Recurrent acute pancreatitis: an approach to diagnosis and management

Abstract

Recurrent acute pancreatitis (RAP) is defined as more than two attacks of acute pancreatitis (AP) without any evidence of underlying chronic pancreatitis (CP). As the known causes of AP are generally taken care of, RAP usually occurs in the idiopathic group, which forms 20%- In general, empirical cholecystectomy should be discouraged with the availability and widespread use of EUS. Endoscopic sphincterotomy is advised if there is strong suspicion of SOD. Minor papilla sphincterotomy should be carried out in those with PD but with limited expectations. Regular follow-up of patients with IRAP is necessary because most patients are likely to develop CP in due course.

An uncommon evaluation in recurrent acute pancreatitis

“…Recurrent acute pancreatitis is characterized by two or more episodes of acute pancreatitis with complete or near complete improvement of clinical features of pancreatitis between episodes and without evidence of chronic pancreatitis. [2] The etiology of recurrent acute pancreatitis includes mechanical, metabolic, anatomical, and other miscellaneous causes. The various causes of anatomical abnormality comprise of pancreas divisum, anomalous pancreaticobiliary ductal union, annular pancreas, choledochal cyst, and duodenal duplication.…”

Relevance of metal based Ayurvedic formulations in the management of recurrent acute/ chronic pancreatitis

“…Pancreatitis is one among such inflammatory disorders, which refers to inflammation of the pancreas and is primarily characterised by abdominal pain, nausea, vomiting and indigestion (Kedia et al, 2013). Repeated episodes of abdominal pain, other symptoms and elevated serum Amylase/ Lipase levels without morphological changes in the pancreas is termed as RAP while, signs and symptoms associated with morphological changes in the pancreas is called Chronic Pancreatitis (Kedia et al, 2013;Sawant and Mishra, 2005).…”

“…Repeated episodes of abdominal pain, other symptoms and elevated serum Amylase/ Lipase levels without morphological changes in the pancreas is termed as RAP while, signs and symptoms associated with morphological changes in the pancreas is called Chronic Pancreatitis (Kedia et al, 2013;Sawant and Mishra, 2005). The average onset of the disease is 24 years and the disease affects more male population than female population (Sawant and Mishra, 2005).…”

Endoscopic Treatment of Pancreatic Diseases

“…Patients with idiopathic AP should be evaluated at specialized centers on pancreatic diseases, applying combined multidisciplinary approach, including advanced endoscopy [1]. Various anatomic (pancreas divisum, anomalous anomalous pancreatobiliary duct junction, choledochal cysts/ choledochocele, periampullarry diverticulae, ampullary tumors) and physiologic anomalies (sphincter of Oddi dysfunction/SOD) can contribute to recurrent episodes of AP and many of them can often be diagnosed and treated endoscopically [3,64,65]. The diagnostic role of ERCP can help define specific causative factors in patients with idiopathic AP, but its major limitation is the risk of post-ERCP pancreatitis, which varies from 5% to 10% and reaches 30% in cases with SOD.…”