review of literature on clinical pancreatology - The Pancreapedia

Epidemiology and demographyChinaCHRONIC PANCREATITISA multicenter study was initiated by the Chinese Chronic Pancreatitis Study Group todetermine the nature and magnitude <strong>of</strong> chronic pancreatitis in China. Twenty-two hospitalsrepresenting all 6 urban health care regions in China participated in the study. The surveycovered a 10-year period from 1994 to 2004. Multiple logistic regression was used foranalyses. Results: The analysis included 2008 patients (65 % were men, mean age, 49years). Chronic pancreatitis prevalence increased yearly from 1996 to 2003: 3.08, 3.91, 5.28,7.61, 10.43, 11.92, 12.84, and 13.52 per 100,000 inhabitants. Chronic pancreatitis etiologieswere alcohol (35 %), biliary stones (34 %), hereditary (7 %), and idiopathic chronicpancreatitis (13 %). Clinical feature were pain (76 %), maldigestion (36 %), jaundice (13 %),and steatorrhea (7 %). Complications were pseudocyst (26 %), diabetes (22 %), bile ductstrictures (13 %), and ascites (2 %). With regard to the diagnosis, the sensitivity andspecificity <strong>of</strong> endoscopic ultrasonography and endoscopic retrograde cholangiopancreatographywere 88 and 93 percent, and 87 and 93 percent, respectively. Threehundred ninety-one patients (19 %) received endoscopic therapy. Surgery was performed in239 patients (12 %). It was concluded that in China, the incidence <strong>of</strong> chronic pancreatitis isrising rapidly [245].IndiaTropical pancreatitis, an idiopathic chronic pancreatitis (ICP) with unique features, has beendescribed in south and north India. It was investigated the clinical pr<strong>of</strong>ile <strong>of</strong> ICP patients innorth India. Detailed demographic data was recorded and hematological and biochemicalinvestigations were performed on 155 patients that had been diagnosed with chronicpancreatitis. Ultrasonography and computed tomography were performed in all patients.Magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography,glucose tolerance test and fecal fat studies were performed on some patients.Patients were divided in to early or lateonset ICP (before or after 35 years <strong>of</strong> age). ICP wasreported in 41 percent <strong>of</strong> patients, followed by alcoholic chronic pancreatitis (38 %). Themean age <strong>of</strong> ICP patients was 33 years and the mean duration <strong>of</strong> symptoms at the time <strong>of</strong>presentation was 40 months. Pain was the dominant symptom in both early- (95 %) and lateonset(100 %) ICP; pseudocyst was the most common local complication. Diabetes wasobserved in 17 percent <strong>of</strong> patients with early-onset ICP and 35 percent with late-onset ICP.Pancreatic calcification was noted in 46 percent <strong>of</strong> patients with early-onset and 48 percentwith late-onset ICP. Pseudocyst and segmental portal hypertension occurred more frequentlyin non-calcific ICP whereas diabetes mellitus and abnormal fecal fat excretion occurred morefrequently in patients with calcific ICP. It was concluded that ICP <strong>of</strong> north India appears to bedifferent from classical tropical pancreatitis described in the <strong>literature</strong> and is associated witha higher prevalence <strong>of</strong> pain, lower frequencies <strong>of</strong> diabetes, calcification and intraductalcalculi [246].Risk <strong>of</strong> cancerIt was monitored 223 patients with chronic pancreatitis on a systematic basis from 1992 to2005. During this 14-year period, we monitored the number <strong>of</strong> cigarettes smoked per year inaddition to standard parametres measured by biochemical methods, endosonography, CTand ERCP exams, and assigned the alcoholic form <strong>of</strong> chronic pancreatitis to patientsconsuming more than 80g <strong>of</strong> alcohol per day on a systematic basis for more than 5 years in