adjuvant pain management use among CP patients requiring ERCP, and identify factors associated with increased opioid reliance. Methods: We conducted a retrospective cohort analysis of patients undergoing ERCP for complications of CP between 1/1/2011 to 12/31/2021. Patients with pancreatic malignancy or less than 1 year follow-up were excluded. Within this group, patients’ discrete opioid prescriptions of 30 days or longer were extracted from their medical records and the Georgia Prescription Drug Monitoring Program. Patient demographics, procedural data, and adjuvant pain medications were also reviewed. Patients were followed for at least 1 year after index ERCP to analyze temporal trends in pain management. Descriptive statistics and multivariate linear regression models were created for assessment. Results: Of the 97 patients who met the inclusion criteria, 79.38% (n=77) used opioids chronically for CP pain. The percentage of total patients using opioids chronically increased from 1 year before index ERCP (51.55%) to 1 year after index ERCP (62.89%). The percentage of patients using adjuvant pain medications (gabapentinoids, TCAs, anticholinergics, anti- spasmodics) also increased in the year after index ERCP, from 17.53% to 51.55%. Of the 77 patients who used opioids, 24.68% were followed in an anesthesia/pain clinic, and 58.4% had their opioid use documented in GI clinic notes. Controlling for other covariates, higher age of index ERCP was associated with decrease in opiate prescription within 1 year of index ERCP (β=-0.15,[-0.26,-0.054]), and a history of smoking was associated with higher opiate prescriptions a year after index ERCP ( β=5.68,[1.95,9.41]). Higher use of adjuvant pain medications trended towards higher opiate prescriptions 1 year after index ERCP ( β= 1.52,[-0.092,3.13]. Various etiologies for chronic pancreatitis or indication for procedure were not associated with number of opiate prescriptions 1 year after index ERCP. Conclusions: ERCP was not predictive of decreasing opioid use in patients with CP. Increasing opiate use and adjuvant pain medication use 1 year post-ERCP, especially among complex structural pancreatic disease sequelae, indicates there may be a population of well-progressed CP patients requiring special attention and multi-disciplinary pain management strategies. Smoking history and younger age of ERCP may also be significant risk factors for higher opiate dependence in CP. Demographic factors of gender and ethnicity were not associated with differences in opiate use. Su1431 DOES THE ETIOLOGY OF CHRONIC PANCREATITIS IMPACT THE CLINICAL OUTCOMES: A POPULATION-BASED ANALYSIS FROM THE TRINETX DIAMOND NETWORK Khaled Elfert, Mahmoud Nassar, Mouhand F. Mohamed, Azizullah Beran, Hazem Abosheaishaa, Islam Mohamed, Saqr Alsakarneh, Ali Khalifa, Khalid Aloum, Sherif E. Elhanafi Introduction: Chronic pancreatitis encompasses various risk factors such as alcohol con- sumption, smoking, autoimmune conditions, and other causes. However, there's limited understanding regarding the difference in disease progression and outcomes among its different subtypes. Our study is a population-based study that aims to evaluate the outcomes between alcohol-related chronic pancreatitis and non-alcohol-related chronic pancreatitis. Methods: TriNetX is the global federated health research network providing access to electronic medical records across large healthcare organizations (HCOs). The analysis utilized the TriNetX Diamond Network; a network that includes 92 HCO(s) and more than 200 million patients in the US. This analysis compared the baseline characteristics and the clinical outcomes of alcohol-related chronic pancreatitis (Alcohol cohort) and non-alcohol-related chronic pancreatitis (Non-alcohol cohort). ICD10 codes were used to identify both cohorts. Any patient with a history of alcohol intake was excluded from the non-alcohol cohort. The primary outcome was mortality. Secondary outcomes were exocrine pancreatic insufficiency, pseudocyst formation, diabetes mellitus, and pancreatic cancer. This analysis included out- comes that occurred in the time window that started 1 day after the first occurrence of the index event (diagnosis