Investigating The Etiology Of Acute Recurrent Pancreatitis:a Study Using Internal And External Treatments Of Chinese Medicine

OBJECTIVE:To investigate the etiology, clinical features, endoscopic changes and prevention of acute recurrent pancreatitis (ARP).METHODS:A retrospective study was conducted on80ARP patients, whom were administrated in the department of Chinese medicine, the department of gastroenterology, the department of surgery and the department of hepatobiliary surgery of Mianyang central hospital from January2011to March2014. The ARP patients were randomly assigned to2treatment groups (internal and external Chinese medicine group and control group, N=40for each group). The clinical symptoms, endoscopic reports, imaging reports, post-treatment recovery/recurrence were compared between the80ARP patients and267 first-time acute pancreatitis (AP) patients, as well as between2ARP treatment groups.RESULTS:The80ARP patients suffered recurrence between1and5(1.7±0.9) time(s),2-96(22.5±18.8) months after first onset of AP. Sixty-four ARP patients (80%of all ARP patients) had recurrence in the past3years. The most common cause was biliary disease for both ARP (52.5%,42out of80patients) and AP patients (54.7%,146out of247patients, not significant between ARP and AP patients). The proportion of ARP patients due to binge drinking was significantly higher (15%,12out of80patients) than that of AP patients (5.3%,15out of267patients, P<0.05). The proportion of ARP patients due to high triglyceride level was significantly higher (16.3%,13out of80patients) than that of AP patients (5.3%,15out of267patients, P<0.05). The proportion of ARP patients due to improper diet was lower (5%,4out of80patients) than that of AP patients (10.5%,28out of267patients), but the statistical test was not significant. The proportion of ARP patients caused by unknown reason was significantly lower (9%,7out of80patients) than that of AP patients (26.6%,71out of267patients, P<0.05). Between ARP and AP patients, neither the difference of the occurrence rate of. severe acute pancreatitis (SAP) nor the difference of recovery rate was significant. Within the ARP patients, there were2and6recurrences in the internal and external Chinese medicine group and control group, respectively. Both groups showed lower recurrence rates than the recurrence fate in the past3years (P<0.05). In addition, the recurrence rate in the internal and external Chinese medicine group is significantly lower than that of control group (P<0.05). CONCLUSION:The common causes of ARP, in the order of descending frequency, are biliary cause, binge drinking, metabolic cause and idiopathic cause. ARP patients are also at high-risk of severe pancreatitis. Identifying the cause of ARP and treat the cause accordingly can considerably reduce recurrence. Internal and external treatments of Chinese medicine can greatly alleviate symptoms, increase recovery rate, and improve the efficacy of clinical treatment. Hence it is of great importance in treating ARP.