title: A single-centre prospective, cohort study of the natural history of acute pancreatitis.
abstract: BACKGROUND
  The natural history of acute pancreatitis is based on clinical studies that aim to elucidate the course of disease on the basis of predicted risk factors.
  
  
  OBJECTIVE
  To evaluate the long-term occurrence of recurrent acute pancreatitis and chronic pancreatitis in a cohort of patients following an initial episode of acute pancreatitis.
  
  
  METHODS
  196 patients were enrolled consecutively and studied prospectively. Clinical characteristics, exogenously/endogenously-associated factors, and evolution to recurrent acute pancreatitis and chronic pancreatitis were analyzed.
  
  
  RESULTS
  40 patients developed recurrent acute pancreatitis 13 of whom developed chronic pancreatitis. In a univariate analysis, recurrent acute pancreatitis was associated with an idiopathic aetiology (p<0.001), pancreas divisum (p=0.001), and higher usage of cigarettes and alcohol (p<0.001; p=0.023). Chronic pancreatitis was associated with a severe first episode of acute pancreatitis (p=0.048), PD (p=0.03), and cigarette smoking (p=0.038). By multivariate analysis, pancreas divisum was an independent risk factor for recurrent acute pancreatitis (OR 11.5, 95% CI 1.6-83.3). A severe first-episode of acute pancreatitis increased the risk of progressing to chronic pancreatitis by nine-fold.
  
  
  CONCLUSIONS
  Special attention should be given to patients who experience a severe first attack of acute pancreatitis as there appears to be an increased risk of developing chronic pancreatitis over the long term.
authors.affiliation: Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, Milan, Italy. Electronic address: cavestro.giuliamartina@hsr.it.
authors.forename: Giulia Martina
authors.initials: GM
authors.lastname: Cavestro
authors.affiliation: Gastroenterology Unit 1, Gastroenterological Hospital 'S. De Bellis' IRCCS, Castellana Grotte, Italy.
authors.forename: Gioacchino
authors.initials: G
authors.lastname: Leandro
authors.affiliation: Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Milena
authors.initials: M
authors.lastname: Di Leo
authors.affiliation: Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Raffaella Alessia
authors.initials: RA
authors.lastname: Zuppardo
authors.affiliation: Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Olivia B
authors.initials: OB
authors.lastname: Morrow
authors.affiliation: Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Notaristefano
authors.affiliation: Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Gemma
authors.initials: G
authors.lastname: Rossi
authors.affiliation: Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Sabrina Gloria Giulia
authors.initials: SG
authors.lastname: Testoni
authors.affiliation: Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Mazzoleni
authors.affiliation: Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Alessandri
authors.affiliation: Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Goni
authors.affiliation: Boston University School of Medicine and Boston Medical Center, Section of Gastroenterology, United States.
authors.forename: Satish K
authors.initials: SK
authors.lastname: Singh
authors.affiliation: Gastroenterology Unit 1, Gastroenterological Hospital 'S. De Bellis' IRCCS, Castellana Grotte, Italy.
authors.forename: Aurore
authors.initials: A
authors.lastname: Giliberti
authors.affiliation: Gastroenterology Unit 1, Gastroenterological Hospital 'S. De Bellis' IRCCS, Castellana Grotte, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Bianco
authors.affiliation: Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Lorella
authors.initials: L
authors.lastname: Fanti
authors.affiliation: Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Edi
authors.initials: E
authors.lastname: Viale
authors.affiliation: Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Paolo Giorgio
authors.initials: PG
authors.lastname: Arcidiacono
authors.affiliation: Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Mariani
authors.affiliation: Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Petrone
authors.affiliation: Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Pier Alberto
authors.initials: PA
authors.lastname: Testoni
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D018450:Disease Progression; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D010195:Pancreatitis / Q000175:diagnosis* / Q000235:genetics*; D050500:Pancreatitis, Chronic / Q000175:diagnosis*; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012907:Smoking
keywords: Acute pancreatitis; Alcohol and smoking habits; Chronic pancreatitis; Pancreas divisum; Recurrent acute pancreatitis; Severe acute disease