Idiopathic acute recurrent pancreatitis

Abstract

Acute recurrent pancreatitis (ARP) results most commonly from alcohol abuse or gallstone disease. Initial evaluation fails to detect the cause of ARP in 10-30% of patients, and as a result the diagnosis of "idiopathic" ARP is given. In these patients, a more extensive evaluation including specialized labs, ERCP, endoscopic ultrasound, or magnetic resonance cholangiopancreatography typically leads to a diagnosis of microlithiasis, sphincter of Oddi dysfunction, or pancreas divisum. Less commonly, hereditary pancreatitis, cystic fibrosis, a choledochocele, annular pancreas, an anomalous pancreatobiliary junction, pancreatobiliary tumors, or chronic pancreatitis are diagnosed. Determining the etiology is important, as it helps to direct therapy, limits further unnecessary evaluation, and may improve a patient's long term prognosis.

Recurrent Acute Pancreatitis: Clinical Profile and an Approach to Diagnosis

“…In the current study, 94 (50%) patients had mechanicalobstructive pancreatitis, 20 (10.6%) had toxic-metabolic pancreatitis, 13 (7%) had multiple etiologies and 61 (32.4%) had idiopathic pancreatitis. Similar to most of the earlier studies, biliary pancreatitis (due to cholelithiasis, choledocholithiasis, and microlithiasis) was the most common etiology of RAP (37%) in our study [3,4,12,[21][22][23][24]. As in other studies, biliary microliths was the predominant cause of biliary pancreatitis [23,24].…”

Biliary dyskinesia in the pediatric patient

“…When SOD is considered as an etiology for recurrent bouts of pancreatitis, extensive evaluation must fi rst exclude other causes. For a full discussion of etiologies and evaluation for recurrent pancreatitis, refer to a comprehensive review by Levy and Geenen [ 41 ]. After elimination of other etiologies for recurrent pancreatitis, SOM may be considered to evaluate for SOD.…”

Pancreatic Disease in Children and Adolescents

“…The association of pancreas divisum and SPINK1 gene mutations in individuals with idiopathic recurrent pancreatitis suggests the possibility of co-factor involvement [16]. Another ductal abnormality is the anomalous pancreaticobiliary junction (APJ) or common channel syndrome [17]. This syndrome occurs when the bile duct and pancreatic duct unite outside of the duodenum.…”

“…This syndrome occurs when the bile duct and pancreatic duct unite outside of the duodenum. APJ has been associated with choledochal cyst, recurrent pancreatitis, and biliary carcinoma [17].…”