Recurrent and Relapsing Pancreatitis
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Recurrent acute pancreatitis is a common clinical problem. Most cases of pancreatitis are identified by a careful history and physical examination. Despite advanced evaluation, the cause is not apparent in about 10% of cases. The etiology of recurrent acute pancreatitis appears to be multifactorial, with genetic and environmental influences playing a significant role. The strength of evidence for certain etiologies is highly variable, and natural history data are limited. Controversy exists regarding the most appropriate diagnostic and therapeutic approach. Recurrent acute pancreatitis often represents a continuum with chronic pancreatitis.
KeywordsPancreatitis Recurrent acute pancreatitis Idiopathic pancreatitis Endoscopic retrograde cholangiopancreatography Endoscopic ultrasound Magnetic resonance cholangiopancreatography
Conflicts of interest: N.M. Guda—grant support, Cook, Inc.; J. Romagnuolo—consultancy, Olympus, grant support, Sanofi, Merck, Pfizer, NIH, ASGE, and CIHR, honoraria and speakers’ honoraria, Cook Endoscopy, and travel reimbursement, Epigenomics and Pfizer; and M.L. Freeman—honoraria, Boston Scientific and Cook, Inc.
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- 6.Guda N, Partington S, Catalano MF, et al.: Idiopathic acute recurrent pancreatitis:lack of uniform standards in diagnosis and treatment and need for consensus [abstract]. Gastrointest Endosc 2007, 65.Google Scholar
- 8.• Romagnuolo J, Guda N, Freeman M, Durkalski V: Preferred designs, outcomes, and analysis strategies for treatment trials in idiopathic recurrent acute pancreatitis. Gastrointest Endosc 2008, 68:966–974. This article explains the problems with the current studies and outlines methods needed to study recurrent acute pancreatitis, including discussion of harder outcomes and quality-of-life issues in recurrent pancreatitis.CrossRefPubMedGoogle Scholar
- 10.• Whitcomb DC, Yadav D, Adam S, 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. This article describes a large, multicenter study of recurrent pancreatitis, including phenotype, risk factors, and genetic issues associated with the disease. Its strength is the large number of patients included and involvement of various centers in developing comprehensive data on the subject.CrossRefPubMedGoogle Scholar
- 11.• Yadav D, Hawes RH, Brand RE, et al.: Alcohol consumption, cigarette smoking, and the risk of recurrent acute and chronic pancreatitis. Arch Intern Med 2009, 169:1035–1045. This article describes a large epidemiological study highlighting the risk of smoking and alcohol and their combined effects on pathogenesis of chronic pancreatitis.CrossRefPubMedGoogle Scholar
- 23.Blondet JJ, Carlson AM, Kobayashi T, et al.: The role of total pancreatectomy and islet autotransplantation for chronic pancreatitis. Surg Clin North Am 2007, 87:1477–501, x.Google Scholar
- 28.• Chari ST: Diagnosis of autoimmune pancreatitis using its five cardinal features: introducing the Mayo Clinic’s HISORt criteria. J Gastroenterol 2007, 42(Suppl 18):39–41. This article highlights the problem of autoimmune pancreatitis and explains the clinical features that aid in diagnosis along with the important features distinguishing between the various types of autoimmune pancreatitis.CrossRefPubMedGoogle Scholar