title: Pancreatic morphological changes in long-term follow-up after initial episode of acute alcoholic pancreatitis.
abstract: OBJECTIVE
  The long-term morphological changes induced by a single episode of alcoholic pancreatitis are not known. Our aim was to study these morphological changes in secretin-stimulated magnetic resonance cholangiopancreatography (S-MRCP) after the first episode of alcohol-associated acute pancreatitis and to evaluate the risk factors and possible protective factors potentially associated with later chronic findings. We have previously reported 2-year follow-up results in pancreatic morphology. This study extends the follow-up to 9 years.
  
  
  METHODS
  In this prospective follow-up study, S-MRCP imaging was performed for 44 (41 M, 3 F; mean age, 46 (25-68) years) patients after their first episode of alcohol-associated pancreatitis. Pancreatic morphology was evaluated at 3 months and at 2, 7, and 9 years after hospitalization. Recurrent attacks of pancreatitis were studied and pancreatic function was monitored by laboratory tests. Patients' alcohol consumption was evaluated with questionnaires, laboratory markers, and self-estimated alcohol consumption via interview. Smoking and body mass index were annually recorded.
  
  
  RESULTS
  At 3 months, 32 % of the patients had normal findings in S-MRCP, 52 % had acute, and 16 % had chronic changes. At 7 years, S-MRCP was performed on 36 patients with normal findings in 53 %, the rest (47 %) having chronic findings. Pancreatic cyst was present in 36 %, parenchymal changes in 28 %, and atrophy in 28 % of the cases. There were no new changes in the pancreas in the attending patients between 7 and 9 years (18 patients). Of the patients with only acute findings at 3 months, 60 % resolved to normal in 7 years, but the rest (40 %) showed chronic changes later on. The initial attack was mild in 65 %, moderate in 25 %, and severe in 10 % of the patients. Patients with mild first attack had fewer chronic changes at 7 years compared to patients with moderate or moderate and severe together (p = 0.03, p = 0.01). Of the patients in the seventh year of S-MRCP, 22 % had suffered a recurrent episode of acute pancreatitis (mean, 22 (2-60) months) and 11 % had a clinical diagnosis of chronic pancreatitis. At 7 years, 88 % of the patients with recurrences had chronic findings in S-MRCP versus 36 % with nonrecurrent pancreatitis (p = 0.02). Six (17 %) patients abstained from alcohol throughout follow-up (mean, 8.7 (7-9.1) years), but even one of these developed pancreatic atrophy. Out of the non-abstinent patients who did not suffer recurrences, 4/22 (18 %) had developed new findings during at follow-up S-MRCP (NS). In univariate analysis, heavy smoking showed no correlation with increased chronic changes compared to nonsmoking.
  
  
  CONCLUSIONS
  Morphological pancreatic changes increase with recurrent episodes of acute pancreatitis. Patients with mild first attack have fewer chronic changes in the pancreas in the long term. However, even a single episode of acute alcoholic pancreatitis may induce chronic morphological changes in long-term follow-up.
authors.affiliation: School of Medicine, University of Tampere, Tampere, Finland.
authors.forename: Jussi
authors.initials: J
authors.lastname: Nikkola
authors.forename: Irina
authors.initials: I
authors.lastname: Rinta-Kiikka
authors.forename: Sari
authors.initials: S
authors.lastname: Räty
authors.forename: Johanna
authors.initials: J
authors.lastname: Laukkarinen
authors.forename: Riitta
authors.initials: R
authors.lastname: Lappalainen-Lehto
authors.forename: Satu
authors.initials: S
authors.lastname: Järvinen
authors.forename: Hanna
authors.initials: H
authors.lastname: Seppänen
authors.forename: Isto
authors.initials: I
authors.lastname: Nordback
authors.forename: Juhani
authors.initials: J
authors.lastname: Sand
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D001284:Atrophy / Q000175:diagnosis; D049448:Cholangiopancreatography, Magnetic Resonance; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology*; D010192:Pancreatic Pseudocyst / Q000175:diagnosis; D019512:Pancreatitis, Alcoholic / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D011446:Prospective Studies; D012008:Recurrence; D012633:Secretin; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D013997:Time Factors
chemical_list: D012633:Secretin