Objectives: Idiopathic Recurrent Acute Pancreatitis (RAP) is defined as ≥2 episodes of acute pancreatitis without a specific cause. Data on long-term outcomes of patients having IRAP is limited. This study aimed to analyse the long-term outcomes of patients with IRAP.
Materials and Methods: In this prospective study, 48 patients with IRAP with minimum follow up of 6 months were included. Baseline data regarding demographic variables, symptoms, medication details were noted. On 3-6 monthly follow-up, history of symptoms, other relevant investigations and a cross-sectional imaging (CT abdomen or MRCP) or endoscopic ultrasound was performed at an interval of 1-2 years to look for features of CP, if the initial CT scan was normal.
Results: 48 patients with IRAP were included of which 36 (75%) were males. The mean number of episodes per year was 3.2 (1.4). The median duration of follow up was 4.5 (IQR 1-6) years. During follow-up, 17 (35.4%) patients developed imaging features suggestive of chronic pancreatitis. 19 (39.6%) had pancreatic exocrine insufficiency while 7 (14.6%) had pancreatic endocrine insufficiency. 21 (43.8%) patients complained of ongoing pancreatic pain (type A) with a mean Izbicki pain score of 37.3 (10.2). 19 (39.6%) were on regular pain medications, 20 (41.7%) were prescribed pancreatic enzyme replacement therapy, and 9 (18.6) were on regular antioxidants. Univariate logistic regression analysis demonstrated that the duration of follow-up (OR=1.36, 95% CI: 1.06-1.74, p=0.01) and the annual frequency of acute episodes (OR=2.24, 95% CI: 1.22-4.11, p=0.01) significantly predicted the progression to chronic pancreatitis.
Conclusion: Around one-third of the patients with IRAP progressed to develop chronic pancreatitis and its development was predicted by the duration of follow-up and annual frequency of episodes.