- Diagnosis relies on a combination of clinical findings, imaging tests, and pancreatic function testing.
- Pancreatic calcifications, dilated pancreatic ducts, diabetes mellitus, and maldigestion characterize advanced disease.
- Early-stage diagnosis remains a clinical challenge, especially in patients with chronic or episodic abdominal pain and no imaging abnormalities.
Although several risk factors for the development of chronic pancreatitis have been identified, the cause of pancreatitis in some instances remains uncertain. Among established risk factors, alcohol ingestion is associated with up to 60–70% of cases of chronic pancreatitis. In addition, ductal obstruction, autoimmune disease, tropical disease, and an association with further systemic illnesses such as scleroderma and hypertriglyceridemia have been described. Recently new insights have been gained into the genetic and molecular basis associated with hereditary forms of chronic pancreatitis. Recent epidemiologic studies clearly demonstrate that smoking is emerging as an independent risk factor for chronic pancreatitis development. The most widely accepted system of etiologic classification for chronic pancreatitis is the TIGAR-O system, which categorizes risk factors according to mechanism and prevalence (Table 26–1). A more recent M-ANNHEIM multiple risk factor classification system incorporates etiology, different stages of the disease, and various degrees of clinical severity. This system will be helpful for research studies 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.
Table 26–1. TIGAR-O Classification of Chronic Pancreatitis. ||Download (.pdf)
Table 26–1. TIGAR-O Classification of Chronic Pancreatitis.
Hyperlipidemia (rare and controversial)
Chronic renal failure
Cause unknown, likely genetic origin
Autosomal recessive/modifier genes
α1-Antitrypsin deficiency (possible)
Isolated autoimmune chronic pancreatitis
- Primary sclerosing cholangitis
- Sjögren syndrome
- Primary biliary cirrhosis
- Type 1 diabetes mellitus
Recurrent and Severe Acute Pancreatitis
Postnecrotic (severe acute pancreatitis)
Pancreas divisum (controversial)
Sphincter of Oddi dysfunction (controversial)
Duct obstruction (tumors, post-traumatic)
Cote GA, Yadav D, Slivka A, et al. Clin Gastroenterol Hepatol. 2010; [Epub ahead of print].
Etemad B, Whitcomb DC. Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology.
Schneider A, Lohr 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.
Yadav D, Hawes RH, Brand RE, et al. Alcohol consumption, cigarette smoking, and the risk of recurrent acute and chronic pancreatitis. Arch Intern Med.
Yadav D, Whitcomb DC. The role of alcohol and smoking in pancreatitis. Nat Rev Gastroenterol Hepatol.
Morphologic changes associated with chronic pancreatitis include ductal, parenchymal, and nerve changes. Pancreatic ducts may become dilated, irregular, or strictured. Meanwhile, the glandular tissue ...