Vnitr Lek 2020, 66(8):e12-e16 | DOI: 10.36290/vnl.2020.152

The role of metabolic syndrome in the induction of chronic pancreatitis after a first attack of acute pancreatitis - multicenter trial

Martina Bojková^1,2, Petr Dítě^1,2, Lumír Kunovský^3,4,5, Martin Blaho^1,2, Bohuslav Kianička^5,6, Ivo Novotný⁷, Magdalena Uvírová⁸, Jana Dvořáčková^2,8, Jiří Dolina^3,5, Marie Přecechtělová^3,5, Hana Mašková^3,5, Vladimír Procházka^4,5, Pavel Janeček^4,5, Oldřich Motyka⁹, Arnošt Martínek^1,2

¹ Department of Internal Medicine, Department of Gastroenterology, University Hospital Ostrava, Ostrava, Czech Republic

² Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic

³ Department of Gastroenterology and Internal Medicine, University Hospital Brno, Brno, Czech Republic

⁴ Department of Surgery, University Hospital Brno, Brno, Czech Republic

⁵ Faculty of Medicine, Masaryk University, Brno, Czech Republic

⁶ 2nd Department of Internal Medicine, Department of Gastroenterology, St. Anne's University Hospital, Brno, Czech Republic

⁷ Department of Gastroenterology, Masaryk Memorial Cancer Institute, Brno, Czech Republic

⁸ CGB Laboratory, a. s., Ostrava, Czech Republic

⁹ Nanotechnology Centre, VŠB - Technical University of Ostrava, Ostrava, Czech Republic

Background: Metabolic syndrome is a serious societal problem worldwide. In the Czech Republic more than 30% of the adult population are sufferers. The role of recurrent acute pancreatitis in the induction of chronic pancreatitis, following the so­‑called „mechanistic definition“ of chronic pancreatitis, has been unequivocally confirmed. However, there are a number of factors that may contribute to the development of chronic pancreatitis. The first aim of the study was to determine whether the metabolic syndrome may affect the development of chronic pancreatitis. The second question we asked ourselves was whether even one acute attack of pancreatitis could be an inductive factor in chronic pancreatitis.

Methods: Based on data obtained retrospectively from a total of 264 people diagnosed with chronic pancreatitis in 4 centers, a total of 59 people (22.3%) diagnosed within 36 months of a first attack of acute pancreatitis was obtained. Etiologies of either genetically induced pancreatitis or autoimmune pancreatitis were excluded. Diagnostics to identify the presence of metabolic syndrome were run on the 59 persons so obtained using the criteria from the so­‑called „harmonized“ definition of 2009 (obesity, arterial hypertension, hypertriglyceridemia, type 2 diabetes mellitus and a decreased level of HDL cholesterol).

Results: Comparing the findings of the individual components of metabolic syndrome in persons with chronic pancreatitis after a 1st attack of acute pancreatitis with the metabolic syndrome and in persons with chronic pancreatitis after the 1st attack of acute pancreatitis but without metabolic syndrome, a statistically significant difference in obesity was found (82.5% vs. 28.5%), hypertriglyceridemia (82.3% vs 17.8%) and arterial hypertension (70.5% vs 21.4%). The interval during which chronic pancreatitis occurred after acute pancreatitis averaged 12 months (10–14 months) in subjects with metabolic syndrome, whereas in the group without metabolic syndrome the interval was longer, 20 months (16–29 months).

Conclusion: Our results show that even one attack of acute pancreatitis (regardless of etiology) can be an inductive factor in chronic pancreatitis. The presence of metabolic syndrome can accelerate the development of chronic pancreatitis after one has had acute pancreatitis.

Keywords: acute pancreatitis, chronic pancreatitis, metabolic syndrome, obesity, hypertriglyceridemia, diabetes mellitus, hypertension, cholesterol.

Published: December 15, 2020  Show citation