Recurrent Acute Pancreatitis Significantly Reduces Quality of Life Even in the Absence of Overt Chronic Pancreatitis

Abstract

OBJECTIVES: The impact of recurrent acute pancreatitis (RAP) on quality of life (QOL) is unknown. We hypothesized that RAP would reduce QOL even in the absence of chronic pancreatitis (CP). METHODS: Data were pooled from three prospective, cross-sectional studies conducted across 27 U.S. centers (the North American Pancreatitis Studies); these included subjects with chronic pancreatitis (n = 1086), RAP alone (n = 508), and non-disease controls (n = 1025). QOL was measured using the Short Form 12 (SF-12), generating a Physical Component Summary (PCS) and the Mental Component Summary score (MCS). Multivariable regression models were developed to measure the effect of RAP on QOL, the predictors of lower QOL in those with RAP, and the differential effect QOL predictors between CP and RAP. RESULTS: Compared to controls (51.0 ±9.4), subjects with RAP (41.1 ± 11.4) and CP (37.2 ± 11.8) had lower PCS (p < 0.01). Subjects with CP had lower PCS compared to those with RAP (p < 0.01). Similarly, MCS was lower among RAP (44.6 ± 11.5) and CP (42.8 ± 12.2) subjects compared to controls (51.7 ± 9.1, p< 0.01). Subjects with CP had lower MCS compared to those with RAP (p < 0.01). After controlling for independent predictors of PCS, RAP was associated with lower PCS (estimate −8.46, p < 0.01) and MCS (estimate −6.45, p < 0.0001) compared to controls. The effect of endocrine insufficiency on PCS was differentially greater among RAP subjects (−1.28 for CP vs. −4.9 for RAP, p = 0.0184). CONCLUSIONS: Even in the absence of CP, subjects with RAP have lower physical and mental QOL. This underscores the importance of identifying interventions to attenuate RAP before the development of overt CP.

Response to Hao et al.

“…First, clinical success rate of CARTO in this article is not more effective than that of balloon-occluded retrograde transvenous obliteration (BRTO) described before [2] (91% (39/43) vs 100% (17/17)). This might be associated with the use of gelfoam slurry as the embolic material.…”

“…To the Editor: We thank Drs. Hao, Li and Hu [1] for their comments on our recent article published on the effect of recurrent acute pancreatitis in the absence of overt chronic pancreatitis (RAP) on quality of life [2]. We appreciate the opportunity to respond on behalf of our co-authors.…”

“…However, the definition of RAP is still controversial. In some studies, RAP was defined as two or more well-documented separate episodes of pancreatitis that resolved with more than 3 months between attacks [2]. As pancreatic parenchymal changes may persist after the complete normalization of pancreatic enzymes and resolution of patient's symptoms, the definition is less specific if the interval between the acute attacks is short [3].…”

Gene expression profiles of recurrent acute pancreatitis risk in patients with sustained chylomicronemia

“…AP is a highly prevalent and devastating clinical consequence of CM [3,5,6]. Not only it is a disabling condition that significantly interferes with patients' quality of life [20], but it is also responsible for hospitalizations, including intensive care unit (ICU) cares, surgery, preg- nancy termination and death, the overall mortality rate being between 3% and 15%, and even higher (up to 30%) in case of persistent organ failure [21]. At present, the expression of AP in CM is not fully understood, nor is it easy to predict or curable.…”

Recent advances in the diagnosis and management of chronic pancreatitis

“…In addition, 36% of patients with recurrent acute pancreatitis progress to chronic pancreatitis [3]. As in patients with chronic pancreatitis, the quality of life of patients with recurrent acute pancreatitis is impaired due to severe pain and related disability [4].…”