Acute pancreatitis complicating acute exacerbation of chronic hepatitis B infection carries a poor prognosis

The clinical outcome of acute pancreatitis complicating acute exacerbation of chronic hepatitis virus B (HBV) infection has never been studied. Ninety patients with acute pancreatitis were recruited. Five patients (5.6%) (Gro up 1) had acute pancreatitis superimposed on acute exacerbation of chronic HBV infection with no other causes of acute pancreatitis being identified. The clinical outcome of these five patients was compared to the 85 non-HBV infected patients (Group 2) with acute pancreatitis. A third group (Group 3 ) of patients (n=406) with acute exacerbation of chronic HBV infections wit hout acute pancreatitis was also recruited for comparison. Group 1 had a si gnificantly higher mortality rate (4 out of 5, 80%) compared to those of Gr oup 2 (13 out of 85, 15.3%, P=0.0041) and Group 3 (9 out of 406, 2.2%, P<0. 0001). In Group 1 patients, the acute pancreatitis occurred during the init ial rise of HBV DNA with relatively low or normal level of alanine amino tr ansferase (ALT) in two patients, during the rise of ALT with declining leve l of HBV DNA in one patient, and during the cholestatic phase of the acute exacerbation in one patient. The acute pancreatitis was clinically silent a nd only diagnosed by computerized tomography in the remaining patient. Dire ct viral damage and/or immunological attack to the pancreatic tissue were p robably the underlying pathogenesis of the acute pancreatitis in these pati ents. In conclusion, acute pancreatitis complicating acute exacerbation of chroni c HBV infection carried an extremely poor prognosis with high mortality.