Liver, Pancreas and Biliary TractA single-centre prospective, cohort study of the natural history of acute pancreatitis

BackgroundThe natural history of acute pancreatitis is based on clinical studies that aim to elucidate the course of disease on the basis of predicted risk factors.AimsTo evaluate the long-term occurrence of recurrent acute pancreatitis and chronic pancreatitis in a cohort of patients following an initial episode of acute pancreatitis.Methods196 patients were enrolled consecutively and studied prospectively. Clinical characteristics, exogenously/endogenously-associated factors, and evolution to recurrent acute pancreatitis and chronic pancreatitis were analyzed.Results40 patients developed recurrent acute pancreatitis 13 of whom developed chronic pancreatitis. In a univariate analysis, recurrent acute pancreatitis was associated with an idiopathic aetiology (p < 0.001), pancreas divisum (p = 0.001), and higher usage of cigarettes and alcohol (p < 0.001; p = 0.023). Chronic pancreatitis was associated with a severe first episode of acute pancreatitis (p = 0.048), PD (p = 0.03), and cigarette smoking (p = 0.038). By multivariate analysis, pancreas divisum was an independent risk factor for recurrent acute pancreatitis (OR 11.5, 95% CI 1.6-83.3). A severe first-episode of acute pancreatitis increased the risk of progressing to chronic pancreatitis by nine-fold.ConclusionsSpecial attention should be given to patients who experience a severe first attack of acute pancreatitis as there appears to be an increased risk of developing chronic pancreatitis over the long term.