Etiology, diagnosis and treatment of chronic pancreatitis: an analysis of 294 cases

Etiology, pathology, management and prognosis of chronic pancreatitis in Chinese population: A retrospective study

The purpose of this study was to investigate the etiology, pathological characteristics, management and prognosis of chronic pancreatitis in the Chinese population. The clinical data of 142 patients with chronic pancreatitis were retrospectively studied. All patients were of Chinese nationality and hospitalized from January 2008 to December 2011. Their ages ranged from 14 to 76 years, with a mean of 43 years. Of 142 patients, there were 72 cases of obstructive chronic pancreatitis (50.70%), 19 cases of alcoholic chronic pancreatitis (13.38%), 14 cases of autoimmune pancreatitis (9.86%) and 37 cases of undetermined etiology (26.06%). Pathologically, the average inflammatory mass diameter was 3.8 ± 3.3 cm, biliary obstruction occurred in 36 cases, gall stones in 70 cases, calcification in 88 cases, ductal dilatation in 61 cases, side branch dilatation in 32 cases, ductal irregularity in 10 cases, lymphocytic inflammation in 23 cases, obliterative phlebitis in 14 cases, extra pancreatic lesion in 19 cases and fibrosis in 142 cases. Location of pancreatic lesion in the region of head (n=97), neck (n=16), body (n=12), tail (n=15) and whole pancreas (n=2) influenced the choice of surgical procedures. Ninety-four patients (66.20%) received surgical treatment and 33.80% received other treatments. After operation, 80.85% of 94 patients experienced decreased pain, and 8.51% of 94 showed recovery of endocrine function but with a complication rate of 12.77%. All the operations were performed successfully. According to the pain scale of European Organization for Research and Treatment of Cancer (QLQ-C30) a decrease from 76 ± 22 to 14 ± 18 was observed. Etiology, pathological characteristics, management and prognosis of chronic pancreatitis in the Chinese population vary from others.

Clinical characteristics of 213 patients with chronic pancreatitis

AIM: To conclude the clinical characteristics of 213 chronic pancreatitis (CP) patients during the past 9 years.

METHODS: The data of pathogenesis, clinical manifestations, diagnosis and missed diagnosis were retrospectively analyzed in 213 CP patients admitted in the past 9 years.

RESULTS: CP patients covered a percentage of 4.38% in department of digestive diseases, and the ratio of male to female was 1∶0.84. The rate of increment every 3 years in the past 9 years was 38.6%. Of 213 cases, the rates were 36.2%, 42.7%, and 13.6% for biliary pancreatitis, alcoholic pancreatitis, and high levels of blood lipid, respectively, and the pathogenesis for 7.5% of 213 was not clear. 9.9% of 213 patients suffered a continual abdominal pain, 44% with abdominal pain after taking food, and 53.5% had the preceding two symptoms. Besides, chronic diarrhea or steatorrhea appeared in 57% patients, abdominal distension or diarrhea in 81% patients after intake of high-fat diet (including alcohol), malabsorption in 41% patients, and diabetes in 7.0% patients. Of all the patients, 72.3% were diagnosed with clinical manifestations, fatty stool or pancreatitic exocrine function test, computed tomography, and endoscopic ultrasonography, and 27.7% were diagnosed with endoscopic ultrasound guided fine needle aspiration biopsy. Of 213 patients, 33.8% were misdiagnosed with chronic gastritis or atrophic gastritis, 30.5% with chronic diarrhea, enteritis or chronic colitis, 11.3% with biliary stones or postcholecystestomy syndrome, and 3.8% with pancreatic neoplasm or cancer.

CONCLUSION: The incidence rate of CP is rising, and its manifestation of abdominal pain is not significant, but of variety. Early diagnosis is important.