Idiopathic Acute Pancreatitis

Abstract

After routine investigations, including a thorough history, routine laboratory study, and noninvasive imaging with transcutaneous ultrasonogram, 10% to 25% of cases of acute pancreatitis have no readily identifiable cause and are termed idiopathic. But modern medicine has made notable advances in uncovering various causes of acute pancreatitis, and several new diagnostic tools that allow clinicians to less invasively approach the patient without sacrificing the diagnostic yield have been introduced. By being knowledgeable of these new changes and by their proper use in a proper circumstances, clinicians will be able to find the cause more accurately and earlier. This better management will not only improve the well-being of the patients but also reduce the number of "true" idiopathic acute pancreatitis to a minimum.

Acute Pancreatitis in Patients With Crohnʼs Disease: Clinical Features and Outcomes

“…Roughly one fifth of the patients in our experience had “idiopathic pancreatitis.” All other possible causes of acute pancreatitis were excluded. Whereas this might suggest the possibility of pancreatitis as an extraintestinal manifestation of CD, the prevalence of idiopathic pancreatitis in this series did not exceed the expected prevalence of idiopathic disease in acute pancreatitis among the general population (10%‐30%) 30,31. It is interesting to note that antibodies to pancreatic juice have been detected in up to 40% of patients with CD,32 a prevalence significantly higher than seen in controls 33.…”

Clinical characteristics of intraductal papillary mucinous neoplasm manifesting as acute pancreatitis or acute recurrent pancreatitis

“…Other well‐known causes of AP/ARP were ruled out: biliary lithiasis (presence of gallbladder or common bile duct lithiasis or sludge at any imaging procedure including endoscopic ultrasound [EUS] ), alcohol (when the patient reported a regular high intake of alcohol or an alcoholic binge directly before the onset of pancreatitis), hypertriglyceridemia or hypercalcemia, medication causing acute pancreatitis, any cause of obstructive pancreatitis (e.g. ampullary or ordinary pancreatic ductal adenocarcinoma), iatrogenic (e.g. post‐endoscopic retrograde cholangiopancreatography [ERCP] pancreatitis), gene associated (in young patients with positive family history of pancreatic disease), and autoimmune (immunoglobulin G4 [IgG4], typical imaging) …”

“…ampullary or ordinary pancreatic ductal adenocarcinoma), iatrogenic (e.g. post‐endoscopic retrograde cholangiopancreatography [ERCP] pancreatitis), gene associated (in young patients with positive family history of pancreatic disease), and autoimmune (immunoglobulin G4 [IgG4], typical imaging) …”

Analysis of PRSS1 and SPINK1 Mutations in Korean Patients With Idiopathic and Familial Pancreatitis

“…1 Familial pancreatitis was defined as when no definite cause of pancreatitis could be determined by this evaluation procedure and history of pancreatitis was present in one or more first-degree relatives. Fifty healthy controls were included for additional analysis of SPINK1 mutations after initial evaluation in patients with pancreatitis.…”

“…After routine investigation, however, 10% to 30% of cases of acute or chronic pancreatitis have no readily identifiable cause and are classified as idiopathic. 1 Recently, genetic mutation has emerged as an important issue in the pathogenesis of pancreatitis because mutations in the cationic trypsinogen gene (protease serine 1 [PRSS1]) were identified in hereditary pancreatitis (HP). 2 Thereafter, mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) and serine protease inhibitor, Kazal type 1 (SPINK1) genes were also identified in patients with idiopathic pancreatitis.…”