review of literature on clinical pancreatology - The Pancreapedia

diagnosed as a leading etiology <strong>of</strong> pancreatitis in the past. One-fourth <strong>of</strong> AP patients whowere heavy drinkers had other explainable etiologies <strong>of</strong> acute pancreatitis [208].In the long term, half <strong>of</strong> patients with their first alcohol-associated acute pancreatitis developacute recurrence, alcohol consumption being the main risk factor. None <strong>of</strong> the recent nationalor international guidelines for treatment include recommendations aimed to decreaserecurrences, possibly because <strong>of</strong> a lack <strong>of</strong> studies. One study investigated whether acuterecurrences can be reduced. One hundred and twenty patients admitted to a universityhospital for their first alcohol-associated acute pancreatitis were randomized either torepeated intervention (n=59) or initial intervention only (n=61). The patients in the two groupsdid not differ. A registered nurse performed an intervention in both groups before discharge,after which it was repeated in the study group at 6-month intervals at the gastrointestinaloutpatient clinic. Acute recurrences during the next 2 years were monitored. There were 9recurrent pancreatitis episodes in 5 patients in the repeated-intervention group comparedwith 20 episodes in 13 patients in the control group, which was a signifikant difference. Therecurrence rates were similar during the first 6 months (4 vs 5 episodes), after which therepeated-intervention group had significantly fewer recurrences than the control group (5 vs15 episodes). It was concluded that the repeated visits at 6-month intervals at thegastrointestinal outpatient clinic, consisting <strong>of</strong> an intervention against alcohol consumption,appear to be better than the single standardized intervention alone during hospitalization inreducing the development <strong>of</strong> recurrent acute pancreatitis during a 2-year period [209].Acute alcoholic pancreatitis (AAP) recurs in up to half <strong>of</strong> the patients, continuous alcoholconsumption being an important risk factor. Changes in pancreatic function and morphologyafter acute pancreatitis have been characterized previously, but their association with laterrecurrences has not been adequately studied. In a prospective follow-up study, thepancreatic function <strong>of</strong> 54 patients (47 males and 7 females) with a median age <strong>of</strong> 49 years(range 25-71) and morphology (35 patients) were evaluated. Pancreatic morphology wasevaluated by secretin-stimulated magnetic resonance pancreatography (SMRP). Patientswere evaluated early (baseline) and at 2 years after the first episode <strong>of</strong> AAP. In order toevaluate later recurrences, the patients were followed for a median <strong>of</strong> 47 (range 28-66)months. Of the 46 patients without previous diabetes, 17 patients (37 %) developed impairedglucose metabolism during the 2 years following the first AAP. The prevalence <strong>of</strong> exocrinedysfunction decreased from 39 percent at baseline to 9 percent at 2 years. Of the patientswith severe pancreatitis (n=13, 24 %), 31 percent had elevated glycosylated haemoglobinlevels compared to 7 percent in patients with mild pancreatitis (odds ratio 5.5, 95 %confidence interval 1.04 to 29.0]. Twenty percent (7/35) <strong>of</strong> the patients had changesconsistent with chronic pancreatitis on baseline SMRP, which persisted in all cases. Of the29 percent <strong>of</strong> patients with acute changes on baseline SMRP, the acute changes resolved in50 percent and chronic pancreatitis was detected in the remaining 50 percent at 2 years.Development <strong>of</strong> chronic changes did not depend on continued alcohol consumption, as itwas also found in three patients practising complete abstinence following their first attack <strong>of</strong>AAP. The presence <strong>of</strong> a chronic pseudocyst at 2 years predicted pancreatitis whencompared to patients lacking pseudocyst formation: 4 (80 %) versus 5 (17 %) (odds ratio 2095 % confidence interval 1.83 to 219). It was concluded taht the severity <strong>of</strong> the first episode<strong>of</strong> AAP was associated with deteriorated diabetes control, but not with pancreatic exocrinedysfunction at 2 years. The number <strong>of</strong> patients with chronic changes on SMRP increasedindependently <strong>of</strong> alcohol consumption. Chronic pseudocyst formation seen on SMRP 2 yearsafter AAP was significantly associated with recurrence <strong>of</strong> pancreatitis [210].Post-ERCP-pancreatitisProphylactic effect <strong>of</strong> allupurinolTo assess the efficacy <strong>of</strong> allopurinol to prevent hyperamylasemia and pancreatitis after