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Objective. Long-term morphological changes induced by a single episode of alcohol pancreatitis are not known. Our aim was to study these morphological changes in secretin stimulated MRCP (S-MRCP) after the first episode of alcohol associated acute pancreatitis, and to evaluate the risk factors and the possible protective factors that might be associated with later chronic findings.

Patients and methods. In this prospective follow-up study S-MRCP-imaging was performed for 44 (41M, 3F, mean age 46 (25-68) years) patients who survived their first episode of alcohol associated pancreatitis. Pancreatic morphology was evaluated at 3 months, and at 2, 7 and 9 years after hospitalization. Recurrent attacks of pancreatitis were studied and pancreatic function was monitored by laboratory tests. Patients' alcohol consumption was evaluated with questionnaires, laboratory markers and self-estimated alcohol consumption via interview. Smoking and BMI were annually recorded.

Results. At 3 months 32% of the patients had normal findings in S-MRCP, 52% had acute and 16% chronic changes. At seven years, S-MRCP was performed to 36 patients, with normal findings in 53%, the rest (47%) having chronic findings. Pancreatic cyst was present in 36%, parenchymal changes in 28% and atrophy in 28% of the cases. 7/36 (19%) patients demonstrated new chronic findings after two years. There were no changes in the pancreas in the attending patients between 7 and 9 years (18 patients). If chronic changes were present at 3 months after diagnosis, they would show in later S-MRCPs also. 45 % of the patients who had only acute findings at 3 months resolved to normal in 7 years, but the rest (55%) showed chronic changes later on. 22% of the patients who attended the seventh year S-MRCP had gone through a recurrent episode of acute pancreatitis (mean 22 (2-60) months), and 8% had a clinical diagnosis of chronic pancreatitis. At 7 years, 88% of patients with recurrences had chronic findings in S-MRCP versus 36% with non-recurrent pancreatitis (p=0.02). 6 (17%) patients maintained abstinence through the follow-up (mean 8.7 (7-9.1) years), but even one of these developed pancreatic atrophy. Out of the non-abstinent patients who didn't have recurrences, 4/22 (18%) developed new findings in the follow-up S-MRCP (NS). Heavy smoking didn't show correlation to increased chronic changes compared to non-smoking in univariate analysis.

Conclusions.
Morphological pancreatic changes increase with recurrent episodes of acute pancreatitis. However, even a single episode of acute alcoholic pancreatitis may induce chronic morphological changes in a long-term follow-up.