of chronic pancreatitis). Patients with outcomes that occurred before the index event were excluded. Results: The study included 17,912 patients in the alcohol cohort and 407,618 patients in the non-alcohol cohort. The mean age (+/- SD) was 52.9 +/- 13.7 in the alcohol cohort and S-749 AGA Abstracts 60.3 +/- 16.9 in the non-alcohol cohort. The proportion of females was 27.5% in the alcohol cohort and 43.8% in the non-alcohol cohort. Propensity score matching was performed on all baseline characteristics that can be potential confounders, including age, sex, smoking status, diabetes, hypertension, ischemic heart disease, and pancreatic congenital malforma- tions. The baseline characteristics of the cohorts before and after matching are summarized in table 1. Outcome analysis after propensity score matching showed lower rates of mortality, exocrine pancreatic insufficiency, pseudocyst, and pancreatic cancer in alcohol-related chronic pancreatitis cohort compared to the other cohort (Table 2). There were lower rates of ERCP and celiac plexus injection utilization in the alcohol cohort. (Table 2) Conclusion: This population-based study revealed more favorable outcomes in alcohol- related chronic pancreatitis including mortality compared to cases attributed to other etiolo- gies. Further research is imperative to comprehend the variances in pathophysiology and disease patterns between these categories, including investigating potential differences in genomic interactions within both types. Table 1: Baseline characteristics of the two study cohorts before and after propensity score matching. Table 2: Clinical outcomes after propensity score matching. Su1432 RISK FACTORS OF RELAPSE OF AUTOIMMUNE PANCREATITIS WITH STEROID THERAPY OR FOLLOW-UP Wataru Ujita, Kazurou Chiba, Tabata Hiroki, Jun Nakahodo, Terumi Kamisawa, Toshiro Iizuka (Objective) To investigate the risk factors of relapse ofautoimmune pancreatitis(AIP) receiving either steroid therapyor follow-up. (Methods) The present study enrolled 120 patients with AIP comprising 83 males and 37 females with a median age at diagnosis of 65 years who were treated at the study centerin or after January 2006 and received at least 12 months’ follow-up. As a rule, steroid therapy was administered to 92 symptomatic patients (group A) while 28 patients (group B) received only follow-up. Complications of other IgG4-related diseases included IgG4-related sclerosing cholangitis in 62 patients (A: 54, B: 8), IgG4- related lacrimal gland/sialadenitis in 32 patients (A: 24, B: 8), and IgG4-related retroperitoneal fibrosis in seven patients in group A. Relapse was defined as the initiation, resumption or increase of steroid therapy for any deterioration of symptoms ofan IgG4-related disease during follow-up. The relationship between relapse and the extent of pancreatic swelling, main pancreatic duct stenosis, intra- and extra-pancreatic bile duct stenosis, pancreatic cysts and stones, IgG4 levels before and after treatment, and extra-pancreatic lesions was examined in both groups. (Results) A relapse occurred in 19 patients (20.7%) in group A and six patients (21.4%) in group B. A relapse occurred in the pancreas, bile duct, lacrimal or salivary glands, and other areas in 15 (A: 10, B: 5), eight (A: 4, B: 4), one (group A), and four (group A) patients, respectively. The duration from the start of steroid therapy to a relapse was <one year in two cases, <three years in six cases, and >three years in 11 cases, with ten cases occurring after steroid therapy discontinuation. The risk factors of relapse were IgG4-related retroperitoneal fibrosis (p=0.026) and extrapancreatic variables (p=0.0054) in group A and diffuse pancreatic enlargement (p=0.04) in group B. In multivariate analysis, complications of IgG4-related retroperitoneal fibrosis (p=0.033) were noted in group A. (Conclusion) A relapse of autoimmune pancreatitis occurred in 20.7% and 21.4%of patients receiving steroid therapyand follow-up only, respectively. The risk factors of relapse were the number of extrapancreatic lesions and IgG4-related retroperitoneal fibrosis in the steroid- therapy group and diffuse pancreatic enlargement in the follow-up group. AGA Abstracts