Acute pancreatitis precedes chronic pancreatitis in the majority of patients: Results from the NAPS2 consortium

Vikesh K Singh; David C Whitcomb; Peter A Banks; Samer AlKaade; Michelle A Anderson; Stephen T Amann; Randall E Brand; Darwin L Conwell; Gregory A Cote; Timothy B Gardner; Andres Gelrud; Nalini Guda; Christopher E Forsmark; Michele Lewis; Stuart Sherman; Thiruvengadam Muniraj; Joseph Romagnuolo; Xiaoqing Tan; Gong Tang; Bimaljit S Sandhu; Adam Slivka; C Mel Wilcox; Dhiraj Yadav; NAPS Consortium

doi:10.1016/j.pan.2022.10.004

Acute pancreatitis precedes chronic pancreatitis in the majority of patients: Results from the NAPS2 consortium

Pancreatology. 2022 Dec;22(8):1091-1098. doi: 10.1016/j.pan.2022.10.004. Epub 2022 Oct 31.

Authors

Vikesh K Singh¹, David C Whitcomb², Peter A Banks³, Samer AlKaade⁴, Michelle A Anderson⁵, Stephen T Amann⁶, Randall E Brand², Darwin L Conwell⁷, Gregory A Cote⁸, Timothy B Gardner⁹, Andres Gelrud¹⁰, Nalini Guda¹¹, Christopher E Forsmark¹², Michele Lewis¹³, Stuart Sherman¹⁴, Thiruvengadam Muniraj¹⁵, Joseph Romagnuolo¹⁶, Xiaoqing Tan¹⁷, Gong Tang¹⁷, Bimaljit S Sandhu¹⁸, Adam Slivka², C Mel Wilcox¹⁹, Dhiraj Yadav²; NAPS Consortium

Collaborators

NAPS Consortium:
C Mel Wilcox²⁰, Nalini Guda¹¹, Peter Banks²¹, Darwin Conwell²¹, Simon K Lo²², Andres Gelrud²³, Timothy Gardner²⁴, John Baillie²⁵, Christopher E Forsmark²⁶, Thiruvengadam Muniraj²⁷, Stuart Sherman²⁸, Vikesh K Singh²⁹, Michele Lewis³⁰, Joseph Romagnuolo³¹, Robert Hawes³¹, Gregory A Cote³¹, Christopher Lawrence³¹, Michelle A Anderson³², Stephen T Amann³³, Babak Etemad³⁴, Mark DeMeo³⁵, Michael Kochman³⁶, Judah N Abberbock³⁷, M Michael Barmada³⁷, Emil Bauer³⁷, Randall E Brand³⁷, Elizabeth Kennard³⁷, Jessica LaRusch³⁷, Michael O'Connell³⁷, Kimberly Stello³⁷, Adam Slivka³⁷, Jyothsna Talluri³⁷, Gong Tang³⁷, David C Whitcomb³⁷, Stephen R Wisniewski³⁷, Dhiraj Yadav³⁷, Frank Burton³⁸, Samer AlKaade³⁸, James DiSario³⁹, Bimaljit S Sandhu⁴⁰, Mary Money⁴¹, William Steinberg⁴²

