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.