Frequency of Progression From Acute to Chronic Pancreatitis and Risk Factors: A Meta-analysis

doi:10.1053/j.gastro.2015.07.066

Gastroenterology

Volume 149, Issue 6, November 2015, Pages 1490-1500.e1

https://doi.org/10.1053/j.gastro.2015.07.066 Get rights and content

Background & Aim

Acute pancreatitis (AP) and chronic pancreatitis (CP) traditionally have been thought to be distinct diseases, but there is evidence that AP can progress to CP. Little is known about the mechanisms of pancreatitis progression. We performed a meta-analysis to quantify the frequency of transition of AP to CP and identify risk factors for progression.

Methods

We searched PubMed, Scopus, and Embase for studies of patients with AP who developed CP, published from 1966 through November 2014. Pooled prevalence and 95% confidence intervals (CIs) were calculated for these outcomes, and sensitivity, subgroup, and meta-regression analyses were conducted.

Results

We analyzed 14 studies, which included a total of 8492 patients. The pooled prevalence of recurrent AP was 22% (95% CI, 18%–26%), and the pooled prevalence of CP was 10% (95% CI, 6%–15%). Sensitivity analyses yielded a pooled prevalence of CP of 10% (95% CI, 4%–19%) and 36% (95% CI, 20%–53%) in patients after the first occurrence and recurrent AP, respectively. Subgroup analyses found alcohol use and smoking to be the largest risk factors for the development of CP, with pooled prevalence values of 65% (95% CI, 48%–56%) and 61% (95% CI, 47%–73%), respectively. Meta-regression analysis found that men were more likely than women to transition from AP to CP.

Conclusions

Ten percent of patients with a first episode of AP and 36% of patients with recurrent AP develop CP; the risk is higher among smokers, alcoholics, and men. Prospective clinical studies are needed to study pancreatitis progression.

Section snippets

Search Methods

A search of the literature for relevant studies was conducted by 2 authors (S. J. S. and A. Y. X) independently, using PubMed, Scopus, and Embase electronic databases. The terms acute pancreatitis, chronic pancreatitis, and pancreatitis recur* OR relaps* OR readmi* OR recrudesce* were first combined with the terms follow up OR followup OR follow-up OR followed up. This search then was combined with the following keyword searches: natural history, course, progression, outcome*, prognosis. The

Study Characteristics

The search resulted in 5836 articles from PubMed, Embase, and Scopus. After removal of duplicates, 3539 articles were screened using the title and abstract. Full text was obtained for 91 articles, which were screened for inclusion eligibility in the study. Overall, 14 articles met the criteria for eligibility and were included in the meta-analysis.21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33 The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram showing the

Discussion

This was a systematic review and meta-analysis of clinical studies that quantified the frequency and determined the risk factors of transition from AP to CP. The results indicate that initial AP progresses to RAP in 22% of patients. The prevalence of CP in patients after their initial episode of AP is 10%, whereas the prevalence of CP in patients who also experienced RAP is 36%. Alcohol and smoking are the 2 most significant modifiable risk factors that affect the transition from AP to CP.

