Acute pancreatitis in Sowetan Africans. A disease with high mortality and morbidity.
CONCLUSIONS
In African blacks, acute pancreatitis requiring hospital admission is a severe disease associated with a high mortality and significant long-term morbidity in surviving patients.


BACKGROUND
It has been suggested that acute pancreatitis has a benign course in Africans in contrast to Western populations. The aim of the present study was to ascertain the incidence of acute pancreatitis at Baragwanath Hospital for a 1-yr period and to test the validity of the above hypothesis.


METHODS
One hundred thirty-six patients with acute pancreatitis were retrospectively assessed. Fifty patients were available for a prospective follow-up examination and underwent sonographic and biochemical investigations. Acute pancreatitis was diagnosed if the patient presented with the typical clinical picture and a raised serum amylase level > 800 U/L.


RESULTS
The study consisted of 108 male and 28 female patients. Alcohol was identified as the predominant etiologic factor in 83.1%, biliary disease in 7.4%, and idiopathic causes in 6.6%. Substantial morbidity was encountered in 32.3% and was caused mainly by pancreatic complications, metabolic derangements, alcohol-related symptoms, and respiratory impairment. A portion (10.3%) of the patients developed further pancreatic pathology, such as pseudocysts, necroses, or an abscess. The overall mortality rate was 8.1%. Patients who died had a higher mean serum amylase, and most deaths occurred within 2 d of admission. Prospective follow-up after an average of 9.3 mo revealed serious morbidity in two-thirds of patients. Fifty-two percent suffered from severe abdominal pain, 36% complained of weight loss, and 18% were shown to have a sonographically abnormal pancreas. Fecal chymotrypsin levels indicated exocrine pancreatic impairment in 30.6%.
John
K D
KD
Department of Gastroenterology, Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa.
Segal
I
I
Hassan
H
H
Levy
R D
RD
Amin
M
M
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000097:blood; D044383:Black People; D002648:Child; D002675:Child, Preschool; D002918:Chymotrypsin / Q000378:metabolism; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010195:Pancreatitis / Q000453:epidemiology* / Q000401:mortality* / Q000503:physiopathology; D019512:Pancreatitis, Alcoholic / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology
D000681:Amylases; D002918:Chymotrypsin