Patients with recurrent acute pancreatitis (AP) who progress to chronic pancreatitis (CP) are more likely to be younger, active smokers, and have an alcohol-related etiology of their recurrent AP and eventually CP, compared with those with CP and without preceding recurrent AP, according to a study in Pancreatology.
The retrospective review sought to identify differences in demographics, clinical presentation, and resource use between patients with CP who had preceding recurrent AP and those without preceding recurrent AP. Eligible participants were adults diagnosed with CP from an academic tertiary care hospital between January 1, 2016, and April 30, 2021. Recurrent AP was defined as at least 2 episodes of AP with resolution in between and no definitive CP changes.
A total of 440 patients were included — 283 patients (mean age, 55.6±14.3 years; women, 47.3%; White, 72.2%) had preceding recurrent AP, and 157 patients (mean age, 63.1±15.2 years; women, 48.4%; White, 77.7%) did not have preceding recurrent AP. Participants with vs without recurrent AP had a mean age at CP diagnosis of 43.7±15.2 years vs 51.5±16.1 years.
The participants with recurrent AP were more likely to have alcohol as the etiology of their CP (49.1% vs 25%) vs those without recurrent AP, who were more likely to have idiopathic CP (61% vs 33%) (P <.001).
Patients with recurrent AP were more frequently active smokers (36% vs 19.9%; P =.002) and used recreational marijuana (23% vs 12.2%; P =.008) compared with those who did not have recurrent AP. In addition, more patients with recurrent AP had chronic daily abdominal pain (47.1% vs 29.2%; P =.002) and nausea (43.3% vs 27.1%; P =.001) vs those without recurrent AP. Exocrine pancreatic insufficiency (65.8% vs 46.5%; P <.001) and pancreatic pseudocyst (45.7% vs 18.7%; P <.001) were more common in patients with recurrent AP vs those without recurrent AP.
Patients with preceding recurrent AP had more hospitalizations for CP compared with those without recurrent AP (3.09 vs 0.87 hospitalizations; P <.001). Also, participants with recurrent AP had emergency department visits that resulted in an opioid prescription more frequently vs those without recurrent AP (9.7% vs 1.9%). In addition, the participants with recurrent AP had an increased use of prescription opioids (58.4% vs 32.3%; P <.001) for abdominal pain related to their CP.
No significant differences were observed in demographic characteristics and clinical presentation between patients with CP who had 1 previous episode of AP and those with de novo CP. Also, no significant difference in resource use was found between patients with CP with 1 prior episode of AP and those with de novo CP, except for increased use of MRI in patients with de novo CP.
Multivariate analysis showed that younger age, alcohol use, and active smoking were associated with recurrent AP.
“With the focus of care shifting from symptomatic treatment of CP to its early prevention, it is important to identify patients who are at risk of developing definitive CP,” the study authors commented. “Considering that AP, [recurrent AP], and CP may be a part of the same disease spectrum, identifying modifiable risk factors for rapid disease progression may potentially help avoid development of end-stage CP and its associated debilitating symptoms.”
Shah I, Bocchino R, Ahmed A, Freedman SD, Kothari DJ, Sheth SG. Impact of recurrent acute pancreatitis on the natural history and progression to chronic pancreatitis. Pancreatology. Published online September 13, 2022. doi:10.1016/j.pan.2022.09.237