Etiological Factors of Non Alcohol Non Gallstone Related Acute Pancreatitis: A Cross sectional hospital based study from Medical College and Hospital, Kolkata, West Bengal

Abstract

Background  Gall  stone  diseases and  alcohol  are  the  two  most  common causes  of  acute  pancreatitis. The  present  work  was undertaken  to  identify the  various etiological  factors  in  acute  pancreatitis  after  excluding  alcoholism  and  gall  stone  diseases. The etiology of an attack of non alcohol non gall stone acute pancreatitis is highly variable. The main objective was to identify the causing factor, because it can have an effect on the specific treatment of acute pancreatitis. . This is a rare cross- sectional study of its kind which is the first one to be reported from India. Materials and Methods A cross-sectional community based study was designed and conducted in Medical College and Hospital, Kolkata, West Bengal, India from July 2009 to June 2011. Z test and Chi square test were used to observe the variation between different variables and strength of the relationship with logistic regression.  Odd ratios were calculated and their 95% confidence intervals (95% CI). p < 0.05 was considered as statistically significant. Results CMV was the commonest etiology of non alcohol and non gallstone acute pancreatitis 26.7% followed by HEV 6.7% and Pancreas Divisum 6.7%%, SOD 3.3%, EBV 3.3%, Mumps 3.3%, Hepatitis 3.3%, Tumour 3.3%, Choledochal cyst 3.3%,Drugs 3.3% and Gallstone 3.3%. Logistic regression analysis finding indicates that acute pancreatitis was found more prevalent in < 40 yrs [OR 2.076,95%(CI 0.339, 12.716)] and among patients  having monthly income of <5000 rs/month yrs [OR 1.4,95%(CI 0.224, 8.768)] . According to the severity of CT grading, Patients had Grade D severity  [OR 2.667,95%(CI 0.158, 45.141)], Grade C[OR 1.333,95%(CI 0.104, 17.098)] and Grade E [OR 1.333,95%(CI 0.88, 20.108)]as compared to Grade B severity of CT.  Conclusion In the  study  an  etiological  factor  was  evident  among  almost 3/4th   of the patients  of  non-alcoholic  and  non-gallstone  pancreatitis. The most common etiological factors were CMV followed by HEV.  These  results  rather  suggests  that the most diligent  workup  including  a  biliary  microcrystal  analysis,  a  sphincter  of  Oddi  manometry  and  possible  gene  analysis  for  hereditary  disorders  may  further  reduce   the  apparently  idiopathic  group in  the  analysis  of  such  patients. DOI: http://dx.doi.org/10.3126/nje.v4i3.10663 Nepal Journal of Epidemiology 2014; 4(3): 351-62