Abstract
Alcoholic chronic pancreatitis usually progresses from acute attacks to chronic pancreatitis within one to 19 years. The factors responsible for the appreciable variability in progression are unclear. In this study the relation between progression and the incidence and severity of acute episodes in a large cohort of patients with alcoholic chronic pancreatitis was analysed. All patients with at least one documented episode of acute pancreatitis have been studied prospectively over the past 30 years according to our protocol. Patients were classified according to their long term course into (a) calcific (n = 185), (b) non-calcific (n = 30), and (c) non-progressive (n = 39) chronic pancreatitis groups. The yearly incidence of acute attacks of pancreatitis was significantly higher in groups (a) and (b) than in group (c). Furthermore, the progression rate to advanced chronic pancreatitis (groups (a) and (b)) correlated with the incidence of severe pancreatitis (associated with pseudocysts in more than 55%). Pseudocysts were located primarily in the cephalic pancreas in groups (a) and (b) (58-71%) and in the pancreatic tail in group (c) (61%). In conclusion, these data suggest that the progression of acute to chronic pancreatitis is closely related to the incidence and severity of acute attacks. This finding and the primary location of pseudocysts in the cephalic pancreas (groups (a) plus (b)) are compatible with the 'necrosis-fibrosis' pathogenetic hypothesis.
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Selected References
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- Ammann R. W., Akovbiantz A., Largiader F., Schueler G. Course and outcome of chronic pancreatitis. Longitudinal study of a mixed medical-surgical series of 245 patients. Gastroenterology. 1984 May;86(5 Pt 1):820–828. [PubMed] [Google Scholar]
- Ammann R. W., Buehler H., Bruehlmann W., Kehl O., Muench R., Stamm B. Acute (nonprogressive) alcoholic pancreatitis: prospective longitudinal study of 144 patients with recurrent alcoholic pancreatitis. Pancreas. 1986;1(3):195–203. [PubMed] [Google Scholar]
- Angelini G., Pederzoli P., Caliari S., Fratton S., Brocco G., Marzoli G., Bovo P., Cavallini G., Scuro L. A. Long-term outcome of acute necrohemorrhagic pancreatitis. A 4-year follow-up. Digestion. 1984;30(3):131–137. doi: 10.1159/000199097. [DOI] [PubMed] [Google Scholar]
- Barthet M., Bugallo M., Moreira L. S., Bastid C., Sastre B., Sahel J. Management of cysts and pseudocysts complicating chronic pancreatitis. A retrospective study of 143 patients. Gastroenterol Clin Biol. 1993;17(4):270–276. [PubMed] [Google Scholar]
- Frey C. F. Pancreatic pseudocyst--operative strategy. Ann Surg. 1978 Nov;188(5):652–662. doi: 10.1097/00000658-197811000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gullo L., Barbara L., Labò G. Effect of cessation of alcohol use on the course of pancreatic dysfunction in alcoholic pancreatitis. Gastroenterology. 1988 Oct;95(4):1063–1068. doi: 10.1016/0016-5085(88)90184-9. [DOI] [PubMed] [Google Scholar]
- HOWARD J. M., EHRLICH E. W. The etiology of pancreatitis: a review of clinical experience. Ann Surg. 1960 Jul;152:135–146. doi: 10.1097/00000658-196007000-00019. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Klöppel G., Maillet B. The morphological basis for the evolution of acute pancreatitis into chronic pancreatitis. Virchows Arch A Pathol Anat Histopathol. 1992;420(1):1–4. doi: 10.1007/BF01605976. [DOI] [PubMed] [Google Scholar]
- Laugier R., Camatte R., Sarles H. Chronic obstructive pancreatitis after healing of a necrotic pseudocyst. Am J Surg. 1983 Nov;146(5):551–557. doi: 10.1016/0002-9610(83)90287-8. [DOI] [PubMed] [Google Scholar]
- MARKS I. N., BANK S. THE AETIOLOGY, CLINICAL FEATURES AND DIAGNOSIS OF PANCREATITIS IN THE SOUTH WESTERN CAPE; A REVIEW OF 243 CASES. S Afr Med J. 1963 Oct 19;37:1039–1053. [PubMed] [Google Scholar]
- Malagelada J. R. The pathophysiology of alcoholic pancreatitis. Pancreas. 1986;1(3):270–278. doi: 10.1097/00006676-198605000-00011. [DOI] [PubMed] [Google Scholar]
- Mercadier M., Clot J. P., Coquillaud J. P. A propos d'une statistique homogène de plus de 100 cas de collections enkystées d'origine pancreatique. Ann Chir. 1967 Jun;21(11):645–659. [PubMed] [Google Scholar]
- Mitchell C. J., Playforth M. J., Kelleher J., McMahon M. J. Functional recovery of the exocrine pancreas after acute pancreatitis. Scand J Gastroenterol. 1983 Jan;18(1):5–8. doi: 10.3109/00365528309181549. [DOI] [PubMed] [Google Scholar]
- Pitchumoni C. S., Glasser M., Saran R. M., Panchacharam P., Thelmo W. Pancreatic fibrosis in chronic alcoholics and nonalcoholics without clinical pancreatitis. Am J Gastroenterol. 1984 May;79(5):382–388. [PubMed] [Google Scholar]
- Renner I. G., Savage W. T., 3rd, Pantoja J. L., Renner V. J. Death due to acute pancreatitis. A retrospective analysis of 405 autopsy cases. Dig Dis Sci. 1985 Oct;30(10):1005–1018. doi: 10.1007/BF01308298. [DOI] [PubMed] [Google Scholar]
- Sarles H., Adler G., Dani R., Frey C., Gullo L., Harada H., Martin E., Norohna M., Scuro L. A. Classifications of pancreatitis and definition of pancreatic diseases. Digestion. 1989;43(4):234–236. doi: 10.1159/000199882. [DOI] [PubMed] [Google Scholar]
- Sarles H., Camarena-Trabous J., Gomez-Santana C., Choux R., Iovanna J. Acute pancreatitis is not a cause of chronic pancreatitis in the absence of residual duct strictures. Pancreas. 1993 May;8(3):354–357. doi: 10.1097/00006676-199305000-00011. [DOI] [PubMed] [Google Scholar]
- Seligson U., Cho J. W., Ihre T., Lundh G. Clinical course and autopsy findings in acute and chronic pancreatitis. Acta Chir Scand. 1982;148(3):269–274. [PubMed] [Google Scholar]
- Staub J. L., Le Genissel H., Sarles H. Etude de la sémiologie et des résultats du traitement chirurgical de 103 cas de pancréatite chronique compliqués de kystes ou de pseudo-kystes. Gastroenterol Clin Biol. 1981 Apr;5(4):433–439. [PubMed] [Google Scholar]
- Strum W. B., Spiro H. M. Chronic pancreatitis. Ann Intern Med. 1971 Feb;74(2):264–277. doi: 10.7326/0003-4819-74-2-264. [DOI] [PubMed] [Google Scholar]
- Traverso L. W., Tompkins R. K., Urrea P. T., Longmire W. P., Jr Surgical treatment of chronic pancreatitis. Twenty-two years' experience. Ann Surg. 1979 Sep;190(3):312–319. doi: 10.1097/00000658-197909000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Warshaw A. L. Conservation of pancreatic tissue by combined gastric, biliary, and pancreatic duct drainage for pain from chronic pancreatitis. Am J Surg. 1985 Apr;149(4):563–569. doi: 10.1016/s0002-9610(85)80057-x. [DOI] [PubMed] [Google Scholar]
