Background: Acute pancreatitis (AP) has a high incidence, and patients can develop recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) after AP. Objectives: We aimed to estimate the pooled incidence rates (IRs), cumulative incidences, and proportions of RAP and CP after AP. Design: A systematic review and meta-analysis of studies reporting the proportion of RAP and CP after AP. Data sources and methods: The systematic search was conducted in three (PubMed, EMBASE, and CENTRAL) databases on 19 December 2023. Articles reporting the proportion of RAP or CP in patients after the first and multiple episodes of AP were eligible. The random effects model was used to calculate the pooled IR with 95% confidence intervals (CIs). The I² value assessed heterogeneity. The risk of bias assessment was conducted with the Joanna Briggs Institute Critical Appraisal Tool. Results: We included 119 articles in the quantitative synthesis and 29 in the IRs calculations. Our results showed that the IR of RAP in adult patients after AP was 5.26 per 100 person-years (CI: 3.99–6.94; I² = 93%), while in children, it was 4.64 per 100 person-years (CI: 2.73–7.87; I² = 88%). We also found that the IR of CP after AP was 1.4 per 100 person-years (CI: 0.9–2; I² = 75%), while after RAP, it increased to 4.3 per 100 person-years (CI: 3.1–6.0; I² = 76%). The risk of bias was moderate in the majority of the included studies. Conclusion: Our results showed that RAP affects many patients with AP. Compared to patients with the first AP episode, RAP leads to a threefold higher IR for developing CP. Trial registration: Our protocol was registered on PROSPERO (CRD42021283252).

INTRODUCTION: The magnitude and modifiers of the association between acute pancreatitis (AP) and pancreatic cancer (PC) are unclear. This systematic review and meta-analysis aimed to quantify the occurrence of PC in AP, the association of PC after AP, and the impact of specific risk factors on PC diagnosis. METHODS: The systematic search was conducted in PubMed, EMBASE, and Central Register of Controlled Trial from inception until July 14, 2025 (PROSPERO: CRD42023470350). Eligible studies included adult populations reporting on the association between AP and PC. Primary outcomes included prevalence, incidence, and diagnosis of PC in individuals with AP, including subset analyses of specific clinical and demographic factors. Meta-analyses were performed using random-effects models to calculate pooled outcome measures and corresponding 95% confidence intervals (CI). RESULTS: A total of 61 studies were included. The prevalence of PC among AP patients was 2% (CI: 2%–4%). The time-dependent analysis revealed an increased hazard of PC in AP vs no AP: 60 months (HR: 1.71, CI: 1.22–2.40). AP patients with subsequently diagnosed chronic pancreatitis (OR: 3.71, CI: 2.00–6.90), new-onset diabetes mellitus (OR: 2.22, CI: 1.02–4.84), idiopathic AP (OR: 2.97, CI: 1.44–6.13), and older than 50 years (OR: 4.04, CI: 2.73–5.97) showed significantly increased odds of having PC. We found no evidence for increased odds for PC with AP severity, smoking, and alcoholic and gallstone etiologies. DISCUSSION: Patients with AP have a higher likelihood of PC diagnosis, especially within the first 2 years. Although the association decreases with time, it remains significant long term. Newly diagnosed chronic pancreatitis, new-onset diabetes mellitus, idiopathic AP may further elevate the likelihood of PC diagnosis. PC diagnosed after AP tends to occur at a younger age, more often at an earlier stage, typically in the pancreatic head.

Background: There are recommendations for anticoagulation resumption after gastrointestinal bleeding (GIB), although data addressing this topic by direct oral anticoagulants (DOACs)-treated patients is lacking. We aim to determine the safety and efficacy of restarting DOACs after GIB. Methods: Studies that reported rebleeding, thromboembolic events, and mortality after restarting or withholding DOACs were selected. The systematic research was conducted in five databases (MEDLINE, EMBASE, CENTRAL, Web of Science, and Scopus). The random effect model was implemented to calculate the pooled odds ratio (OR). The ROBINS-I tool was used for risk of bias assessment, and the certainty of the evidence was evaluated with the GRADE approach. Results: Four retrospective cohort studies (1722 patients) were included in the meta-analysis. We did not find a significant increase in the risk of rebleeding in patients restarting DOACs after index GIB (OR = 1.12; 95% CI: 0.74–1.68). The outcomes of thromboembolic events and mortality data were not suitable for meta-analytic calculations. Single studies did not show statistically significant differences. Data quality assessment showed a serious overall risk of bias and very low quality of evidence (GRADE D). Conclusion: DOAC resumption after a GIB episode may not elevate the risk of rebleeding. However, the need for high-quality randomized clinical trials is crucial.

