Classic chronic pancreatitis is associated with prior acute pancreatitis in only 50% of patients in a large single-institution study

Yasuki Hori, Santhi Swaroop Vege, Suresh T Chari, Ferga C. Gleeson, Michael J. Levy, Randall K. Pearson, Bret Thomas Petersen, Michael L. Kendrick, Naoki M Takahashi, Mark Truty, Rory Smoot, Mark Topazian

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: The sentinel acute pancreatitis event (SAPE) hypothesis for pathogenesis of chronic pancreatitis (CP) postulates that acute pancreatitis (AP), especially recurrent AP (RAP), precedes development of CP. However, in a recent population-based study, 52/89 (58.4%) of CP had no prior episodes of AP. In a large clinic-based CP cohort, we aimed to determine the incidence and timing of prior AP in patients diagnosed with CP. Methods: We retrospectively identified 499 consecutive patients with classic CP diagnosed at our institution from January 2013 through December 2015. We abstracted their demographic and clinical data, especially regarding prior AP. Results: We identified 3 cohorts: 1) CP with no AP (n = 231 [46.3%]), 2) AP before CP (n = 250 [50.1%]), and 3) AP after CP (n = 18 [3.6%]). At CP diagnosis, 249 patients (49.9%) had no prior AP. Compared with the “CP preceded by AP” cohort, the “CP without AP”’ cohort was older (59.2 ± 13.9 vs 48.6 ± 15.7 years; P < .001), had a higher prevalence of diabetes mellitus (30.3% vs 12.4%; P < .001), reported less pain (52.8% vs 87.6%; P < .001), and had a lower rate of endoscopic interventions (16.0% vs 39.2%; P < .001). In the “CP preceded by AP” cohort, 117 (46.8%) had a single episode of AP and 133 (53.2%) had RAP. Conclusion: Nearly half the patients with classic CP did not have prior AP. Only a quarter of patients had CP that could potentially have evolved from prior RAP. Development of CP may be attributable to an altogether different pathogenesis (a non-SAPE pathway) for a considerable proportion of patients.

Original languageEnglish (US)
JournalPancreatology
DOIs
StatePublished - Jan 1 2019

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Chronic Pancreatitis
Pancreatitis

Keywords

  • Acute pancreatitis
  • Chronic pancreatitis
  • Recurrent acute pancreatitis
  • Sentinel acute pancreatitis event

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Gastroenterology

Cite this

Classic chronic pancreatitis is associated with prior acute pancreatitis in only 50% of patients in a large single-institution study. / Hori, Yasuki; Vege, Santhi Swaroop; Chari, Suresh T; Gleeson, Ferga C.; Levy, Michael J.; Pearson, Randall K.; Petersen, Bret Thomas; Kendrick, Michael L.; Takahashi, Naoki M; Truty, Mark; Smoot, Rory; Topazian, Mark.

In: Pancreatology, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Classic chronic pancreatitis is associated with prior acute pancreatitis in only 50{\%} of patients in a large single-institution study",
abstract = "Background: The sentinel acute pancreatitis event (SAPE) hypothesis for pathogenesis of chronic pancreatitis (CP) postulates that acute pancreatitis (AP), especially recurrent AP (RAP), precedes development of CP. However, in a recent population-based study, 52/89 (58.4{\%}) of CP had no prior episodes of AP. In a large clinic-based CP cohort, we aimed to determine the incidence and timing of prior AP in patients diagnosed with CP. Methods: We retrospectively identified 499 consecutive patients with classic CP diagnosed at our institution from January 2013 through December 2015. We abstracted their demographic and clinical data, especially regarding prior AP. Results: We identified 3 cohorts: 1) CP with no AP (n = 231 [46.3{\%}]), 2) AP before CP (n = 250 [50.1{\%}]), and 3) AP after CP (n = 18 [3.6{\%}]). At CP diagnosis, 249 patients (49.9{\%}) had no prior AP. Compared with the “CP preceded by AP” cohort, the “CP without AP”’ cohort was older (59.2 ± 13.9 vs 48.6 ± 15.7 years; P < .001), had a higher prevalence of diabetes mellitus (30.3{\%} vs 12.4{\%}; P < .001), reported less pain (52.8{\%} vs 87.6{\%}; P < .001), and had a lower rate of endoscopic interventions (16.0{\%} vs 39.2{\%}; P < .001). In the “CP preceded by AP” cohort, 117 (46.8{\%}) had a single episode of AP and 133 (53.2{\%}) had RAP. Conclusion: Nearly half the patients with classic CP did not have prior AP. Only a quarter of patients had CP that could potentially have evolved from prior RAP. Development of CP may be attributable to an altogether different pathogenesis (a non-SAPE pathway) for a considerable proportion of patients.",
keywords = "Acute pancreatitis, Chronic pancreatitis, Recurrent acute pancreatitis, Sentinel acute pancreatitis event",
author = "Yasuki Hori and Vege, {Santhi Swaroop} and Chari, {Suresh T} and Gleeson, {Ferga C.} and Levy, {Michael J.} and Pearson, {Randall K.} and Petersen, {Bret Thomas} and Kendrick, {Michael L.} and Takahashi, {Naoki M} and Mark Truty and Rory Smoot and Mark Topazian",
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AU - Hori, Yasuki

