson IC, Dent J, Lee J. Sphincter of Oddi motility disorders in patients with idiopathic recurrent pancreatitis. Br J Surg. 1985;72:859–863.

    Article  CAS  PubMed  Google Scholar 

  43. Whitcomb DC, Yadav D, Adam S, Hawes RH, et al. Multicenter approach to recurrent acute and chronic pancreatitis in the United States: the North American Pancreatitis Study 2 (NAPS2). Pancreatology. 2008;8:520–531.

    Article  PubMed  Google Scholar 

  44. Choudari CP, Imperiale TF, Sherman S, Fogel E, Lehman GA. Risk of pancreatitis with mutation of the cystic fibrosis gene. Am J Gastroenterol. 2004;99:1358–1363.

    Article  CAS  PubMed  Google Scholar 

  45. Thomas M, Catalano MF, Geenen JE. Idiopathic Recurrent Pancreatitis: Does it progress to chronic pancreatitis? G I Endoscopy. 2004;59(5) Abstract T1546.

Download references

Acknowledgments

Conflict of Interest Statement

The authors declare that there are no conflicts of interests. No grants were received for this study.

Author information

Authors and Affiliations

  1. Department of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, 632 004, India

    K. G. Sajith, Ashok Chacko & Amit Kumar Dutta

Authors
  1. K. G. Sajith
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashok Chacko
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amit Kumar Dutta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ashok Chacko.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sajith, K.G., Chacko, A. & Dutta, A.K. Recurrent Acute Pancreatitis: Clinical Profile and an Approach to Diagnosis. Dig Dis Sci 55, 3610–3616 (2010). https://doi.org/10.1007/s10620-010-1175-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-010-1175-8

Keywords

Search

Navigation