Background: Most children recover after an initial acute pancreatitis (AP) episode; however, some progress to recurrent AP (RAP) or chronic pancreatitis (CP).Purpose: We aimed to quantify progression rates and identify the risk factors associated with these transitions.Methods: PubMed/MEDLINE, Embase, and Cochrane databases were searched on December 21, 2024, for pediatric studies reporting progression to RAP or CP (PROSPERO number: CRD420251086520). All observational studies were included, while case reports and case series were excluded. To evaluate the differences in RAP rates, we conducted subgroup analyses of etiology and severity. We also assessed clinical, structural, and genetic risk factors for disease progression. A random-effects model was used to pool proportions and odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity was assessed using the I² statistic.Results: A total of 68 studies met the inclusion criteria. After the first AP attack, RAP developed in 18% (95% CI, 16–22%; I2=76%; k=39 studies) and CP developed in 10% (95% CI, 6–16%; I2=67%; k=5 studies) of patients. Among children with RAP, 35% (95% CI, 24–49%; I2=78%; k=7 studies) progressed to CP. The RAP rates varied according to etiology and severity: hypertriglyceridemia, 33%; idiopathic, 28%; biliary, 19%; traumatic, 16%; drug-induced, 14%; virus-induced, 3%; severe, 39%; moderate, 24%; and mild, 21%. Structural abnormalities were associated with a higher risk of RAP (OR, 3.15; 95% CI, 1.51–6.56; I2=0%; k=5 studies). Pancreas divisum (OR, 2.64; 95% CI, 1.51–4.63; I2=17%; k=7 studies) and PRSS1 mutation (OR: 4.56; 95% CI, 3.06–6.80; I2=0%; k=7 studies) were associated with CP.Conclusion: Approximately one in five pediatric AP episodes recurred, and over one-third of the RAP cases progressed to CP. The risk of RAP is influenced by the underlying etiology and severity of the initial episode, whereas structural and genetic factors are associated with later progression.

Background: Acute gastrointestinal bleeding (GIB) remains a major clinical emergency with substantial morbidity, mortality, and healthcare burden. We aimed to provide a comprehensive characterization of all GIB subtypes, including iatrogenic bleeding, which is underrepresented in previous studies. Methods: In this ambidirectional cohort study, 1021 consecutive adults with overt GIB were enrolled from two Hungarian tertiary centers. Standardized data collection included demographics, comorbidities, medication use, bleeding source, and in-hospital outcomes: mortality, rebleeding, intensive care unit (ICU) admission, length of hospitalization (LoH), endoscopic evaluation and haemostatic intervention, red blood cell transfusion, and surgical intervention. Group comparisons were performed using appropriate statistical tests, and survival was analysed using Kaplan–Meier curves (R v4.4.2; p < 0.05). Results: Non-variceal upper GIB was the most common subtype (51.0%), followed by lower GIB (29.7%), variceal GIB (8.9%), small bowel bleeding (2.3%), and iatrogenic bleeding (7.5%). Overall, in-hospital mortality was 10.6%, highest in variceal bleeding (22%). Rebleeding occurred in 5.3% of cases, most frequently in variceal bleeding. ICU admission was required in 8.9% of patients, again, most common in variceal bleeding (21.6%). The median LoH was 7 days (IQR 4–10), significantly shorter in cases of intraprocedural iatrogenic bleeding. Endoscopy was performed in 91% of cases, with haemostatic intervention in 57%. Surgery was required in 3.4% of patients. Conclusions: Gastrointestinal bleeding represents a heterogeneous clinical entity with distinct outcome profiles across subtypes. Variceal bleeding was associated with the most unfavorable outcomes, whereas intraprocedural iatrogenic bleeding had a favorable course. These findings support subtype-specific clinical management and warrant validation in larger multicenter cohorts.