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Maheshwari A, Patra PS, Ray S, Dhali GK, Das K. External validation of Chronic Pancreatitis Prognosis Score (COPPS): A prospective cohort study. Dig Liver Dis 2022; 54:654-662. [PMID: 34544675 DOI: 10.1016/j.dld.2021.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prognostic stratification in ChronicPancreatitis(CP) remains suboptimal and cumbersome. Chronic Pancreatitis Prognostic Score(COPPS) was recently developed to predict one-year hospitalisations in CP. AIM External validation of COPPS in a geographically divergent patient population. METHODS A single-center prospective cohort study, conducted on out-patients of a tertiary-care hospital. Consecutive adults with CP were assessed for COPPS risk predictors at baseline, similar to the original development cohort, and followed for one-year for: 1)hospitalisations; 2)development of pancreatitis-related complications; and 3)need for endoscopic and/or surgical interventions. Outcomes were compared by Kendall's tau-b(τb) and other statistical tests. Only those who had complete one-year follow-up were included in analysis. RESULTS There were 177 patients(mean±SD age: 35.9 ± 11.2 years), 116(65%) males and 117(66%) with Idiopathic CP. Despite being younger, with significantly more females and Idiopathic CP, than the original development cohort, our cohort was similar to the latter regarding COPPS severity at baseline. Eight patients died over one-year; 169 were evaluated for outcomes. Increasingly severe COPPS categories correlated with increasing number of hospitalisations(both overall and pancreatitis-related) and increasing number of days spent in hospital(both overall and pancreatitis-related) irrespective of age at symptoms-onset(≤35 vs >35years), etiology(idiopathic vs alcohol) and smoking-status. CONCLUSIONS COPPS is effective in a geographically distinct cohort having a different case-mix of CP patients(ClincialTrials.gov ID:NCT04907266).
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Affiliation(s)
- Ankit Maheshwari
- Divisions of Gastroenterology, School of Digestive and Liver Disease, IPGME&R, Kolkata, India
| | - Partha Sarathi Patra
- Divisions of Gastroenterology, School of Digestive and Liver Disease, IPGME&R, Kolkata, India; Gastrointestinal Surgery, School of Digestive and Liver Disease, IPGME&R, Kolkata, India
| | - Sukanta Ray
- Gastrointestinal Surgery, School of Digestive and Liver Disease, IPGME&R, Kolkata, India
| | - G K Dhali
- Divisions of Gastroenterology, School of Digestive and Liver Disease, IPGME&R, Kolkata, India
| | - Kshaunish Das
- Divisions of Gastroenterology, School of Digestive and Liver Disease, IPGME&R, Kolkata, India.
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Schneider A, Hirth M. Pain Management in Chronic Pancreatitis: Summary of Clinical Practice, Current Challenges and Potential Contribution of the M-ANNHEIM Classification. Drugs 2021; 81:533-546. [PMID: 33587287 DOI: 10.1007/s40265-021-01472-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2021] [Indexed: 01/06/2023]
Abstract
Abdominal pain, diarrhea with weight loss, and endocrine insufficiency represent the dominant symptoms of chronic pancreatitis (CP). High intensity of pain and constant pain have been shown to reduce quality of life in CP and may result in disability and increased health resource utilization. Various basic challenges and unanswered questions still exist regarding the treatment of pain in CP. Recently, limited evidence has been gained that early surgery for painful disease might be associated with better treatment results. Thus, timing of pancreatic surgery in painful disease represents a major issue that needs to be clarified in future studies. In this context, surveillance of patients is necessary in clinical practice. It appears that a generally accepted classification of the disease represents a major requirement for inter-institutional comparison of data with future progress in clinical research. Among recently proposed classification systems, the M-ANNHEIM classification system of CP with its recently presented M-ANNHEIM Surgery Score might be a useful tool to picture the course of the disease and to monitor treatment results. Future research is required to clarify the possible role of this system in the management of pain in CP. In the present article, we provide an overview of current status, challenges, and unanswered questions in the treatment of pain in CP, and we demonstrate the potential benefits of the M-ANNHEIM classification system in the management of painful CP.
