Skip to main content

Advertisement

Log in

The changing character of acute pancreatitis: Epidemiology, etiology, and prognosis

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Acute pancreatitis continues to be a diagnostic and therapeutic challenge for physicians and surgeons. It ranks third in the list of hospital discharges for gastro intestinal diseases. In most patients the cause is either gallstones or alcoholism. The overall mortality is less than 5%, but severe acute pancreatitis leads to prolonged hospitalization and much higher mortality. There are important differences in disease susceptibility and case fatality rates: the incidence is higher in blacks than in whites, and mortality is higher in older patients than in younger patients. Reports from various countries reveal that the frequency of acute pancreatitis is increasing, perhaps in relation to rising obesity rates, which would increase the likelihood of gallstone pancreatitis. Conversely, mortality rates for acute pancreatitis are declining in many, but not all, reports.

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

Access this article

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

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Fagenholz PJ, Fernandez-Del Castillo C, Harris NS, et al.: Direct medical costs of acute pancreatitis hospitalizations in the United States. Pancreas 2007, 35:302–307.

    Article  PubMed  Google Scholar 

  2. Wu BU, Johannes RS, Kurtz S, Banks PA: The impact of hospital-acquired infection on outcome in acute pancreatitis. Gastroenterology 2008, 135:816–820.

    Article  PubMed  Google Scholar 

  3. Acute Pancreatitis Classification Working Group: Revision of the Atlanta Classification of Acute Pancreatitis 28 July 2008. Available at http://www.suizou.org/Atlanta_ Classification.pdf. Accessed February 2, 2009.

  4. Bollen TL, van Santvoort HC, Besselink MG, et al.: The Atlanta classification of acute pancreatitis revisited. Br J Surg 2008, 95:6–21.

    Article  PubMed  CAS  Google Scholar 

  5. Shaheen NJ, Hansen RA, Morgan DR, et al.: The burden of gastrointestinal and liver diseases, 2006. Am J Gastroenterol 2006, 101:2128–2138.

    Article  PubMed  Google Scholar 

  6. Fagenholz PJ, Fernandez-Del Castillo C, Harris NS, et al.: National study of United States emergency department visits for acute pancreatitis, 1993–2003. BMC Emerg Med 2007, 7:1.

    Article  PubMed  Google Scholar 

  7. Yang AL, Vadhavkar S, Singh G, Omary MB: Epidemiology of alcohol-related liver and pancreatic disease in the United States. Arch Intern Med 2008, 168:649–656.

    Article  PubMed  Google Scholar 

  8. Kandula L, Lowe ME: Etiology and outcome of acute pancreatitis in infants and toddlers. J Pediatr 2008, 152:106–110.

    Article  PubMed  Google Scholar 

  9. Yadav D, Lowenfels AB: Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review. Pancreas 2006, 33:323–330.

    Article  PubMed  Google Scholar 

  10. 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, 33:336–344.

    Article  PubMed  Google Scholar 

  11. Brown A, Young B, Morton J, et al.: Are health related outcomes in acute pancreatitis improving? An analysis of national trends in the U.S. from 1997 to 2003. JOP 2008, 9:408–414.

    PubMed  Google Scholar 

  12. O’Farrell A, Allwright S, Toomey D, et al.: Hospital admission for acute pancreatitis in the Irish population, 1997–2004: Could the increase be due to an increase in alcohol-related pancreatitis? J Public Health (Oxf) 2007, 29:398–404.

    Article  CAS  Google Scholar 

  13. Roberts SE, Williams JG, Meddings D, Goldacre MJ: Incidence and case fatality for acute pancreatitis in England: geographical variation, social deprivation, alcohol consumption and aetiology—a record linkage study. Aliment Pharmacol Ther 2008, 28:931–941.

    Article  PubMed  CAS  Google Scholar 

  14. Frossard JL, Steer ML, Pastor CM: Acute pancreatitis. Lancet 2008, 371:143–152.

    Article  PubMed  Google Scholar 

  15. Vonlaufen A, Apte MV, Imhof BA, Frossard JL: The role of inflammatory and parenchymal cells in acute pancreatitis. J Pathol 2007, 213:239–248.

    Article  PubMed  CAS  Google Scholar 

  16. Elfar M, Gaber LW, Sabek O, et al.: The inflammatory cascade in acute pancreatitis: relevance to clinical disease. Surg Clin North Am 2007, 87:1325–1340, vii.

