Acute pancreatitis: a lethal disease of increasing incidence.

Abstract

SUMMARY Between 1968 and 1979 650 patients in the Bristol clinical area suffered 737 attacks of acute pancreatitis. Sex distribution was approximately equal and mean age was 60 years.Comparison with the previous decade shows an increase in mean annual incidence of first attacks from 53 8 to 73-0 cases per million population. Case mortality was unchanged at 20%. In no less than 35% of fatal cases the diagnosis was first made at necropsy. Gall stones were detected in 50% of first attacks, predominantly in women. The proportion of alcoholics (8% overall) increased three-fold during the period of the study. In 23% of cases no aetiological cause was identified. Eighty patients suffered 99 recurrent attacks of acute pancreatitis, with a mortality rate (12%) that was not significantly lower than that of the first attack. Neglected gall stones accounted for 51% of these subsequent attacks.Wide differences in the incidence of acute pancreatitis have been reported both within and between countries. Bristol area presenting between 1 January 1968 and 31 December 1979 were assessed. An overlap with the earlier review for 1968 and 1969 was necessary, as patients presenting during these years had not been included in the previous statistical analysis. As before, several approaches were used to maximise case retrieval. The hospital activity analysis of the South Western Regional Health Authority was used to identify most cases; all the hospitals serving the Bristol clinical area were included in the computer search. The analysis coding used was 577.0 (acute pancreatitis), and the same code was used to calculate national returns for both incidence and mortality rate. A search of the death certificate records at the Coroner's office revealed a small number of otherwise unrecorded cases. Lastly, during the period under review various clinical trials in acute pancreatitis have been undertaken in Bristol,5 6 and details from these were included.

A prospective study of clinical, biochemical and radiological features in pancreatitis

“…6 where the mean age was 42.4 years (range 20-69 years) whereas the study by Corfield et al have shown the mean age to be 60 years (range 3-94 years). 7 In chronic pancreatitis, the mean age of the patients were 45.4 years (range 30-69 years) which differs from the study by Balaji LN and Tandon RK where the mean age was 23.9 years. 8 In acute pancreatitis case sex ratio was 1.7:1 (25 males, 15 females).…”

Study of prognostic factors and clinical outcome of Acute Pancreatitis patients with routine investigations in a Teaching Hospital

“…However, the variation of aetiology of pancreatitis is quite marked and depend on country of origin. 17 In this study most cases (60%) were idiopathic i.e. no cause is found.…”

“…4 Approximately 2 to 5% of cases of acute pancreatitis are drug-related. Drugs cause pancreatitis either by a hypersensitivity reaction or by the generation of a toxic metabolites.…”

A clinical study of acute pancreatitis

“…2 Gall stones and chronic ethanol abuse account for 70% of cases of acute pancreatitis. 3 Pathologically there are two types of pancreatitis, interstitial and necrotizing. 4 Pathophysiologic mechanisms include micro-circulatory injury, leucocyte chemo-attraction, release of pro and anti-inflammatory cytokines, oxidative stress, leakage of pancreatic fluid into the region of pancreas, bacterial translocation to the pancreas and systemic circulation.…”