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Affiliation(s)
- Alexander Schneider
- Department of Gastroenterology and Hepatology, Medical Center Bad Hersfeld-Rotenburg, Bad Hersfeld, Germany. .,Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Michael Hirth
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Systematic approach for assessment of imaging features in chronic pancreatitis: a feasibility and validation study from the Scandinavian Baltic Pancreatic Club (SBPC) database. Abdom Radiol (NY) 2020; 45:1468-1480. [PMID: 32170335 DOI: 10.1007/s00261-020-02466-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE There is an unmet need for new systems with quantitative pancreatic imaging assessments to support better diagnosis and understand development of chronic pancreatitis (CP). The aims were to present such an approach for assessment of imaging features in CP, to apply this system in a multi-center cohort of CP patients (feasibility study), and to report inter-reader agreement between expert radiologists (validation study). METHODS The feasibility study included pancreatic computed tomography (CT) or magnetic resonance imaging (MRI) from 496 patients with definitive CP in the Scandinavian Baltic Pancreatic Club (SBPC) database. Images were assessed according to the new SBPC imaging system (quantitative assessments of ductal and parenchymal features). Inter-reader agreement of reported imaging parameters was investigated for 80 CT and 80 MRI examinations by two expert radiologists. RESULTS Reporting of the imaging features into the imaging system was deemed feasible for > 80% of CT and > 90% of MRI examinations. Quantitative assessments of main pancreatic duct diameters, presence/number/diameter of calcifications, and gland diameters had high levels of inter-reader agreement with κ-values of 0.75-0.87 and intraclass correlation coefficients of 0.74-0.97. The more subjective assessments, e.g., irregular main pancreatic duct and dilated side-ducts, had poor to moderate agreement with κ-values of 0.03-0.44. CONCLUSION The presented system provides a feasible mean for systematic assessment of CP imaging features. Imaging parameters based on quantitative assessment, as opposed to subjective assessments, have better reproducibility and should be preferred in the development of new grading systems for understanding pathophysiology and disease progression in CP.
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Abstract
Chronic pancreatitis (CP) is historically defined as an irreversible inflammatory condition of the pancreas leading to varying degrees of exocrine and endocrine dysfunction. Recently however, the paradigm for the diagnosis has changed in that it breaks with the traditional clinicopathologic-based definition of disease, focusing instead on diagnosing the underlying pathologic process early in the disease course and managing the syndrome more holistically to change the natural course of disease and minimize adverse disease effects. Currently, the most accepted mechanistically derived definition of CP is a pathologic fibroinflammatory syndrome of the pancreas in individuals with genetic, environmental, and/or other risk factors who develop persistent pathologic responses to parenchymal injury or stress. The most common symptom of CP is abdominal pain, with other symptoms such as exocrine pancreatic insufficiency and diabetes developing at highly variable rates. CP is most commonly caused by toxins such as alcohol or tobacco use, genetic polymorphisms, and recurrent attacks of acute pancreatitis, although no history of acute pancreatitis is seen in many patients. Diagnosis is made usually on cross-sectional imaging, with modalities such as endoscopic ultrasonography and pancreatic function tests playing a secondary role. Total pancreatectomy represents the only known cure for CP, although difficulty in patient selection and the complications inherent to this intervention make it usually an unattractive option. This guideline will provide an evidence-based practical approach to the diagnosis and management of CP for the general gastroenterologist.
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Frøkjær JB, Akisik F, Farooq A, Akpinar B, Dasyam A, Drewes AM, Haldorsen IS, Morana G, Neoptolemos JP, Olesen SS, Petrone MC, Sheel A, Shimosoegawa T, Whitcomb DC. Guidelines for the Diagnostic Cross Sectional Imaging and Severity Scoring of Chronic Pancreatitis. Pancreatology 2018; 18:764-773. [PMID: 30177434 DOI: 10.1016/j.pan.2018.08.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/16/2018] [Accepted: 08/25/2018] [Indexed: 02/01/2023]
Abstract
The paper presents the international guidelines for imaging evaluation of chronic pancreatitis. The following consensus was obtained: Computed tomography (CT) is often the most appropriate initial imaging modality for evaluation of patients with suspected chronic pancreatitis (CP) depicting most changes in pancreatic morphology. CT is also indicated to exclude other potential intraabdominal pathologies presenting with symptoms similar to CP. However, CT cannot exclude a diagnosis of CP nor can it be used to exclusively diagnose early or mild disease. Here magnetic resonance imaging (MRI) and MR cholangiopancreatography (MRCP) is superior and is indicated especially in patients where no specific pathological changes are seen on CT. Secretin-stimulated MRCP is more accurate than standard MRCP in the depiction of subtle ductal changes. It should be performed after a negative MRCP, when there is still clinical suspicion of CP. Endoscopic ultrasound (EUS) can also be used to diagnose parenchymal and ductal changes mainly during the early stage of the disease. No validated radiological severity scoring systems for CP are available, although a modified Cambridge Classification has been used for MRCP. There is an unmet need for development of a new and validated radiological CP severity scoring system based on imaging criteria including glandular volume loss, ductal changes, parenchymal calcifications and parenchymal fibrosis based on CT and/or MRI. Secretin-stimulated MRCP in addition, can provide assessment of exocrine function and ductal compliance. An algorithm is presented, where these imaging parameters can be incorporated together with clinical findings in the classification and severity grading of CP.
