John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

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Etiological workup for non alcoholic non biliary acute pancreatitis Volume 25, issue 4, Avril 2018

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Authors
CHU Rangueil-Larrey, Pôle digestif, Service de gastroentérologie et pancréatologie, 1 avenue Jean Poulhès, TSA 50032, 31059 Toulouse Cedex 9, France
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The two main etiologies of acute pancreatitis (AP) are cholelithiasis (35 to 45% of cases) and alcohol (25 to 30% of cases). Other causes are shared between non A non B AP (i.e. with a proven cause – 15 to 25% of cases) and “idiopathic” AP (10 to 15 % of cases). The etiological workup of AP is divided into three phases. At the initial phase, it requires extensive interrogation (including medication and toxic), biological assessment, hepatobiliary ultrasound and abdominal CT with injection of contrast medium. Biliary and alcoholic causes will be recognized in 60 % of the cases, 10% of other causes will be identified (such as traumatic, iatrogenic, drugs, infection, hypertriglyceridemia ...) and 30% will be idiopathic or with a cause still uncertain. For these latter cases, a second-line assessment will be carried out at distance (1 to 2 months). It includes a new extensive interrogation, biological assessment (including auto-immune workup, and genetic assessment in young subjects), MRI cholangiopancreatography and endoscopic ultrasound. This new assessment reduces by 50% the rate of AP without initial obvious cause. It is of importance to consider that in the adult older than 35 year-old, biliary, alcoholic and tumoral AP are diagnosed while in the young adults, it will rather be thought of genetic causes, drug and autoimmune pancreatitis. In case of idiopathic AP at the end of these two phases, follow-up should be organized with at least one gallbladder ultrasound every 6 months but also by reiterating biology, CT scan, MRI and endoscopic cholangiopancreatography in case of recurrence. In adults, 10 to 15% of AP remain idiopathic despite this three phases assessment.

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