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TIME COURSE DEVELOPMENT OF CHRONIC PANCREATITIS FOLLOWING ACUTE PANCREATITIS. INTERIM ANALYSIS OF THE GOULASH PLUS TRIAL

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Introduction

96-98% of patients survive acute pancreatitis (AP), but in the post-AP phase, patients are at high risk of morbidity and mortality. The primary objective of the GOULASH PLUS (ISRCTN63396106) longitudinal, observational multicentre study is to investigate the development of chronic pancreatitis (CP) following AP. The GOULASH PLUS trial reached 50% of the planned patient enrolment. This interim data analysis aims to understand the time course evolution of CP after AP.

Aims & Methods

360 patients were yearly followed after AP. We formed four groups according to the baseline morphology status of the pancreas: 1) AP with one episode, 2) RAP with two episodes, 3) ECP with characteristic signs on imaging or three or more episodes of AP 4) CP: Ultrasound or CT were used in the first and third year, whereas, endoscopic ultrasound or magnetic-resonance-cholangiopancreatography in the second and fourth year of follow-up.

Results

Among the 360 patients followed after AP, 269 (74.7%) had AP, 42 (11.7%) RAP, 27 (7.5%) ECP, and 22 (6.1%) had CP at the time of the baseline AP episode. The following data represent the results at 1, 2, 3, and 4 years after AP. In the AP group, ECP was developed in 3%, 12%, 14%, and 18%, whereas, CP was diagnosed in 1%, 6%, 6%, and 11%, respectively. In the RAP population, ECP was developed in 17%, 19%, 21%, and 42% while CP developed in 0%, 0%, 4%, and 8%. In the ECP patient group, CP was developed in 12%, 25%, 35%, and 36%. 15% of patients had exocrine pancreatic insufficiency (EPI) at the first year visit, while this increased to 21% by the fourth annual visit.

Conclusion

RAP and ECP accelerate CP development. Due to the fast progression, it is important to find risk factors and biomarkers associated with recurrence and early morphology changes and to define possible early interventions to avoid or delay the progression to CP.

TIME COURSE DEVELOPMENT OF CHRONIC PANCREATITIS FOLLOWING ACUTE PANCREATITIS. INTERIM ANALYSIS OF THE GOULASH PLUS TRIAL

Mónika Lipp 1, Alexandra Mikó 2, Andrea Szentesi 3, Zsolt Abonyi Tóth 4, Vivien Vass 5, Katalin Márta 1, Ferenc Izbéki 6, László Gajdán 6, Balint Eross 7, Máté Verbói 5, Áron Vincze 8, Peter Jeno Hegyi 1, Patrícia Sarlós 8, Judit Bajor 8, Veronika Lillik 9, Peter Hegyi 10

1 Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary|||Centre for Translational Medicine, Semmelweis University, Budapest, Hungary

2 Department of Medical Genetics, Medical School, University of Pécs, Pécs, Hungary|||Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary

3 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary|||Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary

4 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary

5 Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary

6 Szent György Teaching Hospital of Fejér County, Szekesfehérvár, Hungary

7 Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary|||Centre for Translational Medicine, Semmelweis University, Budapest, Hungary|||Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary

8 Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary

9 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary|||Szent György Teaching Hospital of Fejér County, Szekesfehérvár, Hungary

10 Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary|||Centre for Translational Medicine, Semmelweis University, Budapest, Hungary|||Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary|||Translatio