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Pancreatitis is an inflammatory process of the pancreas that may be limited to just the pancreas, may affect surrounding tissues, or may cause remote organ system dysfunction. Most patients will only have one episode of acute pancreatitis, whereas 15% to 30% will have at least one recurrence.1,2,3 Between 5% and 25% of patients will ultimately develop chronic pancreatitis.2,3

Most cases (~80%) involve only mild inflammation of the pancreas, a disease state with a mortality rate of <1%, which generally resolves with only supportive care.1,4 A small proportion of patients suffer from more severe disease that may involve pancreatic necrosis, inflammation of surrounding tissues, and organ failure, leading to a 30% mortality rate.5,6

The annual incidence of pancreatitis varies among nations and regions. Developed countries have a higher incidence of pancreatitis than developing countries. In general, men and women suffer from acute pancreatitis with equal frequency, although alcohol-associated acute pancreatitis is more common in men, while gallstone-induced pancreatitis is more common in women.7 Blacks are affected two- to threefold more often than whites but have a mortality rate equal to the general population.3,8 The incidence of acute pancreatitis varies with age, with a peak in middle age.9 Other risk factors include smoking, obesity, and diabetes mellitus.9,10

Factors associated with acute pancreatitis are listed in Table 79-1. Most cases are related to either gallstones or alcohol consumption. About 5% of all patients who undergo endoscopic retrograde cholangiopancreatography for treatment of gallstones develop pancreatitis within 30 days.11

TABLE 79-1Causes of Acute Pancreatitis

The nature of the association between alcohol use and acute pancreatitis is unclear. Some studies suggest that consumption of a large amount of alcohol over a short period of time is a more important factor than chronic alcohol use.16 However, others suggest that at least 5 years of heavy alcohol use are required before alcohol can reliably be considered the cause.17

More than 120 drugs have been linked to acute pancreatitis but together account for fewer than 2% of cases. Table 79-2 lists the commonly used drugs found by two sets of authors to be most well linked to acute pancreatitis based on number of case reports and recurrence after drug reexposure.18,...

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