Pirkanmaa Hospital District, M building, Small auditorium, address: Teiskontie 35.
Doctoral defence of Lic.Med. Jussi Nikkola
The field of science of the dissertation is Surgery (gastroenterological surgery).
The opponent is professor Pauli Puolakkainen (University of Helsinki). Professor Teuvo Tammela acts as the custos.
The language of the dissertation defence is Finnish.
New prospective data on long-term outcome and prevention of recurrences after acute alcoholic pancreatitis
Acute pancreatitis is one of the most common reasons for immediate gastrointestinal hospital admissions and in Finland alcohol is the most common etiology. After acute alcoholic pancreatitis, recurrent episodes develop in up to half of the patients and chronic pancreatitis develops in one out of ten. Detailed data on the long-term effects of an episode of acute pancreatitis are controversial and since the precise pathophysiology of the disease is unknown, recognizing the risk factors for disease progression is essential.
In this study, we evaluated the development of pancreatic dysfunction and abnormal imaging findings seen in magnetic resonance imaging after acute alcoholic pancreatitis. In addition, we studied brief alcohol interventions performed during hospitalization for acute alcoholic pancreatitis and ways to prevent recurrent acute pancreatitis.
Endocrine pancreatic dysfunction (prediabetes or diabetes) developed in half of the patients and exocrine dysfunction (persistently low fecal elastase-1) in one fourth. Chronic morphological pancreatic changes seen in secretin-stimulated magnetic resonance imaging were observed in half of the patients. Recurrent acute pancreatitis was found to be the most important risk factor for the development of endocrine dysfunction and chronic morphological changes. New pancreatogenic diabetes developed in 20% of the patients and only in those with previous recurrent acute pancreatitis.
Abstinence from alcohol offered excellent protection from developing recurrent acute pancreatitis. On the other hand, brief alcohol interventions performed during hospitalization did not reduce the development of recurrent acute pancreatitis. Especially young patients and patients with higher AUDIT (Alcohol Use Disorders Identification Test) points were found to be at high risk for developing recurrences.
Based on these results, pancreatic function after acute alcoholic pancreatitis should be actively monitored, and especially in patients with recurrent acute pancreatitis. More effective ways to organize follow-up care for patients with acute alcoholic pancreatitis consisting of routine interventions are needed. Total alcohol abstinence should be recommended to all patients to prevent recurrences of acute alcoholic pancreatitis and further development of pancreatic dysfunction.
The dissertation is published in the publication series of Acta Universitatis Tamperensis; 2276, Tampere University Press, Tampere 2017. The dissertation is also published in the e-series Acta Electronica Universitatis Tamperensis; 1778, Tampere University Press 2017.