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Affiliation(s)
- Jens Brøndum Frøkjær
- Department of Radiology, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark.
| | - Fatih Akisik
- Department of Radiology, Indiana University, Indianapolis, USA
| | - Ammad Farooq
- Department of Radiology, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Burcu Akpinar
- Department of Radiology, Koc University School of Medicine, Istanbul, Turkey
| | - Anil Dasyam
- Department of Radiology, University of Pittsburgh and UPMC, Pittsburgh, PA, USA
| | - Asbjørn Mohr Drewes
- Department of Clinical Medicine, Aalborg University, Denmark; Centre for Pancreatic Diseases, Department of Gastroenterology and Mech-Sense, Aalborg University Hospital, Denmark
| | | | - Giovanni Morana
- Radiological Department, Treviso General Hospital, Treviso, Italy
| | | | - Søren Schou Olesen
- Department of Clinical Medicine, Aalborg University, Denmark; Centre for Pancreatic Diseases, Department of Gastroenterology and Mech-Sense, Aalborg University Hospital, Denmark
| | - Maria Chiara Petrone
- Pancreas Translational and Clinical Research Center Vita Salute San Raffaele University, Milan, Italy
| | - Andrea Sheel
- Department of Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, United Kingdom
| | - Tooru Shimosoegawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - David C Whitcomb
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh and UPMC, Pittsburgh, PA, USA
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Hirth M, Vujasinovic M, Münch M, Weiss C, Löhr M, Ebert MP, Schneider A. Monitoring and predicting disease activity in autoimmune pancreatitis with the M-ANNHEIM-AiP-Activity-Score. Pancreatology 2018; 18:29-38. [PMID: 29158146 DOI: 10.1016/j.pan.2017.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/28/2017] [Accepted: 10/19/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND & OBJECTIVES Autoimmune pancreatitis (AiP) is treated by immunosuppressive therapy. Exact description of disease activity of AiP is essential in clinical practice and research, but a score to describe the disease activity is missing. Thus, we aimed to establish an activity score of AiP. METHODS We retrospectively studied long-term disease courses of 29 patients with AiP (Mannheim, Germany), receiving corticosteroid treatment (CST) by analyzing 613 treatment appointments. Two assumptions were made: First, disease activity is higher at emergency treatments; second, disease activity drops under CST. In all patients, we evaluated established activity- and classification-systems of chronic pancreatitis (cP). Based on the most suitable system, we established an activity score of AiP by including AiP-specific parameters identified from our long-term disease courses and the literature. The new AiP-specific activity score was validated in an external cohort of 14 patients with AiP (Stockholm, Sweden). RESULTS Within published activity indexes of cP, the M-ANNHEIM-classification most significantly correlated with emergency- and treatment-dependent disease activities (p < 0.001 and p < 0.01, conditional-logistic-regression-analysis). Significant correlations of disease activity were found for several clinical parameters (biliary involvement, extrapancreatic lesions, acute pancreatitis, focal pancreatic mass, pancreatic sausage/mass, focal enlargement, ascites; p < 0.05, Wilcoxon-signed-rank-test). Based on these data and disease features from the literature, the M-ANNHEIM-AiP-Activity-Score (MAAS) was established. CST-induced reduction of MAAS disease activity of more than 60% was associated with lower relapse rates (p < 0.05; Chi-Square-test). The results were validated in the external patient cohort. CONCLUSION The MAAS might represent a useful tool to monitor AiP.
