Epidemiology of pancreatic diseases in Lüneburg County. A study in a defined german population.

BACKGROUND/AIMS: Worldwide, the incidence of pancreatic cancer is very well known, that of acute pancreatitis and chronic pancreatitis not. Our study sought to determine the incidence of all three pancreatic diseases in a well-defined population in Germany. METHODS: Records of all patients treated for acute (first attacks only) and chronic pancreatitis as well as pancreatic cancer from 1988 to 1995 and who resided in the county of Lüneburg were evaluated. RESULTS: The crude incidence rates for acute pancreatitis, chronic pancreatitis and pancreatic cancer per 100,000 inhabitants/year were 19.7, 6.4, and 7.8. In acute and chronic pancreatitis the male gender dominated, whereas in pancreatic carcinoma the gender ratio was almost even. Peak incidence for acute pancreatitis was in the age group of 35-44 years, for chronic pancreatitis 45-54, and for pancreatic cancer 65-75. Etiology of acute pancreatitis was biliary in 40%, alcohol abuse in 32%, unknown in 20%, and other in 8% of the patients. In chronic pancreatitis alcohol abuse was the etiology in 72% and unknown (idiopathic) in 28%. CONCLUSION: For the first time, epidemiological data obtained in a well-defined German population are being published relating to all three pancreatic diseases: acute pancreatitis (incidence rate, etiology and severity), chronic pancreatitis (incidence rate and etiology), and pancreatic carcinoma (incidence rate). A peak incidence of chronic pancreatitis occurring in an age group 10 years older than the peak age group for acute pancreatitis suggests that chronic pancreatitis develops during this time-frame following first attacks of acute pancreatitis.

Acute pancreatitis: does gender matter?

In a number of gastrointestinal and nongastrointestinal diseases, gender has been proven to be an independent risk factor for severity. To determine whether this holds true for severity in acute pancreatitis is the aim of our study. This paper derives from a prospective study on the epidemiology of acute pancreatitis, which included 274 patients (172 male and 102 female) with a first attack of the disease. Severity parameters were: Atlanta criteria (arterial Po2 < or = 60 mm Hg, and serum creatinine on admission >2 mg/dl after rehydration); Ranson's and Imrie's prognostic factors; APACHE II score; Balthazar-scored contrast-enhanced computed tomography (CT) results obtained within 72 hr of admission; days spent in the intensive care unit and total hospital stay; the necessity for artificial ventilation, dialysis, or surgery; and mortality. As already known, there is a significant association between gender and etiology of pancreatitis in general. Not surprisingly, the men in our study had alcohol-induced acute pancreatitis more frequently than women, whereas biliary pancreatitis predominated among the women. As for severity, there was no significant association between gender and any of the severity parameters with a few minor exceptions: longer hospital stays, higher Imrie scores and more pseudocysts for women, and more necroses in women with idiopathic pancreatitis. Thus, gender is no independent risk factor for the severity and outcome of acute pancreatitis.

Do we need a computed tomography examination in all patients with acute pancreatitis within 72 h after admission to hospital for the detection of pancreatic necrosis?

BACKGROUND: The aim of this prospective study was to define the role of an initial contrast-enhanced computed tomography (CT) obtained within 72 h after admission to hospital for determining the prognosis of acute pancreatitis and to investigate whether CT scans can be replaced by conventional prognostic parameters. METHODS: The study involves 231 patients admitted to the Lüneburg clinic with a first attack of acute pancreatitis from 1988 to 1995. In all of them, a contrast-enhanced CT was performed within 72 h of admission and scored according to Balthazar. The results were compared with the Ranson and Imrie laboratory prognostic scores and with parameters of the severity of the disease: the initial organ failure according to the Atlanta classification; days spent on intensive care unit or altogether in hospital; indication for artificial ventilation, dialysis and surgical intervention (necrosectomy); development of pancreatic pseudocysts; and mortality. RESULTS: Although there was a good statistical correlation between Ranson, Imrie, and Balthazar scores with the severity of the disease (P < 0.001 to P = 0.03), low and moderately raised Ranson (0-2, 0-5 points) and Imrie scores (0-1.0-3 points) failed to identify all patients with pancreatic necrosis with sufficient sensitivity rates (31.7; 78.0 and 39.0; 78.0%), positive (32.6; 25.3 and 75.0; 45.0%) and negative (91.0; 87.9 and 85.4; 84.8%) predictive values. CONCLUSIONS: A contrast-enhanced CT on admission correlates significantly with the severity of the disease and cannot be replaced by conventional laboratory prognostic scores. The decision to use a CT cannot depend on the results of the Ranson/Imrie scores.

Which etiology causes the most severe acute pancreatitis?

BACKGROUND: The aim of the study was to define the prognostic role of etiology in the course of acute pancreatitis. METHODS: The study involved 208 consecutive patients with a first attack of acute pancreatitis. Etiology was biliary in 81 (39%) patients and alcohol abuse in 69 (33%); other etiologies were present in 16 (8%), and etiology remained unknown in 42 (20%). Etiology was correlated with the following parameters of severity of the disease: days in an intensive care unit (ICU); total hospital stay (THS); Ranson, Imrie, and Balthazar scores (contrast-enhanced computed tomography [CT] within 72 h of admission); indication of artificial ventilation, dialysis, or surgery; development of pancreatic pseudocysts; mortality. RESULTS: Alcoholic etiology correlated significantly more frequently than other subgroups with necrotizing pancreatitis, need for artificial ventilation, and development of pancreatic pseudocysts. For the other parameters, there were no significant differences between the etiologies. CONCLUSION: Patients with alcohol-induced acute pancreatitis should be given special attention because of the higher incidence of necrotizing pancreatitis and necessity for artificial ventilation. Whether the pronounced frequency of pseudocysts in alcoholics suggests progression to chronic pancreatitis has to be clarified in follow-up studies.

The calendar and acute pancreatitis.

To find out whether a seasonal pattern exists for acute pancreatitis, the weekday and month of admission were retrospectively checked for 263 patients admitted to our hospital from 1987 to 1995 with their first attack of this disease. Etiology was biliary in 105 (40%), alcoholic in 84 (32%), unknown in 54 (21%), and presumed to be other in 20 (7%) patients. Forty-two (16%) patients had necrotizing acute pancreatitis. There was no significant correlation between admission and a specific month or weekday. Furthermore, there was no significant correlation between the etiology or onset of symptoms and a specific weekday. In contrast to other gastroenterological diseases such as peptic ulcer and inflammatory bowel disease, there is no seasonal or weekly pattern for acute pancreatitis.