“Idiopathic” Pancreatitis: Do We Need to Know the Cause?

  • C. D. Johnson


In the United Kingdom about half the attacks of acute pancreatitis are related to gallstones and about one-quarter to alcohol consumption (Table 1). Other aetiological agents have been reviewed elsewhere (Tables 2 and 3). This chapter is concerned with the search for an aetiology in patients in whom initial assessment has shown no evidence of gallstones and no excessive alcohol consumption (non-gallstone non-alcohol related (NGNA) pancreatitis). Patients with recurrent NGNA pancreatitis deserve particularly thorough investigation to forestall further sttacks, although these patients have a similar distribution of aetiology to primary cases (Table 4).


Acute Pancreatitis Common Bile Duct Stone Endoscopic Sphincterotomy Pancreas Divisum Ampullary Carcinoma 
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  1. Acosta JM, Ledesma CL (1974) Gallstone migration as a cause of acute pancreatitis. N Engl J Med 290: 484–487PubMedCrossRefGoogle Scholar
  2. Clemens JA, Cameron JL (1989) The pathogenesis of acute pancreatitis. In: Carter DC, Warshaw AL (eds) Pancreatitis. Churchill Livingstone, Edinburgh, pp 1–30Google Scholar
  3. Cooperman M, Ferrara JJ, Carey LC, Thomas FB, Martin EW, Fromkes J J (1981) Idiopathic acute pancreatitis: the value of endoscopic retrograde cholangiopancreatography. Surgery 90: 666–670PubMedGoogle Scholar
  4. Corfield AP, Cooper MJ, Williamson RCN et al. (1985a) Prediction of severity in acute pancreatitis: prospective comparison of three prognostic indices. Lancet ii: 403–407CrossRefGoogle Scholar
  5. Corfield AP, Cooper MJ, Williams RCN (1985b) Acute pancreatitis: a lethal disease of increasing incidence. Gut 26: 724–729PubMedCrossRefGoogle Scholar
  6. Dickson AP, O’Neill J, Imrie CW (1984) Hyperlipidaemia, alcohol abuse and acute pancreatitis. Br J Surg 71: 685–688PubMedCrossRefGoogle Scholar
  7. Farinon AM, Ricci CL, Sianesi M, Percudani M, Zanella E (1987) Physiopathologic role of microlithiasis in gallstone pancreatitis. Surg Gynecol Obstet 164: 252–256PubMedGoogle Scholar
  8. Feller ER (1984) Endoscopic retrograde cholangiopancreatography in the diagnosis of unexplained pancreatitis. Arch Intern Med 144: 1797–1799PubMedCrossRefGoogle Scholar
  9. Goodman AJ, Neoptolemos JP, Carr-Locke DL, Finaly DBL, Fossard DP (1985) Detection of gallstones after acute pancreatitis. Gut 26: 125–132PubMedCrossRefGoogle Scholar
  10. Guzman S, Nervi F, Llanos O, Leon P, Valdivieso V (1985) Impaired lipid clearance in patients with previous acute pancreatitis. Gut 26: 888–891PubMedCrossRefGoogle Scholar
  11. Heath D, Leese T, Carr-Locke DL, Thornton Holmes J (1987) Obstructing calculous material in a periampullary duodenal diverticulum associated with primary common bile duct calculi and acute pancreatitis. Br J Surg 74: 648PubMedCrossRefGoogle Scholar
  12. Imrie CW, Ferguson JC, Sommerville RG (1977) Coxsackie and mumps virus infection in a prospective study of acute pancreatitis. Gut 18: 53–56PubMedCrossRefGoogle Scholar
  13. Kelly TJ (1976) Gallstone pancreatitis: pathophysiology. Surgery 80: 488–492PubMedGoogle Scholar
  14. London NJM, Neoptolemos JP, Lavelle J, Bailey I, James D (1989) Serial computed tomography scanning in acute pancreatitis: a prospective study. Gut 30: 397–403PubMedCrossRefGoogle Scholar
  15. Neoptolemos JP, Carr-Locke DL, London N, Bailey I, Fossard DP (1988a) ERCP findings and the role of endoscopic sphincterotomy in acute gallstone pancreatitis. Br J Surg 75: 954–960PubMedCrossRefGoogle Scholar
  16. Neoptolemos JP, Davidson BR, Winder AF, Vallance D (1988b) Role of duodenal bile crystal analysis in the investigation of “idiopathic” pancreatitis. Br J Surg 75: 450–453PubMedCrossRefGoogle Scholar
  17. Ranson HC (1984) Acute pancreatitis: pathogenesis, outcome and treatment. Clin Gastroenterol 13: 843–863PubMedGoogle Scholar
  18. Robertson JFR, Imrie CW (1987) Acute pancreatitis associated with carcinoma of the ampulla. Br J Surg 74: 395–397PubMedCrossRefGoogle Scholar
  19. Sitges–Serra A, Alonso M, de Lecea C, Gores PF, Sutherland DER (1988) Pancreatitis and hyperparathyroidism. Br J Surg 75: 158–160CrossRefGoogle Scholar
  20. Thomson SR, Hendry WS, McFarlane GA, Davidson AI (1987) Epidemiology and outcome of acute pancreatitis. Br J Surg 74: 398–401PubMedCrossRefGoogle Scholar
  21. Toouli J, Roberts-Thomson IC, Deut J, Lee J (1985) Sphincter of Oddi motility disorders in patients with idiopathic recurrent pancreatitis. Br J Surg 72: 859–863PubMedCrossRefGoogle Scholar
  22. Waldron R, Drumm J, McCarthy CF, Murray JP, Murphy B (1985) Surgically correctable recurring pancreatitis. Br J Surg 72: 203PubMedCrossRefGoogle Scholar

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© Springer-Verlag London Limited 1991

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  • C. D. Johnson

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