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Affiliation(s)
- Michael Hirth
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty at Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Miroslav Vujasinovic
- Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, K 53 141 86 Stockholm, Sweden
| | - Markus Münch
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty at Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Christel Weiss
- Medical Statistics, University Medical Center Mannheim, Medical Faculty at Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Matthias Löhr
- Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, K 53 141 86 Stockholm, Sweden
| | - Matthias P Ebert
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty at Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Alexander Schneider
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty at Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
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Beyer G, Mahajan UM, Budde C, Bulla TJ, Kohlmann T, Kuhlmann L, Schütte K, Aghdassi AA, Weber E, Weiss FU, Drewes AM, Olesen SS, Lerch MM, Mayerle J. Development and Validation of a Chronic Pancreatitis Prognosis Score in 2 Independent Cohorts. Gastroenterology 2017; 153:1544-1554.e2. [PMID: 28918191 DOI: 10.1053/j.gastro.2017.08.073] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS The clinical course of chronic pancreatitis is unpredictable. There is no model to assess disease severity or progression or predict patient outcomes. METHODS We performed a prospective study of 91 patients with chronic pancreatitis; data were collected from patients seen at academic centers in Europe from January 2011 through April 2014. We analyzed correlations between clinical, laboratory, and imaging data with number of hospital readmissions and in-hospital days over the next 12 months; the parameters with the highest degree of correlation were used to develop a 3-stage chronic pancreatitis prognosis score (COPPS). The predictive strength was validated in 129 independent subjects identified from 2 prospective databases. RESULTS The mean number of hospital admissions was 1.9 (95% confidence interval [CI], 1.39-2.44) and 15.2 for hospital days (95% CI, 10.76-19.71) for the development cohort and 10.9 for the validation cohort (95% CI, 7.54-14.30) (P = .08). Based on bivariate correlations, pain (numeric rating scale), level of glycated hemoglobin A1c, level of C-reactive protein, body mass index, and platelet count were used to develop the COPPS system. The patients' median COPPS was 8.9 points (range, 5-14). The system accurately discriminated stages of disease severity (low to high): A (5-6 points), B (7-9), and C (10-15). In Pearson correlation analysis of the development cohort, the COPPS correlated with hospital admissions (0.39; P < .01) and number of hospital days (0.33; P < .01). The correlation was validated in the validation set (Pearson correlation values of 0.36 and 0.44; P < .01). COPPS did not correlate with results from the Cambridge classification system. CONCLUSIONS We developed and validated an easy to use dynamic multivariate scoring system, similar to the Child-Pugh-Score for liver cirrhosis. The COPPS allows objective monitoring of patients with chronic pancreatitis, determining risk for readmission to hospital and potential length of hospital stay.
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Affiliation(s)
- Georg Beyer
- Department of Medicine A, Universitätsmedizin Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany; Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Ujjwal M Mahajan
- Department of Medicine A, Universitätsmedizin Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany; Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Christoph Budde
- Department of Medicine A, Universitätsmedizin Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany
| | - Thomas J Bulla
- Department of Medicine A, Universitätsmedizin Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany
| | - Thomas Kohlmann
- Institut für Community Medicine, Universitätsmedizin Greifswald, Ernst-Moritz-Arndt-Universität Greifswald, Germany
| | - Louise Kuhlmann
- Centre for Pancreatic Diseases and Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kerstin Schütte
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
| | - Ali A Aghdassi
- Department of Medicine A, Universitätsmedizin Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany
| | - Eckhard Weber
- Department of Medicine A, Universitätsmedizin Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany
| | - F Ulrich Weiss
- Department of Medicine A, Universitätsmedizin Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany
| | - Asbjørn M Drewes
- Centre for Pancreatic Diseases and Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Søren S Olesen
- Centre for Pancreatic Diseases and Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Markus M Lerch
- Department of Medicine A, Universitätsmedizin Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany
| | - Julia Mayerle
- Department of Medicine A, Universitätsmedizin Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany; Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.