    Article  PubMed  Google Scholar 

  17. Jerrells TR, Vidlak D, Strachota JM: Alcoholic pancreatitis: mechanisms of viral infections as cofactors in the development of acute and chronic pancreatitis and fibrosis. J Leukoc Biol 2007, 81:430–439.

    Article  PubMed  CAS  Google Scholar 

  18. Pelli H, Lappalainen-Lehto R, Piironen A, et al.: Risk factors for recurrent acute alcohol-associated pancreatitis: a prospective analysis. Scand J Gastroenterol 2008, 43:614–621.

    Article  PubMed  Google Scholar 

  19. Xin MJ, Chen H, Luo B, Sun JB: Severe acute pancreatitis in the elderly: etiology and clinical characteristics. World J Gastroenterol 2008, 14:2517–2521.

    Article  PubMed  Google Scholar 

  20. van Erpecum KJ: Gallstone disease. Complications of bileduct stones: acute cholangitis and pancreatitis. Best Pract Res Clin Gastroenterol 2006, 20:1139–1152.

    Article  PubMed  Google Scholar 

  21. Wittel UA, Pandey KK, Andrianifahanana M, et al.: Chronic pancreatic inflammation induced by environmental tobacco smoke inhalation in rats. Am J Gastroenterol 2006, 101:148–159.

    Article  PubMed  CAS  Google Scholar 

  22. Lindkvist B, Appelros S, Manjer J, et al.: A prospective cohort study of smoking in acute pancreatitis. Pancreatology 2008, 8:63–70.

    Article  PubMed  Google Scholar 

  23. DiMagno MJ, DiMagno EP: New advances in acute pancreatitis. Curr Opin Gastroenterol 2007, 23:494–501.

    PubMed  Google Scholar 

  24. Smith CJ, Olsen CH, Mocroft A, et al.: The role of antiretroviral therapy in the incidence of pancreatitis in HIV-positive individuals in the EuroSIDA study. AIDS 2008, 22:47–56.

    Article  PubMed  CAS  Google Scholar 

  25. Fessel J, Hurley LB: Incidence of pancreatitis in HIV-infected patients: comment on findings in EuroSIDA cohort. AIDS 2008, 22:145–147.

    Article  PubMed  Google Scholar 

  26. Quraishi ER, Goel S, Gupta M, et al.: Acute pancreatitis in patients on chronic peritoneal dialysis: an increased risk? Am J Gastroenterol 2005, 100:2288–2293.

    Article  PubMed  Google Scholar 

  27. Lankisch PG, Weber-Dany B, Maisonneuve P, Lowenfels AB: Frequency and severity of acute pancreatitis in chronic dialysis patients. Nephrol Dial Transplant 2008, 23:1401–1405.

    Article  PubMed  Google Scholar 

  28. Makela JT, Eila H, Kiviniemi H, et al.: Computed tomography severity index and C-reactive protein values predicting mortality in emergency and intensive care units for patients with severe acute pancreatitis. Am J Surg 2007, 194:30–34.

    Article  PubMed  Google Scholar 

  29. Whitcomb DC: Clinical practice. Acute pancreatitis. N Engl J Med 2006, 354:2142–2150.

    Article  PubMed  Google Scholar 

  30. Harrison DA, D’Amico G, Singer M: Case mix, outcome, and activity for admissions to UK critical care units with severe acute pancreatitis: a secondary analysis of the ICNARC Case Mix Programme Database. Crit Care 2007, 11(Suppl 1):S1.

    Article  PubMed  Google Scholar 

  31. Harrison DA, D’Amico G, Singer M: The Pancreatitis Outcome Prediction (POP) score: a new prognostic index for patients with severe acute pancreatitis. Crit Care Med 2007, 35:1703–1708.

    Article  PubMed  Google Scholar 

  32. Ueda T, Takeyama Y, Yasuda T, et al.: Simple scoring system for the prediction of the prognosis of severe acute pancreatitis. Surgery 2007, 141:51–58.

    Article  PubMed  Google Scholar 

  33. Ueda T, Takeyama Y, Yasuda T, et al.: Serum interleukin-15 level is a useful predictor of the complications and mortality in severe acute pancreatitis. Surgery 2007, 142:319–326.

    Article  PubMed  Google Scholar 

  34. Gardner TB, Vege SS, Chari ST, et al.: The effect of age on hospital outcomes in severe acute pancreatitis. Pancreatology 2008, 8:265–270.

