Natural history of acute pancreatitis. A long-term study.

Detailed clinical and laboratory follow-up was made of 113 patients, two to 12 years after their first attack of acute pancreatitis, to assess complete recovery versus the development either of acute relapsing pancreatitis, or of chronic pancreatitis. Mortality was low in patients with recurrent attacks of acute pancreatitis. Complete recovery decreased wih increasing periods of follow-up. In the group of alcoholic patients, complete recovery decreased continuously with a corresponding increase in chronic pancreatitis. In the group of patients with gallstones, chronic pancreatitis developed up to about three years after the acute attack, after which the recovery rate remained steady. Chronic pancreatitis in the patients with gallstones was usually painless. In patients with idiopathic pancreatitis, a high incidence of acute relapsing pancreatitis was seen, but this rarely persisted after three years. Pancreas function rarely recovered completely after an attack of severe acute pancreatitis. Alcohol withdrawal decreased the pain syndrome, but not the development of chronic pancreatitis. Early removal of gallstones minimized the development of chronic pancreatitis. Complete recovery did occur after one attack of acute pancreatitis, but probably only when the aetiological antecedent (alcohol or gallstones) had not been operating for a long time, as it is the antecedent rather than the acute attack which determines the eventual outcome.