P1058 - Comparison of Clinical Characteristics, Outcomes, and Resource Utilization in Alcohol and Idiopathic Chronic Pancreatitis

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Rachel L. Bocchino, MD

Beth Israel Deaconess Medical Center, Harvard Medical School
Boston, MA, United States

Rachel Bocchino, MD¹, Ishani Shah, MD¹, William Yakah, BS¹, Awais Ahmed, MD¹, Steven D. Freedman, MD, PhD¹, Darshan J. Kothari, MD², Sunil G. Sheth, MD¹
¹Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; ²Duke University Medical Center, Durham, NC

Introduction: Patients with chronic pancreatitis (CP) often have several clinical complications resulting in significant resource utilization. The natural history and progression of CP may differ based on the underlying etiology. In this study we aim to compare the clinical course, outcomes, and resource utilization in patients with alcohol-induced CP (ACP) and idiopathic CP (ICP).

Methods: We retrospectively reviewed all patients with an established diagnosis of CP who were followed in the Pancreas Center at our institution between 2018 and 2020. We reviewed the use of controlled substances by reviewing the data from the state monitoring program that tracks all such prescriptions. We then compared the demographics, clinical features, comorbidities, outcomes and resource utilization of patients with ACP and ICP.

Results: We identified 350 patients with CP during the study period of which 150 had ACP. There were several differences between the two groups. Women were more likely to have ICP (59.1% vs 31.3%; p < 0.001). There was a significantly greater proportion of active tobacco use (54.1% vs 14.5%; p < 0.001) and liver disease (18.2% vs 9.84%; p = 0.037) in those with ACP. A significantly higher proportion of ACP patients were disabled (29.8% vs 12.8%; p < 0.001) and had recurrent acute pancreatitis (73.6% vs 55.7%; p = 0.001). Small intestinal bacterial overgrowth (SIBO) was more common in ICP (35.1% vs 23.6%; p = 0.036). However, splanchnic vein thrombosis, pseudocysts and exocrine pancreatic insufficiency were more prevalent in ACP. ACP patients were more likely to be using opioids (60.8% vs 43.6%; p = 0.002) and followed by a pain specialist (44.9% vs 33.7%; p=0.046). These patients also underwent more CT scans (3.74 ± 3.39 vs 2.89 ± 3.10; p = 0.021) and had a higher rate of hospitalization for flares (2.76 ± 3.76 vs 1.95 ± 3.38; p = 0.046).

Discussion: Our study demonstrates that patients with ACP have greater rates of disability, more local pancreatic complications, undergo more testing, require more opioids for pain management and are more likely to be hospitalized for flares of their pancreatitis. These results suggest that the disease course for patients with ACP may be more morbid than those with ICP.

	Alcohol (n=150)	Idiopathic (n=200)	p-value
Demographics
Age	57.1 (12.4)	59.0 (16.2)	0.208
BMI	25.5 (5.13)	25.9 (5.02)	0.552
Gender			< 0.001
Female	47 (31.3%)	117 (59.1%)
Male	103 (68.7%)	81 (40.9%)

Comorbidities
Chronic pain syndrome from diagnosis other than pancreatitis	26 (17.9%)	31 (16.2%)	0.791
Cardiac disease	44 (29.7%)	66 (34.2%)	0.449
Liver disease	27 (18.2%)	19 (9.84%)	0.037
CKD	23 (15.5%)	24 (12.4%)	0.505
Malignancy	18 (12.2%)	28 (14.5%)	0.639
Tobacco use disorder			< 0.001
Former	49 (33.1%)	70 (36.3%)
Current	80 (54.1%)	28 (14.5%)

Associated Complications
Disabled/Unemployed	42 (29.8%)	23 (12.8%)	< 0.001
History of recurrent acute pancreatitis	109 (73.6%)	108 (55.7%)	0.001
SIBO	35 (23.6%)	67 (35.1%)	0.031
Splanchnic vein thrombosis	27 (18.2%)	10 (5.21%)	< 0.001
Pseudocyst	81 (54.4%)	42 (21.9%)	< 0.001
Biliary obstruction	33 (22.8%)	17 (8.90%)	0.001
Exocrine pancreatic insufficiency	104 (70.3%)	98 (51.3%)	0.001

Medication & Resource Utilization
Opioids	90 (60.8%)	85 (43.6%)	0.002
Pain Physician	66 (44.9%)	65 (33.7%)	0.046
Number of CTs since diagnosis	3.74 (3.39)	2.89 (3.10)	0.021
Number of ERCPs since diagnosis	1.39 (1.96)	0.99 (1.72)	0.054
Number of EGDs for abdominal pain	0.77 (1.20)	1.08 (1.33)	0.029
Surgery For CP	16 (11.0%)	31 (16.1%)	0.235
Number of flares requiring hospitalization in the last two years	2.76 (3.76)	1.95 (3.38)	0.046

Table: Comparison of Patients with Alcohol CP and Idiopathic CP

Disclosures:
Rachel Bocchino indicated no relevant financial relationships.
Ishani Shah indicated no relevant financial relationships.
William Yakah indicated no relevant financial relationships.
Awais Ahmed indicated no relevant financial relationships.
Steven Freedman indicated no relevant financial relationships.
Darshan Kothari indicated no relevant financial relationships.
Sunil Sheth indicated no relevant financial relationships.

Rachel Bocchino, MD¹, Ishani Shah, MD¹, William Yakah, BS¹, Awais Ahmed, MD¹, Steven D. Freedman, MD, PhD¹, Darshan J. Kothari, MD², Sunil G. Sheth, MD¹. P1058 - Comparison of Clinical Characteristics, Outcomes, and Resource Utilization in Alcohol and Idiopathic Chronic Pancreatitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.