75 Calcifications and Moderate to Marked Ductal Changes Are Only Seen in Patients With Imaging Documented Acute Recurrent Pancreatitis

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INTRODUCTION: Acute pancreatitis (AP) is often diagnosed on the basis of abdominal pain and elevations in pancreatic enzymes without abdominal imaging. However, neither pain nor enzyme elevations are specific for AP and recurrent presentations without confirmatory imaging may lead to a misdiagnosis of acute recurrent pancreatitis (ARP) and/or chronic pancreatitis (CP). METHODS: Adult patients with a diagnosis of ARP and/or CP between 2010–2019 were evaluated. All medical records and imaging studies from prior AP admissions were reviewed at our institution. Definite ARP was defined as ≥2 episodes of abdominal pain, elevated serum amylase and/or lipase ≥3X upper limit normal and abdominal imaging(s) showing changes or sequelae of AP. Probable ARP was defined as above but without any evidence of AP on abdominal imaging. Possible ARP was defined as ≥2 episodes of abdominal pain either with serum amylase and/or lipase levels that were normal or <3X ULN without any abdominal imaging showing AP. This was included as a category as referring physicians had diagnosed and managed these patients as ARP. The M-ANNHEIM criteria were used to define definite CP. Any patients with definite CP without a history of ARP were excluded. RESULTS: There were a total of 854 patients with ARP and/or CP with a mean age of 51.2 ± 14 years; 54.9% female; 75% white. There were 489 (57.2%) definite ARP, 162 (19%) probable ARP and 202 (23.7%) possible ARP with a similar mean duration of disease of 8.5 ± 7.8, 5.2 ± 4.1 and 6.8 ± 3.4 years, respectively. All patients were followed for a mean of 5.3 ± 2 years. Pancreatic calcification(s) and marked to moderate ductal changes were only seen in definite ARP. There were higher rates of exocrine insufficiency in definite ARP compared to probable and possible ARP (P = 0.005). Chronic opioid use was higher among the probable ARP compared to definite ARP and possible ARP (P < 0.001). All other characteristics including demographics, rates of alcohol use and smoking, diabetes and BMI similar between the 3 groups. CONCLUSION: Recurrent presentations of abdominal pain and pancreatic enzyme elevations without confirmatory changes of AP on imaging is problematic for the diagnosis of ARP as none of these patients developed definite changes of CP over the duration of disease and follow-up. This study highlights the nonspecific nature of abdominal pain and enzyme elevations for the diagnosis of AP and suggests that current diagnostic criteria may require revision.