Acute Pancreatitis to Pancreatic Damage and Diabetes: Gastroenterology | March 2026

Introduction

Acute pancreatitis (AP) is often considered a self-limited illness once the acute episode resolves, with survival exceeding 95%. However, increasing evidence suggests that AP frequently initiates a cascade of long-term pancreatic complications, including recurrent acute pancreatitis (RAP), early chronic pancreatitis (ECP), chronic pancreatitis (CP), and progressive endocrine dysfunction such as prediabetes and diabetes mellitus. The Goulash-Plus study, a prospective multicenter cohort from the Hungarian Pancreatic Study Group, was designed to longitudinally track structural pancreatic changes and endocrine outcomes following AP, aiming to clarify when disease progression occurs and identify critical periods for monitoring.

Summary

In this ongoing prospective cohort study, 360 patients with AP were followed for four years. At baseline, most patients (74.7%) had a single AP episode without morphologic pancreatic changes. Over time, structural progression was substantial: the proportion of patients with RAP, ECP, or CP increased from 25.3% at baseline to 55.1% at 4 years. Among patients with a single AP episode initially, 35.1% developed morphologic progression. Endocrine dysfunction progressed even more dramatically. At baseline, 59% had normal glucose metabolism, but by four years, prediabetes or diabetes occurred in 76.4%, and diabetes alone increased from 13.6% to 39.2%. Notably, most progression—both structural and endocrine—occurred within the first two years after AP. These findings highlight AP as a major risk factor for chronic pancreatic disease and metabolic dysfunction, supporting structured follow-up with pancreatic imaging and glucose testing during the first two years after AP.