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To investigate profiles of circulating immune signatures in healthy controls and chronic pancreatitis patients (CP) with and without a preceding history of acute pancreatitis (AP).
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CP patients with a preceding history of AP have signs of systemic inflammatory activity even during a clinically quiescent phase. In contrast, CP patients without a history of AP have low systemic inflammatory activity. These findings suggest the presence of two immunologically diverse subtypes of CP.
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There were 4,663,864 individuals included (mean age, 46 years; 51% were women). During a mean follow-up of 16.8 years, 31,396 individuals were diagnosed with incident AP, 5546 with RAP, 8898 with CP, and 18,182 with pancreatic cancer. The cumulative incidence of pancreatitis (acute and chronic) during the study period was 0.80% (95% CI, 0.79%–0.80%). The transition incidence rates to CP were 12.1 (95% CI, 8.1–18.1) from AP, 46.8 (95% CI, 31.6–69.3) from RAP, and 0.07 (95% CI, 0.04–0.13) from a healthy state. Similar patterns were observed for transitions to pancreatic cancer. Most patients diagnosed with CP (64.2%) and pancreatic cancer (96.4%) transitioned directly from a healthy state. Among patients with pancreatitis, 41.0% (95% CI, 40.5%–41.5%) died during follow-up.
The study findings revealed an increased risk of CP and pancreatic cancer in patients with a history of AP. However, most patients with CP and pancreatic cancer transitioned directly from a healthy state.
Are we missing pancreatic exocrine insufficiency in ‘at-risk’ groups? Prospective assessment of the current practice and yield of faecal elastase testing in patients with diabetes mellitus, HIV and/or high alcohol intake
2023, Clinical Medicine, Journal of the Royal College of Physicians of London
There is cumulative evidence that pancreatic exocrine insufficiency (PEI) is under-recognised and can occur in patients with ‘at-risk’ conditions. Thus, we aimed to assess the current practice and yield of requesting faecal elastase (FEL-1), an indicator of PEI, in patients with ‘at-risk’ conditions. We prospectively recruited patients attending secondary care clinics with diabetes mellitus (DM), people living with HIV (PLHIV) and inpatients admitted to hospital with high alcohol intake (HAI). All patients underwent testing with FEL-1. Those patients with PEI (FEL-1 <200 μg/g) were contacted and offered a follow-up review in gastroenterology clinic. In total, 188 patients were recruited (HAI, n=78; DM, n=64; and PLHIV, n=46). Previous FEL-1 testing had not been performed in any of the patients. The return rate of samples was 67.9% for patients with HAI, 76.6% for those with DM and 56.5% for those with PLHIV. The presence of PEI was shown in 20.4% of patients with DM, 15.4% of patients with PLHIV and 22.6% in those with HAI. Diarrhoea and bloating were the most reported symptoms in followed-up patients with low FEL-1 (31.8% and 22.7% of patients, respectively). Follow-up computed tomography (CT) scans in those patients with PEI identified chronic pancreatitis changes in 13.6% and pancreatic atrophy in 31.8% of patients. These results suggest that there is a lack of testing for PEI in ‘at-risk’ groups. Our findings also suggest that using FEL-1 to test for PEI in patients with DM, PLHIV and HAI has a significant impact, although further studies are required to validate these findings.

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: Conflicts of interest The authors disclose no conflicts.

: Funding This study was part of the Clinical and epidemiOlogical inveStigations in Metabolism, nutritiOn, and pancreatic diseaseS (COSMOS) program. COSMOS is supported in part by Mylan New Zealand Limited, which played no role in the study design; collection, analysis, or interpretation of data; or writing of the manuscript.

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Original ResearchFull Report: Clinical—PancreasFrequency of Progression From Acute to Chronic Pancreatitis and Risk Factors: A Meta-analysis

Background & Aim

Methods

Results

Conclusions

Section snippets

Search Methods

Study Characteristics

Discussion

Gastrointest Endosc

Lancet

Gastroenterology

Control Clin Trials

Clin Gastroenterol Hepatol

Clin Gastroenterol Hepatol

Dig Liver Dis

J Gastrointest Surg

Gastroenterology

Dig Liver Dis

Gastroenterology

Clin Gastroenterol Hepatol

Dig Liver Dis

Burden of gastrointestinal disease in the United States: 2012 update

Gastroenterology

Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review

Pancreas

Chronic pancreatitis and its effect on employment and health care experience: results of a prospective American multicenter study

Pancreas

Classification of pancreatitis

Gut

Mechanisms of disease: advances in understanding the mechanisms leading to chronic pancreatitis

Nat Clin Pract Gastroenterol Hepatol

Definitions and classifications of pancreatitis

Pancreas

Chronic pancreatitis: evolution of the disease

Hepatogastroenterology

Hereditary pancreatitis: new insights into acute and chronic pancreatitis

Gut

ErbB2 oncogene expression supports the acute pancreatitis-chronic pancreatitis sequence

Virchows Arch

Original Research
Full Report: Clinical—Pancreas
Frequency of Progression From Acute to Chronic Pancreatitis and Risk Factors: A Meta-analysis