Impact of recurrent acute pancreatitis on the natural history and progression to chronic pancreatitis

Background and aims: It is believed that acute pancreatitis (AP), recurrent AP (RAP) and chronic pancreatitis (CP) represent stages of the same disease spectrum. We aimed to identify risk factors, clinical presentation and outcomes in patients with prior RAP who develop CP. Methods: We retrospectively reviewed patients with CP who were seen at our Pancreas Center during 2016-2021. We divided them into two groups: with and without RAP (>= 2 episodes of AP). We compared demographics, clinical presentation and resource utilization between the two groups. Results: We identified 440 patients with CP, of which 283 (64%) patients had preceding RAP. These patients were younger (55.6 vs 63.1 years), active smokers (36% vs 20%) and had alcohol-related CP (49% vs 25%) compared to those without RAP and CP (p < 0.05). More patients with RAP had chronic abdominal pain (89% vs 67.9%), nausea (43.3% vs 27.1%) and exocrine pancreatic insufficiency (65.8% vs 46.5%) (p < 0.05). More patients with RAP used opioids (58.4% vs 32.3%) and gabapentinoids (56.6% vs 34.8%) (p < 0.05). They also had more ED visits resulting in an opioid prescription (9.68% vs 2%) and more CP flares requiring hospitalization (3.09 vs 0.87) (p < 0.05). Conclusion: Young age, smoking and alcohol use are seen in patients with RAP who progress to CP. These patients are highly symptomatic and use more healthcare resources, suggestive of an overall a more course compared to those patients who develop CP without preceding RAP. Early identification and counselling of these patients may slow down progression to CP. (c) 2022 IAP and EPC. Published by Elsevier B.V. All rights reserved.

Automated summary

This study aimed to identify the risk factors, clinical presentation, and outcomes in patients with recurrent acute pancreatitis (RAP) who develop chronic pancreatitis (CP). The results showed that younger age, smoking, and alcohol use were associated with a higher risk of progression from RAP to CP. These patients had more severe symptoms and utilized more healthcare resources, suggesting a poorer prognosis. Early identification and counseling may help slow down disease progression.