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Kamath MG, Pai CG, Kamath A, Kurien A. Comparing acid steatocrit and faecal elastase estimations for use in M-ANNHEIM staging for pancreatitis. World J Gastroenterol 2017. [PMID: 28405150 DOI: 10.3748/wjg.v23.i12.2217.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2022] Open
Abstract
AIM To compare two tests for exocrine pancreatic function (EPF) for use in M-ANNHEIM staging for pancreatitis. METHODS One hundred and ninety four consecutive patients with acute pancreatitis (AP; n = 13), recurrent acute pancreatitis (RAP; n = 65) and chronic pancreatitis (CP; n = 116) were enrolled. EPF was assessed by faecal elastase-1 (FE-1) estimation and stool fat excretion by the acid steatocrit method. Patients were classified as per M-ANNHEIM stages separately based on the results of the two tests for comparison. Independent Student's t-test, χ2 test, Kruskal-Wallis test, Mann-Whitney U test and McNemar's test were used as appropriate. RESULTS Sixty-one (52.5%) patients with CP had steatorrhoea when assessed by the acid steatocrit method; 79 (68.1%) with CP had exocrine insufficiency by the FE-1 test (χ2 test, P < 0.001). The results of acid steatocrit and FE-1 showed a significant negative correlation (Spearman's rho = -0.376, P < 0.001). A statistically significant difference was seen between the M-ANNHEIM stages as classified separately by acid steatocrit and the FE-1. Thirteen (6.7%), 87 (44.8%), 89 (45.8%) and 5 (2.5%) patients were placed in M-ANNHEIM stages 0, I, II, and III respectively, with the use of acid steatocrit as against 13 (6.7%), 85 (43.8%), 75 (38.6%), and 21 (10.8%) respectively by FE-1 in stages 0, I, II, and III thereby altering the stage in 28 (14.4%) patients (P < 0.001, McNemar's test). CONCLUSION FE-1 estimation performed better than the acid steatocrit test for use in the staging of pancreatitis by the M-ANNHEIM classification since it diagnosed a higher proportion of patients with exocrine insufficiency.
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Affiliation(s)
- M Ganesh Kamath
- M Ganesh Kamath, Department of Physiology, Melaka Manipal Medical College, Manipal University, Manipal 576104, India
| | - C Ganesh Pai
- M Ganesh Kamath, Department of Physiology, Melaka Manipal Medical College, Manipal University, Manipal 576104, India
| | - Asha Kamath
- M Ganesh Kamath, Department of Physiology, Melaka Manipal Medical College, Manipal University, Manipal 576104, India
| | - Annamma Kurien
- M Ganesh Kamath, Department of Physiology, Melaka Manipal Medical College, Manipal University, Manipal 576104, India
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The Chronic Pancreatitis International Classification of Diseases, Ninth Revision, Clinical Modification Code 577.1 Is Inaccurate Compared With Criterion-Standard Clinical Diagnostic Scoring Systems. Pancreas 2016; 45:1276-1281. [PMID: 27776047 PMCID: PMC5021551 DOI: 10.1097/mpa.0000000000000631] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Epidemiological studies utilizing administrative databases use the International Classification of Diseases, Ninth Revision, Clinical Modification code (577.1) to identify patients with chronic pancreatitis (CP). We hypothesized that coding of CP in these databases is inaccurate. METHODS We retrospectively reviewed the records of 1343 consecutive patients having an International Classification of Diseases, Ninth Revision, Clinical Modification code 577.1 between October 1, 2005, and November 1, 2008. We labeled patients as definite CP or non-CP, defined as fulfilling any of the 3 diagnostic criteria for definite CP: Mayo, Ammann's, and the Japanese Pancreas Society criteria. RESULTS Six hundred fifty-eight subjects (49%) had definite CP. Definite CP among Mayo, Ammann's, and Japanese Pancreas Society criteria was similar (49.0, 42.1, and 43.8, respectively); 84.3% of the definite CP fulfilled all 3 criteria, 6.7% fulfilled 2, and 9.0% filled 1 criterion. Etiologies of definite CP were definite/suspected nonalcohol (57.8%) or alcohol (33.5%) and not reported (8.7%). In non-CP (n = 685), 93.7% had available imaging (5.7% had endoscopic ultrasonography ≥5 or Cambridge II-III scores), and 63.5% had symptoms suggestive of CP but did not fulfill other features for definite CP. The CP versus non-CP groups had similar mean ages but significantly more men and patients ever smoking and ever drinking alcohol. CONCLUSIONS Fifty-one percent of subjects coded as CP do not fulfill the diagnostic criteria for definite CP. Relying solely on the International Classification of Diseases, Clinical Modification code for CP in administrative databases may lead to erroneous epidemiological conclusions.
