Etiological Analysis Of Recurrent Acute Pancreatitis

Etiological analysis of Recurrent Acute Pancreatitis, A Clinical RetrospectiveStudy.Nabin Shrestha (Master Degree Candidate); Prof. Wang Chunyou, MD, PhD (Tutor).Pancreatic Disease Institute, Union Hospital of Tongji Medical College of HuazhongUniversity of Science and Technology, Wuhan, Hubei, ChinaIntroduction and Aims: Numerous factors have been associated with the etiology inrecurrent acute pancreatitis (RAP). The main purpose of this study is to investigate theetiology and clinical profiles of RAP and evaluate the diagnostic output of invasiveand non-invasive tests.Methods: All patients with RAP were screened retrospectively and included in thestudy. Initial etiological evaluation of the patients (noninvasive investigation)comprised of LFTs, fasting serum calcium and lipid profile, abdominal ultrasound,CECT abdomen and MRCP. Patients who remained undiagnosed after theseinvestigations were subjected to invasive investigation (ERCP). Patients were labeledas having idiopathic recurrent acute pancreatitis (IRAP) if the above investigationswere normal.Results: In119patients with RAP, the mean age was a41.07±14.84year with70.58%being males. A definite etiology was established in91(76.47%) patients afterapplying noninvasive investigations and in8(28.57%,8/28) patients after application of ERCP. Biliary pancreatitis was the most common etiology of RAP (25.21%,)followed by alcohol (21.04%). Alcoholic cause was found more in males (P=0.0463)but biliary stones and pancreatic divisum were found more in females (P=0.0021and0.0474respectively). The incidence of severe acute pancreatitis and pancreaticnecrosis were higher in patients with multiple etiologies (P=0.0191and0.0131respectively). No etiology was detected in20(16.81%) patients.Conclusions: Biliary stone disease is the most common cause of RAP followed byalcoholism. The patients with multiple etiologies tend to be more severe than thosewith a single etiology. ERCP is an important diagnostic tool to establish an etiology inIRAP.