Aetiology

The most common causes of acute pancreatitis in adults are:

• gallstones in the lower end of the common bile duct - 50%
  • risk is higher in patients with gallstones smaller than 5 mm, microlithiasis, or biliary sludge
  • a linear increase in the incidence of gallstone pancreatitis across the UK and European countries has been observed in several epidemiological studies
  • incidence increases with age in both men and women
    • women over the age of 60 years is at higher risk
• alcohol - 25%
  • incidence of alcohol-induced pancreatitis is much lower in the UK when compared with European studies
  • is more common in middle-aged men
• idiopathic - 20%–34%
  • incidence is similar in men and in women
• rare causes – 5%
  • e.g. drugs (for example, valproate, steroids, azathioprine), endoscopic retrograde cholangiopancreatography, hypertriglyceridaemia or lipoprotein lipase deficiency, hypercalcaemia, pancreas divisum, and some viral infections (mumps, coxsackie B4) (1,2)

Regional difference with regard to the aetiology has been observed:

• alcohol is the main cause of acute pancreatitis in Finland and USA while in Hong Kong, England, Italy, and Greece, gallstones obstruction is more common (3)

Reference:

• (1) Johnson CD, Besselink MG, Carter R. Acute pancreatitis. BMJ. 2014;349:g4859
• (2) Shah AP, Mourad MM, Bramhall SR. Acute pancreatitis: current perspectives on diagnosis and management. J Inflamm Res. 2018;11:77-85
• (3) Stimac D et al. Epidemiology of Acute Pancreatitis in the North Adriatic Region of Croatia during the Last Ten Years. Gastroenterol Res Pract. 2013;2013:956149