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Ito T, Ishiguro H, Ohara H, Kamisawa T, Sakagami J, Sata N, Takeyama Y, Hirota M, Miyakawa H, Igarashi H, Lee L, Fujiyama T, Hijioka M, Ueda K, Tachibana Y, Sogame Y, Yasuda H, Kato R, Kataoka K, Shiratori K, Sugiyama M, Okazaki K, Kawa S, Tando Y, Kinoshita Y, Watanabe M, Shimosegawa T. Evidence-based clinical practice guidelines for chronic pancreatitis 2015. J Gastroenterol 2016; 51:85-92. [PMID: 26725837 DOI: 10.1007/s00535-015-1149-x] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 11/18/2015] [Indexed: 02/07/2023]
Abstract
Chronic pancreatitis is considered to be an irreversible progressive chronic inflammatory disease. The etiology and pathology of chronic pancreatitis are complex; therefore, it is important to correctly understand the stage and pathology and provide appropriate treatment accordingly. The newly revised Clinical Practice Guidelines of Chronic Pancreatitis 2015 consist of four chapters, i.e., diagnosis, staging, treatment, and prognosis, and includes a total of 65 clinical questions. These guidelines have aimed at providing certain directions and clinically practical contents for the management of chronic pancreatitis, preferentially adopting clinically useful articles. These revised guidelines also refer to early chronic pancreatitis based on the Criteria for the Diagnosis of Chronic Pancreatitis 2009. They include such items as health insurance coverage of high-titer lipase preparations and extracorporeal shock wave lithotripsy, new antidiabetic drugs, and the definition of and treatment approach to pancreatic pseudocyst. The accuracy of these guidelines has been improved by examining and adopting new evidence obtained after the publication of the first edition.
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Affiliation(s)
- Tetsuhide Ito
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan.
| | - Hiroshi Ishiguro
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Hirotaka Ohara
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Terumi Kamisawa
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Junichi Sakagami
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Naohiro Sata
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Yoshifumi Takeyama
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Morihisa Hirota
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Hiroyuki Miyakawa
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Hisato Igarashi
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Lingaku Lee
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Takashi Fujiyama
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Masayuki Hijioka
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Keijiro Ueda
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Yuichi Tachibana
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Yoshio Sogame
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Hiroaki Yasuda
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Ryusuke Kato
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Keisho Kataoka
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Keiko Shiratori
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Masanori Sugiyama
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Kazuichi Okazaki
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Shigeyuki Kawa
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Yusuke Tando
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Yoshikazu Kinoshita
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Mamoru Watanabe
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Tooru Shimosegawa
- Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for chronic pancreatitis", The Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13. Ginza, Chuo, Tokyo, 104-0061, Japan
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Martínez J, Abad-González Á, Aparicio JR, Aparisi L, Boadas J, Boix E, de las Heras G, Domínguez-Muñoz E, Farré A, Fernández-Cruz L, Gómez L, Iglesias-García J, García-Malpartida K, Guarner L, Lariño-Noia J, Lluís F, López A, Molero X, Moreno-Pérez Ó, Navarro S, Palazón JM, Pérez-Mateo M, Sabater L, Sastre Y, Vaquero EC, De-Madaria E. Recomendaciones del Club Español Pancreático para el diagnóstico y tratamiento de la pancreatitis crónica: parte 1 (diagnóstico). GASTROENTEROLOGIA Y HEPATOLOGIA 2013; 36:326-39. [DOI: 10.1016/j.gastrohep.2012.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 12/14/2012] [Accepted: 12/27/2012] [Indexed: 12/20/2022]
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Martínez J, Abad-González A, Aparicio JR, Aparisi L, Boadas J, Boix E, de Las Heras G, Domínguez-Muñoz E, Farré A, Fernández-Cruz L, Gómez L, Iglesias-García J, García-Malpartida K, Guarner L, Lariño-Noia J, Lluís F, López A, Molero X, Moreno-Pérez O, Navarro S, Palazón JM, Pérez-Mateo M, Sabater L, Sastre Y, Vaquero E, de-Madaria E. The Spanish Pancreatic Club recommendations for the diagnosis and treatment of chronic pancreatitis: part 1 (diagnosis). Pancreatology 2012; 13:8-17. [PMID: 23395564 DOI: 10.1016/j.pan.2012.11.309] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Revised: 11/13/2012] [Accepted: 11/18/2012] [Indexed: 12/11/2022]
Abstract
Chronic pancreatitis (CP) is a relatively uncommon, complex and heterogeneous disease. The absence of a gold standard applicable to the initial phases of CP makes its early diagnosis difficult. Some of its complications, particularly chronic pain, can be difficult to manage. There is much variability in the diagnosis and treatment of CP and its complications amongst centers and professionals. The Spanish Pancreatic Club has developed a consensus on the management of CP. Two coordinators chose a multidisciplinary panel of 24 experts on this disease. A list of questions was drafted, and two experts reviewed each question. Then, a draft was produced and shared with the entire panel of experts and discussed in a face-to-face meeting. This first part of the consensus addresses the diagnosis of CP and its complications.