Affiliations

¹ Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: vsingh1@jhmi.edu.
² Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
³ Division of Gastroenterology, Brigham & Women's Hospital, Boston, MA, USA.
⁴ Mercy Clinic Gastroenterology, St. Louis, MO, USA.
⁵ Division of Gastroenterology & Hepatology, Mayo Clinic, Phoenix, AZ, USA.
⁶ Division of OneGI, Tupelo, MS, USA.
⁷ Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA.
⁸ Division of Gastroenterology, Oregon Health Science University, Portland, OR, USA.
⁹ Division of Gastroenterology & Hepatology, Dartmouth-Hitchcock Medical Center, Hanover, NH, USA.
¹⁰ GastroHealth, Miami, FL, USA.
¹¹ Aurora St. Luke's Medical Center, Milwaukee, WI, USA.
¹² Division of Gastroenterology, Hepatology & Nutrition, University of Florida, Gainesville, FL, USA.
¹³ Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, FL, USA.
¹⁴ Division of Gastroenterology & Hepatology, Indiana University, Indianapolis, IN, USA.
¹⁵ Digestive Diseases, Yale University, New Haven, CT, USA.
¹⁶ Palmetto Health, Columbia Gastroenterology Associates, Columbia, SC, USA.
¹⁷ Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA.
¹⁸ Gastroenterology Associates, Richmond, VA, USA.
¹⁹ Division of Gastroenterology & Hepatology, University of Alabama, Birmingham, AL, USA.
²⁰ University of Alabama, Birmingham, AL, USA.
²¹ Brigham & Women's Hospital, Boston, MA, USA.
²² Cedars-Sinai Medical Center, Los Angeles, CA, USA.
²³ University of Cincinnati, Cincinnati, OH, USA.
²⁴ Dartmouth-Hitchcock Medical Center, Hanover, NH, USA.
²⁵ Duke University Medical Center, Durham, NC, USA.
²⁶ University of Florida, Gainesville, FL, USA.
²⁷ Griffin Hospital, CT, USA.
²⁸ Indiana University, Indianapolis, IN, USA.
²⁹ Johns Hopkins University, Baltimore, MD, USA.
³⁰ Mayo Clinic, Jacksonville, FL, USA.
³¹ Medical University of South Carolina, Charleston, SC, USA.
³² University of Michigan, Ann Arbor, MI, USA.
³³ North Mississippi Medical Center, Tupelo, MS, USA.
³⁴ Ochsner Medical Center, New Orleans, LA, USA.
³⁵ Rush University Medical Center, Chicago, IL, USA.
³⁶ University of Pennsylvania, Philadelphia, PA, USA.
³⁷ University of Pittsburgh, Pittsburgh, PA, USA.
³⁸ St. Louis University, St. Louis, MO, USA.
³⁹ University of Utah Health Science Center, Salt Lake City, UT, USA.
⁴⁰ Virginia Commonwealth University, Richmond, VA, USA.
⁴¹ Washington County Hospital, Hagerstown, MD, USA.
⁴² Washington Medical Center, Washington, DC, USA.

Abstract

Introduction: The mechanistic definition of chronic pancreatitis (CP) identifies acute pancreatitis (AP) as a precursor stage. We hypothesized that clinical AP frequently precedes the diagnosis of CP and is associated with patient- and disease-related factors. We describe the prevalence, temporal relationship and associations of AP in a well-defined North American cohort.

Methods: We evaluated data from 883 patients with CP prospectively enrolled in the North American Pancreatitis Studies across 27 US centers between 2000 and 2014. We determined how often patients had one or more episodes of AP and its occurrence in relationship to the diagnosis of CP. We used multivariable logistic regression to determine associations for prior AP.

Results: There were 624/883 (70.7%) patients with prior AP, among whom 161 (25.8%) had AP within 2 years, 115 (18.4%) within 3-5 years, and 348 (55.8%) >5 years prior to CP diagnosis. Among 504 AP patients with available information, 436 (86.5%) had >1 episode. On multivariable analyses, factors associated with increased odds of having prior AP were a younger age at CP diagnosis, white race, abdominal pain, pseudocyst(s) and pancreatic duct dilatation/stricture, while factors associated with a lower odds of having prior AP were exocrine insufficiency and pancreatic atrophy. When compared with patients with 1 episode, those with >1 AP episode were diagnosed with CP an average of 5 years earlier.

Conclusions: Nearly three-quarters of patients were diagnosed with AP prior to CP diagnosis. Identifying which AP patients are at-risk for future progression to CP may provide opportunities for primary and secondary prevention.

Keywords: Alcohol; Natural history; Pancreatitis; Prevention; Treatment.

MeSH terms

Abdominal Pain
Acute Disease
Humans
Pancreatic Diseases*
Pancreatitis, Chronic* / complications
Pancreatitis, Chronic* / epidemiology

Abstract

MeSH terms

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