Published online Dec 7, 2014. doi: 10.3748/wjg.v20.i45.16891
Revised: June 19, 2014
Accepted: September 18, 2014
Published online: December 7, 2014
Processing time: 208 Days and 19.2 Hours
Acute recurrent pancreatitis (ARP) refers to a clinical entity characterized by episodes of acute pancreatitis which occurs on more than one occasion. Recurrence of pancreatitis generally occurs in a setting of normal morpho-functional gland, however, an established chronic disease may be found either on the occasion of the first episode of pancreatitis or during the follow-up. The aetiology of ARP can be identified in the majority of patients. Most common causes include common bile duct stones or sludge and bile crystals; sphincter of oddi dysfunction; anatomical ductal variants interfering with pancreatic juice outflow; obstruction of the main pancreatic duct or pancreatico-biliary junction; genetic mutations; alcohol consumption. However, despite diagnostic technologies, the aetiology of ARP still remains unknown in up to 30% of cases: in these cases the term “idiopathic” is used. Because occult bile stone disease and sphincter of oddi dysfunction account for the majority of cases, cholecystectomy, and eventually the endoscopic biliary and/or pancreatic sphincterotomy are curative in most of cases. Endoscopic biliary sphincterotomy appeared to be a curative procedure per se in about 80% of patients. Ursodeoxycholic acid oral treatment alone has also been reported effective for treatment of biliary sludge. In uncertain cases toxin botulin injection may help in identifying some sphincter of oddi dysfunction, but this treatment is not widely used. In the last twenty years, pancreatic endotherapy has been proven effective in cases of recurrent pancreatitis depending on pancreatic ductal obstruction, independently from the cause of obstruction, and has been widely used instead of more aggressive approaches.
Core tip: Acute recurrent pancreatitis still represents a challenging disease. In the recent years a significant improvement has been achieved in the knowledge of aetiopathogenesis and factors involved in the occurrence of disease because of advanced diagnostic tools as magnetic resonance cholangiopancreatography with secretin test, endoscopic ultrasonography and botulin toxin injection of sphinc ter of oddi. The review reports an updated diagnostic and therapeutic flow-chart flow-chart, and recent data on clinical outcomes.