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40-70% of acute pancreatitis cases are caused by stones in the gallbladder or bile duct and 25-35% by excessive, prolonged alcohol consumption. Smoking also increases the risk of acute pancreatitis. Other causes include conditions that lead to pancreatic outflow obstruction (e.g. biliopancreatic neoplasms and pancreas divisum), drugs, consumption of toxic substances (e.g. cannabis, cocaine), iatrogenesis (e.g. pancreatic puncture and retrograde cholangiography), severe hypertriglyceridaemia (triglyceride levels greater than 1000 mg/dL), mutations in susceptible genes (e.g. in the CFTR, SPINK1 and CTRC genes), infections by viruses, bacteria, fungi or parasites, autoimmune pancreatitis, acute ischaemia, vasculitis and abdominal trauma.
The main risk factors associated with chronic pancreatitis are alcohol consumption and smoking, especially when consumed in combination. The risk increases with the amount and duration of consumption. Other factors are genetic mutations (in the CFTR, SPINK1, PRSS1, CTRC and phospholipase A2 genes), autoimmune pancreatitis and causes of pancreatic outflow obstruction.
No causal factor is identified in 10-20% of acute and chronic pancreatitis cases.
Preventive measures depend on the causative factor. Cholecystectomy is recommended in patients with acute biliary pancreatitis as soon as possible to avoid recurrence. Eliminating alcohol consumption and smoking is always recommended, as they are pro-inflammatory and proven risk factors for pancreatitis.
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