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Affiliation(s)
- J Martínez
- Pancreatic Unit, University General Hospital of Alicante, Spain.
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Conwell DL, Wu BU. Chronic pancreatitis: making the diagnosis. Clin Gastroenterol Hepatol 2012; 10:1088-95. [PMID: 22642958 DOI: 10.1016/j.cgh.2012.05.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2010] [Revised: 04/21/2012] [Accepted: 05/20/2012] [Indexed: 02/07/2023]
Affiliation(s)
- Darwin L Conwell
- Center for Pancreatic Disease, Brigham and Women's Hospital, Division of Gastroenterology, Hepatology and Endoscopy, Harvard Medical School, Boston, MA, USA.
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The revised Japanese clinical diagnostic criteria for chronic pancreatitis. J Gastroenterol 2010; 45:584-91. [PMID: 20422433 DOI: 10.1007/s00535-010-0242-4] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 03/17/2010] [Indexed: 02/07/2023]
Abstract
In Japan, we are now using the clinical diagnostic criteria for chronic pancreatitis (CP) that were revised in 2001 to add the findings of magnetic resonance cholangiopancreatography to the criteria compiled by the Japan Pancreas Society (JPS) in 1995. Because the current criteria are set for diagnosing advanced CP, they are unlikely to improve patients' prognoses. In addition, they seem unsuitable for current clinical practice because exocrine pancreatic function tests, which have become obsolete in Japan, are included in the diagnostic factors. For these reasons, the Research Committee on Intractable Pancreatic Diseases supported by the Ministry of Health, Labour and Welfare of Japan, the JPS and the Japanese Society of Gastroenterology have revised the criteria. The revised criteria are unique in that they contain an introduction to the concept of early CP. It is a challenge aimed at improvement of the long-term prognosis of CP patients by early diagnosis and therapeutic intervention in this disease. We need to determine and clarify the clinico-pathological outcome of early CP by a prospective long-term follow-up of the patients in this category.
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Büchler MW, Martignoni ME, Friess H, Malfertheiner P. A proposal for a new clinical classification of chronic pancreatitis. BMC Gastroenterol 2009; 9:93. [PMID: 20003450 PMCID: PMC2804657 DOI: 10.1186/1471-230x-9-93] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Accepted: 12/14/2009] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The clinical course of chronic pancreatitis is still unpredictable, which relates to the lack of the availability of a clinical classification. Therefore, patient populations cannot be compared, the course and the outcome of the disease remain undetermined in the individual patient, and treatment is not standardized. AIM To establish a clinical classification for chronic pancreatitis which is user friendly, transparent, relevant, prognosis- as well as treatment-related and offers a frame for future disease evaluation. METHODS Diagnostic requirements will include one clinical criterion, in combination with well defined imaging or functional abnormalities. RESULTS A classification system consisting of three stages (A, B and C) is presented, which fulfils the above-mentioned criteria. Clinical criteria are: pain, recurrent attacks of pancreatitis, complications of chronic pancreatitis (e.g. bile duct stenosis), steatorrhea, and diabetes mellitus. Imaging criteria consist of ductal or parenchymal changes observed by ultrasonography, ERCP, CT, MRI, and/or endosonography. CONCLUSION A new classification of chronic pancreatitis, based on combination of clinical signs, morphology and function, is presented. It is easy to handle and an instrument to study and to compare the natural course, the prognosis and treatment of patients with chronic pancreatitis.
