Etiology of Recurrent Acute Pancreatitis: 10-year Review from a Large Tertiary Hospital

Abstract

Background: Recurrent acute pancreatitis (RAP) is an important spectrum of pancreatitis. Most studies of RAP focused on idiopathic recurrent acute pancreatitis (IRAP); RAP that remains idiopathic after ruling out causes by routine investigations. Studies on the etiology of overall RAP are lacking. Objective: To determine the etiology of RAP in a single tertiary hospital in Thailand. Methods: Medical records, imaging and endoscopic data of patients who presented with acute pancreatitis for more than once during 2005-2014 were retrospectively reviewed and analyzed. Results: There were 67 RAP patients over the 10-year period. Majority (68.7%) were men. Mean age was 47 ± 18 years. Thirty percent smoked and 47% drank significant alcohol (defined as ethanol >80 g/day for >5 years). Liver function test, serum triglyceride and calcium were done in every case. Ultrasonography, computed tomography and endoscopic ultrasonography were performed in 55.2%, 52.2% and 32.8%, respectively. Genetic study ( PRSS1 and SPINK1 mutations) were performed in 9 patients (13.4%) and mutations were found for PRSS1 in 1 and SPINK1 in 2 patients. Alcohol was the most common etiology of RAP (40.2%), followed by biliary stone (28.3%), all of which were macrolithiasis. ICP was the third most common cause (9.0%) and hereditary pancreatitis was diagnosed in 1 patient (1.5%). Seventeen patients (25.4%) had miscellaneous etiologies and 2 (2.9%) finally had IRAP. More than half (58%) of patients with RAP from macrolithiasis were associated with delayed cholecystectomy after the sentinel gallstone pancreatitis. Conclusion: The most common etiologies of RAP in order were alcohol, macrolithiasis and ICP. Among RAP patients from macrolithiasis, the main cause was delayed cholecystectomy after sentinel gallstone pancreatitis.