Clinical Profile and Genetic studies in Recurrent Acute Pancreatitis : A Five Year Study.

Sajith, K G (2008) Clinical Profile and Genetic studies in Recurrent Acute Pancreatitis : A Five Year Study. Masters thesis, Christian Medical College, Vellore.


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INTRODUCTION : Numerous studies have been conducted on acute and chronic pancreatitis , but only few have focused on recurrent acute pancreatitis(RAP). Recurrent acute pancreatitis may be due to biliary disease, alcohol, metabolic factors (hypercalcemia, hypertriglyceridemia), drugs, trauma, sphincter of Oddi dysfunction, pancreas divisum and pancreatic carcinoma. Evaluation fails to detect the cause in 10 – 30% of patients , and these patients are labelled as idiopathic recurrent acute (IAP) pancreatitis(IRAP). Further evaluation and therapy is important because more than 50% of untreated patients with RAP experience recurrent episodes that can lead to chronic pancreatitis Mutations in cationic trypsinogen gene (PRSS1) , SPINK1 gene ,cystic fibrosis transmembrane conductance regulator gene (CFTR) and Cathepsin B gene have been demonstrated in acute and chronic pancreatitis(3-6). It is possible that genetic mutations may be the cause of pancreatitis in patients now labelled as Idiopathic Recurrent Pancreatitis. Few patients with gall stones or alcoholism develop RAP. It is therefore conceivable that genetic mutations enhance susceptibility to RAP in patients with other predisposing factors. RAP may be a complex disease process resulting from an interplay of genetic susceptibilities and environmental factors. AIMS AND OBJECTIVES : 1. To study the clinical profile, efficacy of medical / endoscopic therapy and outcome of recurrent acute pancreatitis. 2. To assess the prevalence of genetic mutations in recurrent acute pancreatitis. CONCLUSIONS: Biliary disease (stone (20%); sludge / microlithiasis (28%) is the most common cause of recurrent acute pancreatitis (RAP). Determining etiology is important to assess the progressive nature of the disease . The extent of evaluation impacts the frequency with which an etiology can be found. Bile for microliths and ERCP should therefore be part of evaluation of RAP as these detect the etiology in 1/3rd of patients. Distribution of etiological factors was similar in East , South and North India. After extensive evaluation including ERCP and testing bile for microliths , a cause for RAP could not be detected in 18% of patients. Genetic mutations do not play a major role in the etiopathogenesis of RAP. Further studies with larger sample size needs to be done. Severe pancreatitis (14%) was predominantly seen in biliary and Idiopathic RAP. Patients with biliary microlithiasis responded well to treatment with UDCA and biliary sphincterotomy. Patients with pancreas divisum responded well to accessory papilla sphincterotomy. Some patients labeled as Idiopathic RAP may respond to empiric biliary sphincterotomy as they may have occult biliary microlithiasis or sphincter of Oddi dysfunction. Patients (38%) labeled as Idiopathic RAP responded to empiric trial of pancreatic enzymes. Large controlled trials are required to determine the role of pancreatic enzymes , antioxidants or octreotide in therapy of Idiopathic RAP. Does Idiopathic RAP really exist ? An etiology was obtained in 93% of patients after extensive evaluation , empiric biliary sphincterotomy in Idiopathic RAP and development of chronic pancreatitis on follow up.It is possible that on further follow up , the 7 % of patients may progress to chronic pancreatitis. Follow up of patients with idiopathic RAP is necessary as some may progress to chronic pancreatitis.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Recurrent Acute Pancreatitis ; Genetic studies ; Clinical Profile ; Five Year Study.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 14 Jul 2017 03:13
Last Modified: 14 Jul 2017 03:13

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