Comparative study of the outcome between alcohol and gallstone pancreatitis in a high‐volume tertiary care center

Abstract

Background and Aim The two most common etiologies of acute pancreatitis (AP) are alcohol and gallstone. Whether etiology contributes to the outcome in patients with AP is an unresolved issue, more so in the severe form of the disease. The aim is to study the effects of the etiological factors of alcohol and gallstone on the disease course and the role of etiology in the subgroup of severe AP. Methods Consecutive patients of AP with alcohol or gallstone etiology were included. Various severity parameters and various outcome measures, such as need for organ support, intensive care, surgical or radiological intervention, hospital stay, and mortality, were evaluated between the two groups. Results Of the 759 patients, alcoholic pancreatitis was seen in 368 (48.5%), while gallstone disease was observed in 246 (32.4%). Gallstone pancreatitis occurred in older age ( P < 0.0001), had a higher female predilection ( P < 0.001), and a higher body mass index ( P = 0.002) compared to alcohol pancreatitis. Both groups were similar in terms of development of various organ failures and various severity assessment scores. Alcoholic AP had higher rates of necrosis ( P = 0.05) and the need for percutaneous catheter drainage ( P = 0.02). Outcome measures such as length of hospital stay, need for intensive care, organ support, surgical intervention, or mortality were similar between the two groups. Subset analysis of severe AP (303 patients) showed no difference between the two etiologies with regard to outcome. Conclusion The outcome of AP was independent of the etiology of the disease, alcohol or gallstone, and more so in the severe form of the disease. The number of local complications tends to be slightly higher in the alcoholic group.

Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice

“…It is the most common gastrointestinal cause of hospitalization [1], associated with high financial burdens [2]. Several studies have shown that the incidence of AP is increasing [3,4], probably as a result of a combination of risk factors, such as obesity and gallstone disease [5]. The overall mortality rate is 3% to 10%, but patients with the severe form of the disease are at an increased risk of death, with a mortality rate of 36% to 50% [2,6,7].…”

“…The overall mortality rate is 3% to 10%, but patients with the severe form of the disease are at an increased risk of death, with a mortality rate of 36% to 50% [2,6,7]. Although its etiology is complex and not known for certain, the two most common causes are gallstones and alcohol [3,8]. Numerous studies have been published about the pathogenesis of AP; however, the precise mechanism behind this pathology remains unclear [9].…”

Acute biliary pancreatitis has better outcomes but increased resource utilization compared to acute alcohol-induced pancreatitis: insights from a nationwide study

“…In our study, there was no significant difference in all-cause in-hospital mortality between patients with AAP and ABP (aOR 0.95, 95%CI 0.69-1.31; P=0.79). Multiple studies have reported a similar absence of mortality difference between the 2 groups [ 8 , 13 , 20 ]. However, some studies reported a more severe course and higher mortality in the alcohol group [ 11 , 12 ], while other, older studies reported a more severe outcome in the biliary group [ 9 , 10 ].…”

“…However, it is pertinent to remember that, while statistically significant, the differences in some of these outcomes were quite modest and indicate a somewhat similar clinical course between the 2 groups. There have been previous studies comparing the outcomes of alcohol-induced and gallstone pancreatitis in patients admitted to tertiary centers, but the sample size was in the hundreds [ 20 , 21 ]. In comparison, we were able to look at 553,480 adult patients with AP across the nation, including 140,195 (25.3%) with AAP and 96,540 (17.44%) with ABP.…”

“…The smaller number observed in our study is probably due to the discrepancy in billing codes submitted by the physicians. It is possible that complications such as necrosis and infection are submitted as secondary diagnoses, and may have been missed by our inclusion of primary diagnosis only [ 20 ]. We also demonstrated that patients with ABP had a lower likelihood of shock, AKI, or ICU admission, and they were also more likely to be discharged home.…”