    Article  PubMed  Google Scholar 

  35. Sempere L, Martinez J, de Madaria E, et al.: Obesity and fat distribution imply a greater systemic inflammatory response and a worse prognosis in acute pancreatitis. Pancreatology 2008, 8:257–264.

    Article  PubMed  Google Scholar 

  36. Papachristou GI, Papachristou DJ, Avula H, et al.: Obesity increases the severity of acute pancreatitis: performance of APACHE-O score and correlation with the inflammatory response. Pancreatology 2006, 6:279–285.

    Article  PubMed  Google Scholar 

  37. Bartosch-Harlid A, Andersson B, Aho U, et al.: Artificial neural networks in pancreatic disease. Br J Surg 2008, 95:817–826.

    Article  PubMed  CAS  Google Scholar 

  38. Mofidi R, Duff MD, Madhavan KK, et al.: Identification of severe acute pancreatitis using an artificial neural network. Surgery 2007, 141:59–66.

    Article  PubMed  Google Scholar 

  39. Cichoz-Lach H, Partycka J, Nesina I, et al.: Alcohol dehydrogenase and aldehyde dehydrogenase gene polymorphism in alcohol liver cirrhosis and alcohol chronic pancreatitis among Polish individuals. Scand J Gastroenterol 2007, 42:493–498.

    Article  PubMed  CAS  Google Scholar 

  40. Walkowiak J, Lisowska A, Blaszczynski M: The changing face of the exocrine pancreas in cystic fibrosis: pancreatic sufficiency, pancreatitis and genotype. Eur J Gastroenterol Hepatol 2008, 20:157–160.

    Article  PubMed  Google Scholar 

  41. Felderbauer P, Karakas E, Fendrich V, et al.: Pancreatitis risk in primary hyperparathyroidism: relation to mutations in the SPINK1 trypsin inhibitor (N34S) and the cystic fibrosis gene. Am J Gastroenterol 2008, 103:368–374.

    Article  PubMed  CAS  Google Scholar 

  42. National Center for Health Statistics: Summary National Hospital Discharge Survey Data. Available at http://www.cdc.gov/nchs/about/major/hdasd/nhdsdes.htm. Accessed September 25, 2008.

  43. Eland IA, Sturkenboom MJ, Wilson JH, Stricker BH: Incidence and mortality of acute pancreatitis between 1985 and 1995. Scand J Gastroenterol 2000, 35:1110–1116.

    Article  PubMed  CAS  Google Scholar 

  44. Floyd A, Pedersen L, Nielsen GL, et al.: Secular trends in incidence and 30-day case fatality of acute pancreatitis in North Jutland County, Denmark: a register-based study from 1981-2000. Scand J Gastroenterol 2002, 37:1461–1465.

    Article  PubMed  CAS  Google Scholar 

  45. Tinto A, Lloyd DA, Kang JY, et al.: Acute and chronic pancreatitis—diseases on the rise: a study of hospital admissions in England 1989/90–1999/2000. Aliment Pharmacol Ther 2002, 16:2097–2105.

    Article  PubMed  CAS  Google Scholar 

  46. Lindkvist B, Appelros S, Manjer J, Borgstrom A: Trends in incidence of acute pancreatitis in a Swedish population: Is there really an increase? Clin Gastroenterol Hepatol 2004, 2:831–837.

    Article  PubMed  Google Scholar 

  47. Goldacre MJ, Roberts SE: Hospital admission for acute pancreatitis in an English population, 1963–98: database study of incidence and mortality. BMJ 2004, 328:1466–1469.

    Article  PubMed  Google Scholar 

  48. Yadav D, Lowenfels AB: Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review. Pancreas 2006, 33:323–330.

    Article  PubMed  Google Scholar 

  49. Spanier BW, Dijkgraaf MG, Bruno MJ: Trends and forecasts of hospital admissions for acute and chronic pancreatitis in the Netherlands. Eur J Gastroenterol Hepatol 2008, 20:653–658.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Albert B. Lowenfels.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lowenfels, A.B., Maisonneuve, P. & Sullivan, T. The changing character of acute pancreatitis: Epidemiology, etiology, and prognosis. Curr Gastroenterol Rep 11, 97–103 (2009). https://doi.org/10.1007/s11894-009-0016-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-009-0016-4

Keywords

Navigation