AU - Vege, Santhi Swaroop

AU - Chari, Suresh T

AU - Gleeson, Ferga C.

AU - Levy, Michael J.

AU - Pearson, Randall K.

AU - Petersen, Bret Thomas

AU - Kendrick, Michael L.

AU - Takahashi, Naoki M

AU - Truty, Mark

AU - Smoot, Rory

AU - Topazian, Mark

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: The sentinel acute pancreatitis event (SAPE) hypothesis for pathogenesis of chronic pancreatitis (CP) postulates that acute pancreatitis (AP), especially recurrent AP (RAP), precedes development of CP. However, in a recent population-based study, 52/89 (58.4%) of CP had no prior episodes of AP. In a large clinic-based CP cohort, we aimed to determine the incidence and timing of prior AP in patients diagnosed with CP. Methods: We retrospectively identified 499 consecutive patients with classic CP diagnosed at our institution from January 2013 through December 2015. We abstracted their demographic and clinical data, especially regarding prior AP. Results: We identified 3 cohorts: 1) CP with no AP (n = 231 [46.3%]), 2) AP before CP (n = 250 [50.1%]), and 3) AP after CP (n = 18 [3.6%]). At CP diagnosis, 249 patients (49.9%) had no prior AP. Compared with the “CP preceded by AP” cohort, the “CP without AP”’ cohort was older (59.2 ± 13.9 vs 48.6 ± 15.7 years; P < .001), had a higher prevalence of diabetes mellitus (30.3% vs 12.4%; P < .001), reported less pain (52.8% vs 87.6%; P < .001), and had a lower rate of endoscopic interventions (16.0% vs 39.2%; P < .001). In the “CP preceded by AP” cohort, 117 (46.8%) had a single episode of AP and 133 (53.2%) had RAP. Conclusion: Nearly half the patients with classic CP did not have prior AP. Only a quarter of patients had CP that could potentially have evolved from prior RAP. Development of CP may be attributable to an altogether different pathogenesis (a non-SAPE pathway) for a considerable proportion of patients.

AB - Background: The sentinel acute pancreatitis event (SAPE) hypothesis for pathogenesis of chronic pancreatitis (CP) postulates that acute pancreatitis (AP), especially recurrent AP (RAP), precedes development of CP. However, in a recent population-based study, 52/89 (58.4%) of CP had no prior episodes of AP. In a large clinic-based CP cohort, we aimed to determine the incidence and timing of prior AP in patients diagnosed with CP. Methods: We retrospectively identified 499 consecutive patients with classic CP diagnosed at our institution from January 2013 through December 2015. We abstracted their demographic and clinical data, especially regarding prior AP. Results: We identified 3 cohorts: 1) CP with no AP (n = 231 [46.3%]), 2) AP before CP (n = 250 [50.1%]), and 3) AP after CP (n = 18 [3.6%]). At CP diagnosis, 249 patients (49.9%) had no prior AP. Compared with the “CP preceded by AP” cohort, the “CP without AP”’ cohort was older (59.2 ± 13.9 vs 48.6 ± 15.7 years; P < .001), had a higher prevalence of diabetes mellitus (30.3% vs 12.4%; P < .001), reported less pain (52.8% vs 87.6%; P < .001), and had a lower rate of endoscopic interventions (16.0% vs 39.2%; P < .001). In the “CP preceded by AP” cohort, 117 (46.8%) had a single episode of AP and 133 (53.2%) had RAP. Conclusion: Nearly half the patients with classic CP did not have prior AP. Only a quarter of patients had CP that could potentially have evolved from prior RAP. Development of CP may be attributable to an altogether different pathogenesis (a non-SAPE pathway) for a considerable proportion of patients.

KW - Acute pancreatitis

KW - Chronic pancreatitis

KW - Recurrent acute pancreatitis

KW - Sentinel acute pancreatitis event

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