The Etiologic Evaluation of Acute Pancreatitis in a General Hospital of Seoul-Gyeonggi Province in Korea

Gun Jung Youn; Woo Chul Chung; Ji Min Lee; Chang-Nyol Paik; Jung Hwan Oh; Sung Hoon Jung

doi:10.4166/kjg.2017.70.4.190

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Youn, Chung, Lee, Paik, Oh, and Jung: The Etiologic Evaluation of Acute Pancreatitis in a General Hospital of Seoul-Gyeonggi Province in Korea

Original Article

Korean J Gastroenterol 2017;70(4):190-197.

Published online: 4 October 2017

DOI: https://doi.org/10.4166/kjg.2017.70.4.190

The Etiologic Evaluation of Acute Pancreatitis in a General Hospital of Seoul-Gyeonggi Province in Korea

Gun Jung Youn, Woo Chul Chung, Ji Min Lee, Chang-Nyol Paik, Jung Hwan Oh¹, Sung Hoon Jung¹

Division of Gastroenterology, Department of Internal Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea

¹Division of Gastroenterology, Department of Internal Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to: Sung Hoon Jung, Division of Gastroenterology, Department of Internal Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, 180 Wangsan-ro, Dongdaemun-gu, Seoul 02559, Korea. Tel: +82-2-958-2343, Fax: +82-2-968-7250, E-mail: shjung74@catholic.ac.kr

Received 27 March 2017 Revised 11 June 2017 Accepted 13 June 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

In recent years, the incidence of acute pancreatitis (AP) has been increasing. A better understanding of the etiology is directly linked to more favorable outcomes. Unfortunately, there have been reports suggesting the variation of etiologies of AP across countries. The objective of this study was to determine the etiology of AP in a general hospital of Seoul-Gyeonggi province in Korea during the past decade.

Methods

We retrospectively reviewed the medical records of consecutive patients with AP who were admitted to St. Paul's Hospital (Seoul, Korea) with an affiliation to the Catholic University of Korea between January 2003 and January 2013.

Results

A total of 1,110 patients were enrolled, totaling 1,833 attacks, and the most frequent cause of AP was alcohol consumption. The recurrence rate of AP was 24.5% (272/1,110), and habitual recurrence rate (more than three times) was 12.6% (140/1,110). The rate of severe AP was 4.9% (90/1,833 attacks). The mortality rate of AP was 2.6% (29/1,110 patients). The frequency of an idiopathic cause of AP was 13.3%. The recurrence rate and mortality rate of idiopathic AP were 16.2% and 5.4%, respectively. In 41.7% (10/24) of cases of idiopathic AP, microlithiasis was suspected.

Conclusions

Between 2003 and 2013 in Korea, alcohol was the most frequent cause of AP in the general hospital of Seoul-Gyeonggi province of Korea. It appears that alcohol abstinence program may be necessary. Further nationwide studies would be needed to evaluate the etiologies of AP.

Keywords: Pancreatitis, Alcohols, Gallstone

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Fig. 1.

Etiology of acute pancreatitis in Korea. Alcohol consumption and gallstones are the main etiologic factors of AP. Other etiology of AP includes autoimmune (n=14), drug-induced (n=7), cancer-related (n=15), IPMN (n=8), pancreas divisum (n=5), and hypertriglyceridemia (n=4). AP, acute pancreatitis; IPMN, intraductal papillary mucinous neoplasm.

Fig. 2.

Autoimmune pancreatitis. (A) Pancreatic parenchymal swelling (arrow) and peripancreatic lower density rim like change (arrowhead). (B) Focal low-attenuating mass (arrow) around the celiac axis and adjacent para-aortic space in a patient with retroperitoneal fibrosis.

Fig. 3.

Unusual cause of acute pancreatitis-APBDU. (A) In MRCP image, fusiform dilatation of extrahepatic duct (arrow) suggestive of choledochal cyst is observed (Todani classification IA). (B). Fluoroscopic image taken during ERCP showing long common channel (arrow), a definitive finding of APBDU. APBDU, anomalous pancreaticobiliary ductal union; MRCP, magnetic resonance cholangiopancreatography; ERCP, endoscopic retrograde cholangiopancreatography.

Fig. 4.

Unusual cause of acute pancreatitis-pancreatic AVM. (A) Acute intrapancreatic parenchymal bleeding and hematoma formation (arrow) is observed on CT coronal image. (B) In celiac artery angiography, dense stain in the pancreatic head region and early filling of the veins (double arrows) suggests pancreatic AVM. AVM, arteriovenous malformation; CT, computed tomography.

Fig. 5.

Unusual cause of acute pancreatitis-pancreatic cancer. (A) Fluoroscopic image taken during ERCP shows focal segmental pancreatic duct narrowing (double arrows) in the proximal body area with post-stenotic dilatation. (B) About 3.0 cm sized ill-defined mass (arrow) of the proximal body of pancreas and pancreatic duct dilatation (arrowhead) of the tail is observed in CT axial view. ERCP, endoscopic retrograde cholangiopancreatography; CT, computed tomography.

Fig. 6.

Unusual cause of acute pancreatitis-non-Hodgkin's lymphoma and lung cancer. (A) Peripancreatic mass invading the adjacent pancreatic body parenchyme (arrow) resulting in pancreatitis in the pancreatic tail (arrowhead) in diffuse large B cell lymphoma patient. (B) Heterogeneous contrast enhancing mass in the pancreatic tail (arrow) with peri-pancreatic infiltrations in lung cancer patient, suggesting pancreatic metastasis.

Table 1.

Etiologic Analysis of Acute Pancreatitis in Korea

	Alcohol	Gallstones	Autoimmune	Drug	Miscellaneous	Idiopathic	Total
No. of patients	660 (59.5)	245 (22.1)	14 (1.3)	7 (0.6)	36 (3.2)	148 (13.3)	1,110 (100)
No. of attacks	1,213 (66.2)	319 (17.4)	27 (1.5)	9 (0.5)	65 (3.5)	182 (9.9)	1,833 (100)
Age (year)	51.40±14.60	59.51±15.57	55.29±22.51	51.29±14.42	54.00±20.83	56.80±16.92
Sex (male:female)	528:132	154:91	9:5	0:7	22:14	54:94	767:343
BMI (kg/m²)	22.01±5.29	24.04±3.51	22.62±3.00	21.10±2.68	22.70±2.58	23.64±3.14
AP re-attack	171 (62.9)	54 (19.9)	7 (2.6)	2 (0.7)	14 (5.1)	24 (8.8)	272 (100)
SAP by Atlanta classification	53 (58.9)	19 (21.1)	1 (1.1)	0 (0)	0 (0)	17 (18.9)	90 (100)
SAP by revised Atlanta classification	35 (57.4)	16 (26.2)	1 (1.6)	0 (0)	0 (0)	9 (14.8)	61 (100)
Pancreatitis related death	18 (62.1)	1 (3.4)	2 (6.9)	0 (0)	0 (0)	8 (27.6)	29 (100)

Values are presented as n (%) or mean±standard deviation unless otherwise indicated.

BMI, body mass index; AP, acute pancreatitis; SAP, severe acute pancreatitis.

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