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Affiliation(s)
- Markus W Büchler
- Department of General Surgery, University of Heidelberg, Germany
| | | | - Helmut Friess
- Department of Surgery, Technical University Munich, Germany
| | - Peter Malfertheiner
- Department of Gastroenterology and Infectious Diseases, Otto von Guericke University, Magdeburg, Germany
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Ramesh H, Jacob G, Venugopal A, Lekha V, Jacob M. Surgical management of chronic pancreatitis with portal hypertension--a 19-year experience. Surgery 2007; 143:252-8. [PMID: 18242342 DOI: 10.1016/j.surg.2007.08.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Revised: 08/23/2007] [Accepted: 08/25/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND The presence of portal hypertension in chronic pancreatitis imposes great challenges on the clinician. The objective of this retrospective analysis is to identify the demographics, presentation, management and outcomes among patients suffering from chronic pancreatitis with associated portal hypertension. PATIENTS The data of fifty-seven patients (36 males, 21 females, age range 23 to 54 years; median 34.5) with chronic pancreatitis and portal hypertension who were operated either for intractable pain or complications over a 19-year period were analyzed. The etiology was alcohol abuse in 28 and idiopathic (tropical) in the remainder. The commonest presentation was abdominal pain in 52 patients (91%). Only 11 patients presented with gastrointestinal bleeding (19%), and they were managed by endoscopic therapy (sclerotherapy, banding, or ethoxysklerol injection). The surgical procedures were: 43 Frey procedures, 11 lateral pancreaticojejunostomies, and 3 Whipple's resections with additional procedures (cyst/biliary drainage or distal pancreatectomy) when appropriate. Direct operations for portal hypertension were required in only 19 patients (splenectomy (n = 15) and gastric devascularization (n = 4)). RESULTS Operating times ranged from 210 to 490 minutes (median 320), yet only 11 patients required blood transfusion. There were 24 complications in 18 patients, and hospital stay ranged between 11 and 62 days (median 18.5). One patient died of liver failure on day 17 after operation. Forty-nine out of 53 patients available for follow-up had excellent or good pain relief. CONCLUSION Surgery provided good relief of pain and complications in patients with chronic pancreatitis and portal hypertension. Isolated surgery for portal hypertension alone was not required in any of the patients.
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Affiliation(s)
- H Ramesh
- Department of Gastrointestinal Surgery, Lakeshore Hospital, Cochin, India
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Schneider A, Löhr JM, Singer MV. The M-ANNHEIM classification of chronic pancreatitis: introduction of a unifying classification system based on a review of previous classifications of the disease. J Gastroenterol 2007; 42:101-19. [PMID: 17351799 DOI: 10.1007/s00535-006-1945-4] [Citation(s) in RCA: 271] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Accepted: 12/14/2006] [Indexed: 02/04/2023]
Abstract
BACKGROUND Several classification systems of chronic pancreatitis have been proposed to provide a basis for treatment and research. All of these previous classifications were designed at the height of pancreatic research of their respective times; thus, each represented the most current knowledge available to pancreatologists at the time. However, none of these classifications provide simultaneously a simple standardized system for the clinical classification of chronic pancreatitis according to etiology, clinical stage, and severity of the disease, nor are they consistently useful for directing clinical practice and comparing interinstitutional data. Thus, we aimed to develop a new classification system of chronic pancreatitis to provide a framework for studying the interaction of various risk factors on the course of the disease. METHODS We reviewed the literature on the clinical course of all different forms of chronic pancreatitis, and we reviewed all previous classification systems of the disease. This approach provided a basis for the development of a new and unifying classification of chronic pancreatitis. RESULTS We established the M-ANNHEIM multiple risk factor classification system based on the current knowledge of acute and chronic pancreatitis. This classification allows patients to be categorized according to the etiology, clinical stage, and severity of their disease. The severity of pancreatic inflammation was assessed using a scoring system that takes into account the clinical symptoms and treatment options of chronic pancreatitis. Finally, four hypothetical patients were categorized according to the M-ANNHEIM classification system to provide examples of its applicability in clinical practice. CONCLUSIONS The M-ANNHEIM multiple risk factor classification system is simple, objective, accurate, and relatively noninvasive, and it incorporates etiology, different stages of the disease, and various degrees of clinical severity. This new classification system will be helpful for investigating the impact and interaction of various risk factors on the course of the disease and will facilitate the comparison and combination of interinstitutional data.
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Affiliation(s)
- Alexander Schneider
- Department of Medicine II, Medical Faculty at Mannheim, University of Heidelberg, Theodor Kutzer Ufer 1-3, D-68135, Mannheim, Germany
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