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

Abstract

Objective: To determine the etiology of recurrent acute pancreatitis (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 66 RAP patients over the 10-year period. Majority (69.7%) were men. Mean age was 47 ± 19 years. Thirty percent smoked and 48% 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 54.5%, 53.0% and 33.3%, respectively. Genetic studies (PRSS1 and SPINK1 mutations) were performed in 9 patients (13.6%) and mutations were found for PRSS1 in 1 and SPINK1 in 2 patients. Alcohol was the most common etiology of RAP (40.9%), followed by biliary stone (27.3%), all of which
were macrolithiasis. ICP was the third most common cause (9.1%) and hereditary pancreatitis was diagnosed in 1 patient (1.5%). Seventeen patients (25.7%) had miscellaneous etiologies and 2 (3.0%) finally had idiopathic recurrent acute pancreatitis (IRAP). More than half (61%) of patients with RAP from macrolithiasis were associated with
delayed cholecystectomy after 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.