title: Etiology of recurrent acute pancreatitis, with special emphasis on pancreaticobiliary malformation.
abstract: OBJECTIVE
  This study was aimed to investigate etiology and clinical profiles of recurrent acute pancreatitis (RAP), particularly from the morphology of the pancreaticobiliary duct system.
  
  
  METHODS
  Pancreaticobiliary morphology was examined in 230 of 381 patients with acute pancreatitis (AP) using endoscopic retrograde cholangiopancreatography. We analyzed factors associated with RAP including the pancreaticobiliary duct system.
  
  
  RESULTS
  RAP was diagnosed in 74 patients (19%). Major etiologies of RAP were alcoholic (38%), idiopathic (26%) and pancreaticobiliary malformation (22%). Patients with alcoholic RAP were significantly younger (47.2±11.6 years) than those with gallstone RAP (67.3±16.8; p<0.05). RAP with pancreaticobiliary malformation (male-to-female ratio: 1:4.3; p<0.01) and gallstone RAP (1:1.7; p<0.05) occurred predominantly in females in comparison with alcoholic RAP (1:0.2). Recurrence rate was 80% for AP with pancreaticobiliary malformation, significantly higher than for the others (p<0.01). Pancreas divisum was suspected as the etiology of mild RAP in 7 patients. Four RAP patients with pancreas divisum underwent endoscopic minor papilla sphincterotomy and improved. Pancreaticobiliary maljunction with biliary dilatation (choledochal cyst) was suspected as the etiology of mild RAP in 3 patients. The 3 RAP patients with choledochal cyst underwent prophylactic flow diversion surgery with complete resection of the dilated common bile duct, and achieved improvement. High confluence of pancreaticobiliary ducts was suspected as the etiology of mild RAP in 6 patients.
  
  
  CONCLUSIONS
  Pancreaticobiliary malformation is one of the major causes of RAP. As some of them benefit from endoscopic or surgical treatment, morphology of the pancreaticobiliary duct system should be examined where possible in RAP patients.
authors.affiliation: Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Takuma
authors.forename: T
authors.initials: T
authors.lastname: Kamisawa
authors.forename: S
authors.initials: S
authors.lastname: Hara
authors.forename: T
authors.initials: T
authors.lastname: Tabata
authors.forename: S
authors.initials: S
authors.lastname: Kuruma
authors.forename: K
authors.initials: K
authors.lastname: Chiba
authors.forename: G
authors.initials: G
authors.lastname: Kuwata
authors.forename: T
authors.initials: T
authors.lastname: Fujiwara
authors.forename: H
authors.initials: H
authors.lastname: Egashira
authors.forename: K
authors.initials: K
authors.lastname: Koizumi
authors.forename: J
authors.initials: J
authors.lastname: Fujiwara
authors.forename: T
authors.initials: T
authors.lastname: Arakawa
authors.forename: K
authors.initials: K
authors.lastname: Momma
authors.forename: Y
authors.initials: Y
authors.lastname: Igarashi
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000002:abnormalities*; D002648:Child; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015529:Choledochal Cyst / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000002:abnormalities*; D010195:Pancreatitis / Q000209:etiology* / Q000601:surgery; D012008:Recurrence; D016717:Sphincterotomy, Endoscopic; D055815:Young Adult