Evaluation of Recurrent or Idiopathic Pancreatitis

Recurrent acute pancreatitis (RAP) is defined as two or more true episodes of acute pancreatitis and about 20% of patients with acute pancreatitis experience at least one episode of recurrence. In about 10% of RAP, no definite etiology is found despite extensive evaluation. This entity is called idiopathic acute pancreatitis (IAP). Toxicmetabolic, idiopathic, genetic, autoimmune, recurrent and severe acute pancreatitis, obstructive (TIGAR-O) classification is commonly used to identify risk factors for RAP. Modalities employed to find causes of RAP and IAP include meticulous history taking, blood tests, diagnostic imaging, genetic testing, bile crystal analysis, endoscopic ultrasonography, and endoscopic retrograde cholangiopancreatography with/ without sphincter of Oddi manometry. Each modality is briefly reviewed in this review.