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 T. Petersen, Michael L. Kendrick, Naoki Takahashi, Mark J. Truty, Rory L. Smoot, Mark D. Topazian

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

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)
Pages (from-to)224-229
Number of pages6
JournalPancreatology
Volume19
Issue number2
DOIs
StatePublished - Mar 2019

Keywords

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

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Gastroenterology

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