The Natural History of “Acute Pancreatitis”

A follow-up review of at least three years was carried out on 80 patients diagnosed as suffering from attacks of acute pancreatitis. Thirty had associated cholelithiasis, 28 were alcoholics, and in 22 instances the pancreatitis was classified as idiopathic. It is clear that there is a widely varying response to continued alcoholism; one group will suffer only a single episode of acute pancreatitis, a few patients will develop acute relapsing pancreatitis, and a smaller number will progress to gross pancreatic destruction associated with persistent low-grade pain, weight loss and endocrine insufficiency. In the group with gallstones, we were impressed by the association of stones with the recurrence of attacks, and in contrast the freedom from attacks endowed by a cholecystectomy or choledochotomy. In the idiopathic group, those patients aged over 50 years usually had one single attack without subsequent trouble; for patients aged below 50 years, the chances are highly in favour of further relapses. This series supports the view expressed by Howard and Jordan (1960) and Sarles et alii (1965) that pancreatitis associated with alcoholism, pancreatitis associated with gallstones and pancreatitis of unknown œtiology have greatly differing natural histories and clinical patterns.