Extensive aetiological investigations in acute pancreatitis: results of a 1-year prospective study.
BACKGROUND
Epidemiological data on acute pancreatitis are poorly defined.


OBJECTIVE
To prospectively evaluate the aetiology of acute pancreatitis and to assess the benefits of intensive investigations.


METHODS
In a prospective, 1-year study all cases of acute pancreatitis in the Nice catchment area were enrolled. Subjects underwent routine (serum calcium, phosphate and triglycerides; abdominal ultrasonography and CT scan) and additional, delayed intensive investigations (ERCP with bile sampling and/or endoscopy ultrasonography).


RESULTS
One hundred and twenty-one cases were included. After routine investigations, a biliary, alcoholic, miscellaneous or unknown origin was diagnosed in 43%, 31.4%, 9.9% and 15.7%, respectively. In subjects with biliary pancreatitis, 43% had no previous history of biliary disease. In the alcohol-related subgroup, pancreatitis recurred in 18.5% during 114.5 days mean follow-up. In subjects with a first episode of alcoholic pancreatitis, delayed supplemental investigations revealed underlying chronic pancreatitis in 92.8%. After routine investigations, a diagnosis of pancreatitis of unknown origin was made in 15.7% (n = 19) of subjects. Additional investigations revealed an underlying cause in 57.8% of these patients (n = 11), including malignancy (n = 3) and biliary disease (n = 4), reducing the overall rate of pancreatitis with no apparent cause to 6.6%.


CONCLUSIONS
Investigative techniques, particularly ERCP, will reveal the underlying aetiology of pancreatitis in the majority of patients presenting with 'idiopathic' pancreatitis and should be considered when routine tests are negative.
Maes
B
B
Department of Hepato-Gastroenterology, Hopital de l'Archet I, CHU, Nice, France.
Hastier
P
P
Buckley
M J
MJ
Peten
E P
EP
Paolini
O
O
Staccini
P
P
Conio
M
M
Caroli-Bosc
F X
FX
Demarquay
J F
JF
Dumas
R
R
Delmont
J P
JP
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects; D001660:Biliary Tract Diseases / Q000150:complications / Q000175:diagnosis; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D019512:Pancreatitis, Alcoholic / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D011446:Prospective Studies; D012737:Sex Factors