Definition for early chronic pancreatitis

AutoriP. Hegyi Jr 1,2, M.Bátovsky2, P.Hegyi1

Pracovisko: 1Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary,
2Gastroenterological Clinic, Faculty of Medicinie, Slovak Medical University in Bratislava


Objectives:  Early diagnosis of chronic pancreatitis (CP) would be important in order to stop the disease progression in time. Unfortunately, neither definitions nor biomarkers of early CP are available. It has been reported that acute recurrent pancreatitis (ARP) can lead to  CP, therefore, the number of previous attacks or ARP-associated parameters may be suitable for characterizing 

early CP. The main aim of this study is to identify biomarkers which are significantly different in acute pancreatitis (AP), ARP, and CP. Another aim is to understand the modifying effect of the number of acute episodes which could be considered as early CP.

Methods: The Hungarian Pancreatic Study group has built up a prospective register of subjects with AP. In the last six years, precise clinical data were collected from 1435
patients. In this study, data on the number of ep.
Results: In our cohort, 983 (74.75%), 270 (20.53%), 62 (4.72%) patients had a single episode of AP, ARP, and CP, respectively. In the ARP group, 173 patients (64.07%) had 2 episodes, 43 (15.93%) had 3 episodes, 24 (8.89%) had 4 episodes, and 30 (11.11%) had 5 or more episodes. Thirteen biomarkers were significantly different in the first attack of  AP and CP. The significant difference between AP and CP disappeared after the second episode of AP
concerning 8 biomarkers (gender, age, biliary etiology, alcohol consumption, pseudocyst development, gammaGT, amylase, and red blood cell count), as did after the third episode concerning 3 biomarkers (biliary etiology, body mass index, ASAT) as did after the fourth and fifth episodes concerning 2 biomarkers (ALAT and smoking). As an average, the significant differences between AP and CP disappeared from 2.63 attacks. The average number of  acute episodes of patients with pre-existing morphological alterations of the pancreas (CP group) was 4.77.

Conclusion: A definition of early CP may be 3 or more previous attacks of AP without chronic morphological alterations in the pancreas.