Long-Term Prognosis of Acute Pancreatitis in Japan

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This study was undertaken to evaluate the long-term prognosis of acute pancreatitis (AP) in Japan and to identify factors that predict major complications. In 1987, 2533 patients with moderate or severe acute pancreatitis were registered in a national survey in Japan. Follow-up studies were done in 2000 and in 2004 to evaluate recurrence of acute pancreatitis, transition to chronic pancreatitis, development of diabetes mellitus, and mortality. The relationship between incidence of complications and alcohol consumption during follow-up period was also analyzed. Valid replies were obtained from 714 cases in 2000 and 450 cases in 2004. Recurrence of acute pancreatitis occurred in 145 cases, and the recurrence rate was significantly higher in alcoholic pancreatitis compared with other etiologies. A transition to chronic pancreatitis occurred frequently in alcoholic pancreatitis and inversely correlated with existence of pancreatic necrosis in the initial disease. Complication with diabetes mellitus and the transition to chronic pancreatitis strongly correlated with persistent alcohol intake during follow-up period. During the follow-up period, 199 patients died, and 43 died of malignant disease. Recurrence of acute pancreatitis and a transition to chronic pancreatitis frequently occurred in alcoholic pancreatitis. Transition to chronic pancreatitis was inversely correlated with the existence of pancreatic necrosis at the initial presentation. Mortality as a result of malignant disease was not excessive in the patients with history of acute pancreatitis.

Section snippets

Patients and Methods

In Japan under the financial support of the government, nationwide survey of AP has been done periodically from 1987, and a database of 2533 cases registered in 1987 has been available. From this registry a follow-up study was performed in 2000, and valid replies were available from 714 cases. At the time of admission, all the patients were classified by severity into moderate and severe according to the criteria for clinical diagnosis and grading severity (1990) formulated by the Research

Recurrence of Acute Pancreatitis

During the follow-up period, recurrence of AP was observed in 145 cases (20.3%). The recurrence rate was 23.1% in moderate pancreatitis and 16.7% in SAP. The recurrence rates in alcoholic pancreatitis, biliary pancreatitis, idiopathic pancreatitis, and pancreatitis of other etiologies were 32.4%, 7.4%, 17.9%, and 10.7%, respectively. Recurrence rate was significantly higher in alcoholic pancreatitis compared with the other origins (P < .01). The recurrence rate was not influenced by either the

Discussion

Previous reports on overall recurrence rates of AP range from 21%–27%.5, 6 The recurrence rate in the present analysis was 20.3%, which was similar to the previous reports. With respect to the etiology of AP, Pelli et al3 reported that the recurrence of AP was noted in 46% of 568 patients with alcoholic AP and that 80% of recurrent AP occurred within 4 years after the first episode. In the present study, the recurrence rate in alcoholic AP was significantly higher (32.4%) than other etiologies.

Summary

This prospective longitudinal study has examined the natural history of AP in a Japanese population that has been followed for more than 20 years. The key findings of this study are that the extent of necrosis at the time of initial presentation affects the risk of subsequently developing CP. In patients with alcoholic pancreatitis, continued drinking had a significant impact on the risk for developing CP and DM. Finally, a history of AP did not appear to affect the risk for developing

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Conflicts of interest The author discloses no conflicts.

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