title: Risk of Recurrent Pancreatitis and Progression to Chronic Pancreatitis After a First Episode of Acute Pancreatitis.
abstract: OBJECTIVE
  Patients with a first episode of acute pancreatitis can develop recurrent or chronic pancreatitis (CP). However, little is known about the incidence or risk factors for these events.
  
  
  METHODS
  We performed a cross-sectional study of 669 patients with a first episode of acute pancreatitis admitted to 15 Dutch hospitals from December 2003 through March 2007. We collected information on disease course, outpatient visits, and hospital readmissions, as well as results from imaging, laboratory, and histology studies. Standardized follow-up questionnaires were sent to all available patients to collect information on hospitalizations and interventions for pancreatic disease, abdominal pain, steatorrhea, diabetes mellitus, medications, and alcohol and tobacco use. Patients were followed up for a median time period of 57 months. Primary end points were recurrent pancreatitis and CP. Risk factors were evaluated using regression analysis. The cumulative risk was assessed using Kaplan-Meier analysis.
  
  
  RESULTS
  Recurrent pancreatitis developed in 117 patients (17%), and CP occurred in 51 patients (7.6%). Recurrent pancreatitis developed in 12% of patients with biliary disease, 24% of patients with alcoholic etiology, and 25% of patients with disease of idiopathic or other etiologies; CP occurred in 3%, 16%, and 10% of these patients, respectively. Etiology, smoking, and necrotizing pancreatitis were independent risk factors for recurrent pancreatitis and CP. Acute Physiology and Chronic Health Evaluation II scores at admission also were associated independently with recurrent pancreatitis. The cumulative risk for recurrent pancreatitis over 5 years was highest among smokers at 40% (compared with 13% for nonsmokers). For alcohol abusers and current smokers, the cumulative risks for CP were similar-approximately 18%. In contrast, the cumulative risk of CP increased to 30% in patients who smoked and abused alcohol.
  
  
  CONCLUSIONS
  Based on a retrospective analysis of patients admitted to Dutch hospitals, a first episode of acute pancreatitis leads to recurrent pancreatitis in 17% of patients, and almost 8% of patients progress to CP within 5 years. Progression was associated independently with alcoholic etiology, smoking, and a history of pancreatic necrosis. Smoking is the predominant risk factor for recurrent disease, whereas the combination of alcohol abuse and smoking produces the highest cumulative risk for chronic pancreatitis.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Usama
authors.initials: U
authors.lastname: Ahmed Ali
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Yama
authors.initials: Y
authors.lastname: Issa
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Julia C
authors.initials: JC
authors.lastname: Hagenaars
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Olaf J
authors.initials: OJ
authors.lastname: Bakker
authors.affiliation: Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Harry
authors.initials: H
authors.lastname: van Goor
authors.affiliation: Department of Surgery, Isala Clinics, Zwolle, The Netherlands.
authors.forename: Vincent B
authors.initials: VB
authors.lastname: Nieuwenhuijs
authors.affiliation: Department of Radiology, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Bollen
authors.affiliation: Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Bert
authors.initials: B
authors.lastname: van Ramshorst
authors.affiliation: Department of Gastroenterology, Gelderse Vallei Hospital, Ede, The Netherlands.
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Witteman
authors.affiliation: Department of Gastroenterology, Meander Medical Center, Amersfoort, The Netherlands.
authors.forename: Menno A
authors.initials: MA
authors.lastname: Brink
authors.affiliation: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Alexander F
authors.initials: AF
authors.lastname: Schaapherder
authors.affiliation: Department of Surgery and NUTRIM, University Hospital Maastricht, Maastricht, The Netherlands.
authors.forename: Cornelis H
authors.initials: CH
authors.lastname: Dejong
authors.affiliation: Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: B W Marcel
authors.initials: BW
authors.lastname: Spanier
authors.affiliation: Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands.
authors.forename: Joos
authors.initials: J
authors.lastname: Heisterkamp
authors.affiliation: Department of Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands.
authors.forename: Erwin
authors.initials: E
authors.lastname: van der Harst
authors.affiliation: Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Casper H
authors.initials: CH
authors.lastname: van Eijck
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Besselink
authors.affiliation: Department of Evidence Based Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Hein G
authors.initials: HG
authors.lastname: Gooszen
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Hjalmar C
authors.initials: HC
authors.lastname: van Santvoort
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: m.a.boermeester@amc.uva.nl.
authors.forename: Marja A
authors.initials: MA
authors.lastname: Boermeester
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications*; D050500:Pancreatitis, Chronic / Q000453:epidemiology*; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D011795:Surveys and Questionnaires
keywords: Chronic Pancreatitis; Longitudinal Study; Pancreatitis Progression; Risk Factors