Meta Analysis Of Etiology And Clinical Features Of Recurrent Acute Pancreatitis

Objective: RAP(recurrent acute pancreatitis)is a special type of AP and it has become an important issue how to effectively prevent the recurrence of AP.The aim of this study was to explore the etiology and clinical features of recurrent acute pancreatitis(RAP)by collecting clinical trials on RAP and AP.Method: With “Pancreatitis”,“Recurrence”,“Etiology”,“factor” as key words,Pubmed、Medline、EMBASE、Science Direct、Cochrane Library、CBM、CNKI,Wan fang and VIP database were retrieved by computer and relevant research on RAP were collected according to the predefined inclusion and exclusion criteria.Studies were screened,data were extracted,and the methodological quality was assessed by 2 reviewers independently.Meta-analysis was conducted by Rev Man 5.3 software.Fixed or random effects models were used based on heterogeneity and binary variables which were ended by odd ratio for evaluated;interval estimation using 95% confidence interval.Results: A total of 16 studies involved 3980 participants(RAP1231,AP2749)were included.The results showed that the recurrence incidence after a first episode of acute pancreatitis was 24.25%.In the past 10 years,the etiology of AP is still dominated by biliary diseases in our country,Hyperlipidemia is essential for RAP,the pooled OR(95%CI)values as2.16(1.34,3.49).There were no significant differences between the two groups on other factors such as age,sex,biliary factors,improper diet,alcohol(OR=0.73,95% CI 0.34~1.57,P=0.42),(OR=0.97,95% CI 0.83~1.13,P=0.68)(OR=1.19,95% CI 0.77~1.85,P=0.44),(OR=1.24,95% CI0.89~1.72,P=0.21),(OR=0.69,95% CI 0.45 ~ 1.05,P=0.08).Postcholecystectomy AP still have recurrence,the two group have no statistical difference(OR=1.74,95% CI 0.95~3.18,P=0.07).RAP have higher incidence of severe acute pancreatitis and the occurrence of jaundice,local complications compared with AP(OR=1.61,95%CI1.16~2.23,P=0.005),(OR=1.61,95%CI1.16~2.23,P=0.005),(OR=1.60,95% CI 1.15~2.22,P=0.005).Idiopathic factors is less in RAP(OR=0.57,95% CI 0.44~0.72,P<0.05).Conclusion: Hyperlipidemia is the predominant risk factor for recurrent disease,it was more likely to develop severe acute pancreatitis in recurrent group.Biliary diseases still account for a high proportion in the etiology of RAP,but not high-risk factor for recurrence.Currently,most patients with RAP through comprehensive treatment can achieve better efficacy,early prevention measures should be taken.