Recurrent Acute Pancreatitis Significantly Reduces Quality... : Official journal of the American College of Gastroenterology | ACG (original) (raw)

ARTICLE

Recurrent Acute Pancreatitis Significantly Reduces Quality of Life Even in the Absence of Overt Chronic Pancreatitis

Coté, Gregory A. MD, MS1; Yadav, Dhiraj MD, MPH2; Abberbock, Judah A. PhD2; Whitcomb, David C. MD, PhD2; Sherman, Stuart MD3; Sandhu, Bimaljit S. MD4; Anderson, Michelle A. MD5; Lewis, Michele D. MD6; Alkaade, Samer MD7; Singh, Vikesh K. MD8; Baillie, John MD9; Banks, Peter A. MD10; Conwell, Darwin MD11; Guda, Nalini M. MD12; Muniraj, Thiruvengadam MD13; Tang, Gong PhD2; Brand, Randall MD2; Gelrud, Andres MD14; Amann, Stephen T. MD15; Forsmark, Christopher E. MD16; Wilcox, Mel C. MD17; Slivka, Adam MD, PhD2; Gardner, Timothy B. MD18

1Medical university of South Carolina, Charleston, SC, USA. 2University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 3Indiana university School of Medicine, Indianapolis, IN, USA. 4Richmond Gastroenterology Associates, Richmond, VA, USA. 5university of Michigan, Ann Arbor, MI, USA. 6Mayo Clinic, Jacksonville, FL, USA. 7Saint Louis university, St. Louis, MO, USA. 8Johns Hopkins Medical Institutions, Baltimore, MD, USA. 9Virginia Commonwealth university, Richmond, VA, USA. 10Brigham and Women's Hospital, Boston, MA, USA. 11Ohio State university, Columbus, OH, USA. 12Aurora St. Luke's Medical Center, Milwaukee, WI, USA. 13Yale School of Medicine, New Haven, CT, USA. 14University of Chicago, Chicago, IL, USA. 15Digestive Health Specialists, Tupelo, MS, USA. 16University of Florida, Gainesville, FL, USA. 17University of Alabama, Birmingham, AL, USA. 18Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.

Correspondence: G.A.C. (email: [email protected])

Received 24 July 2017; accepted 13 March 2018; published online 5 June 2018

Abstract

OBJECTIVES:

The impact of recurrent acute pancreatitis (RAP) on quality of life (QOL) is unknown. We hypothesized that RAP would reduce QOL even in the absence of chronic pancreatitis (CP).

METHODS:

Data were pooled from three prospective, cross-sectional studies conducted across 27 U.S. centers (the North American Pancreatitis Studies); these included subjects with chronic pancreatitis ( n = 1086), RAP alone ( n = 508), and non-disease controls ( n = 1025). QOL was measured using the Short Form 12 (SF-12), generating a Physical Component Summary (PCS) and the Mental Component Summary score (MCS). Multivariable regression models were developed to measure the effect of RAP on QOL, the predictors of lower QOL in those with RAP, and the differential effect QOL predictors between CP and RAP.

RESULTS:

Compared to controls (51.0 ± 9.4), subjects with RAP (41.1 ± 11.4) and CP (37.2 ± 11.8) had lower PCS ( p < 0.01). Subjects with CP had lower PCS compared to those with RAP ( p < 0.01). Similarly, MCS was lower among RAP (44.6 ± 11.5) and CP (42.8 ± 12.2) subjects compared to controls (51.7 ± 9.1, p < 0.01). Subjects with CP had lower MCS compared to those with RAP ( p < 0.01). After controlling for independent predictors of PCS, RAP was associated with lower PCS (estimate -8.46, p < 0.01) and MCS (estimate -6.45, p < 0.0001) compared to controls. The effect of endocrine insufficiency on PCS was differentially greater among RAP subjects (-1.28 for CP vs. -4.9 for RAP, p = 0.0184).

CONCLUSIONS:

Even in the absence of CP, subjects with RAP have lower physical and mental QOL. This underscores the importance of identifying interventions to attenuate RAP before the development of overt CP.