| Abstract|| |
Background: The epidemiology of acute pancreatitis in Saudi Arabia is greatly different from that in Western Countries. Aim: To evaluate and compare the risk factors and clinical features of acute pancreatitis. Patients and Methods: The course of acute pancreatitis was retrospectively analyzed in 218 patients who had their first attack and were admitted at Riyadh Armed Forces Hospital during the period 1.01.85-31.05.97. Results: From these 218, 130 patients were in the age group of 20-55 yrs. (74+, 56>), 76 were > 55 yrs. Of age (42 +, 34>) and only 12 were < 20 yrs. (6 Females, 6 Males). The precipitating cause was biliary disease in 147, post-operative in ten, hyperlipidemia in seven, post-ERCP in five, infection in four and alcohol in four. Four had rare causes and 37 no obvious cause. Severe pancreatitis diagnosed in 70 patients, 51 of them were > 55 yrs. of age and 45 were precipitated by biliary disease. Twenty six developed complications (21 were > 55 yrs. old) and four deaths. Twenty two patients of these who had severe form had diabetes mellitus, 37 had fever at presentation and 56 had leukocytosis. Conclusions: The commonest etiology of acute pancreatitis was biliary in 147 patients (67.5%) followed by postoperative pancreatitis in 10 patients (4.6%). Alcohol as etiological factor was rare (1.8%). The epidemiology and the risk factors differed markedly in Saudi Arabia, where alcohol is prohibited
|How to cite this article:|
Al-Karawi MA, Mohamed AE, Dafala MM, Yasawi MI, Ghadour ZM. Acute pancreatitis in Saudi patients. Saudi J Gastroenterol 2001;7:30-3
Acute Pancreatitis is an acute inflammatory process arising in the pancreas, with variable involvement of peripancreatic tissue or remote organs. Various studies reported an incidence from 10 to 50/100,000 per year, but there is a wide geographical variation in the incidence and etiological association. In western society alcohol abuse is assumed to be the cause in most cases, while in The Middle East, biliary pancreatitis has the higher incidence ,,.
| Patients and Methods|| |
In the period 1.1.85-31.5.97, the medical records of 218 Saudi patients, who presented to Riyadh Armed Forces Hospital, with their first attack of acute pancreatitis, were retrospectively analyzed for clinical presentation, etiology and the outcome. Acute pancreatitis diagnosis was based on an elevated amylase level of more than 300 (Normal range 0-100) U/L. In these patients' serum amylase level ranged from 300 to over 3000 U/L. 204 patients studied had abdominal ultrasound and 56 of the patients had CT abdomen. All patients had full blood count and liver function tests, serum calcium, urea and electrolyte. These patients were classified according to the age into three groups in relation to the sex [Table - 1]. The degree of severity was assessed by the modified Glasgow Score (Imrie's class ification)  .
| Results|| |
Over a period of 12.5 years, 32,537 patients were admitted to Riyadh Armed Forces Hospital. Two hundred and eighteen patients (0.67%) presented with the clinical picture of acute pancreatitis. The laboratory findings are summarized in [Table - 2]. Females to males' ratio were 1.3:1.0 and the median age was 37 years. Abdomen pain, nausea/vomiting and fever were the cardinal symptoms in 215(98.6%), 195 (90.8%) and 72 (33%) of patients, respectively.
According to Imrie's classification, seventy patients had severe acute pancreatitis; 51 of them were > 55 years old. Fever, diabetes mellitus and leukocytosis were directly related to severity as shown in [Table - 3]. Two hundred and four patients had abdominal ultrasound and fifty-six patients had abdominal CT. 147 patients had biliary pancreatitis, and abdominal ultrasound or CT showed either gall bladder stones, dilated common bile duct or intrahepatic ducts. Abnormality in the pancreas or biliary tree was found in 133 patients (65%) who had ultrasound and in 54 patients (96.4%) who had CT. ERCP showed Cholelithiasis in 142 and tumors in three patients and two patients had Ascaris Lumbricoides in common bile duct, which were extracted. In another 27 patients including nonbiliary and idiopathic pancreatitis. Forty two had no ERCP. Four patients with rare causes, two normal ERCP had (steroid and immunosuppressive) post renal transplant and the other two had pancreas divisium.
Forty five patients with biliary pancreatitis had severe form of pancreatitis and complications occurred in the form of hemorrhagic, necrotic pancreatitis, septicemia, cardiac, renal or pulmonary complications and four of these patients died. Death occurred 4-10 days. after the ERCP. The precipitating cause for acute pancreatitis in these patients is shown in the [Table - 4]. [Table - 5] shows the cause of death in the four patients
| Discussion|| |
Acute pancreatitis constitutes a major medical problem in western society with considerable morbidity, 20-30% and mortality, 8-20% ,, . We calculated a prevalence of 67/10000 hospital admissions. The current data concorded with previous results reported by Laajam that acute pancreatitis is not common in Saudi Arabia . The commonest cause of acute pancreatitis in this study, was of biliary origin in 147 patients (67.5%). This finding was consistent with a previous studies from Riyadh. ,
All the patients had raised serum amylase (>300 U/L) and the vast majority had abdominal pain (98.6%). Those who had no abdominal pain presented with nausea and intractable vomiting; two of them were on steroid & immunosuppressants for renal transplant. Leukocytosis was found in nearly half of the patients. Raised liver enzymes were commonly encountered, even in non-biliary etiology, ALT/AST in 66%, alkaline phosphatase in 36% and total serum bilirubin 47% of patients. CTscan of the abdomen was sensitive and gave positive result in 96.4% when compared to ultrasonograph that, gave positive finding in only 65%. This may be due to the difficulty encountered in visualizing the pancreas during the acute phase as the result of bowel gaseous distension. 56% of our patients were females. The age of 60% of them ranged between 22 and 55 years. These results explained the higher prevalence of biliary pancreatitis as an etiological factor, which was slightly different from that found by other authors , . Alcohol as a postulated cause found in only 1.8% and this was markedly lower than reported from the West. Alcohol is prohibited in Islamic countries. Postoperative pancreatitis occurred in 4.6% and all had surgery in upper abdomen and all were above 55 years of age. Hyperlipidemia, has been reported in 2.3%, all were diabetics and elderly  . Acute pancreatitis occurred following ERCP in 2.3% of patients who had normal serum amylase before which, rose to a high level after the ERCP. The direct cause most likely related to difficulty in the procedure experienced during the pancreatic duct filling that lead to chemical pancreatitis or edema. In 17% no obvious cause found including 14 patients who had neither ultrasound or CT abdomen, but a small stone could not be ruled out which might have lead to a transient obstruction and then passed to the duodenum. This result was similar to that found by some workers , but different from Lajam report  .
Severe form of acute pancreatitis diagnosed in 32% of patients and most of them (73%) were above 55 years in age. This finding denotes that severity is directly related to the patient age. 64.2% of patients who had severe form had biliary etiology requiring ERCP and stone extraction before complications occur. This study found a direct relation between the severity and occurrence of diabetes mellitus. Local and systemic complications occurred in 12% of patient with severe form except one who died with ventricular arrhythmia secondly to rheumatic heart disease and septicemia. Others who expired had severe form with a concomitant serious disease; congestive heart failure and septicemia.
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Mohamed A Al-Karawi
Riyadh Armed Forces Hospital, P.O. Box 7897, Riyadh 11159
Source of Support: None, Conflict of Interest: None
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]