45 Years of experience in the surgical treatment of pancreatic insulinoma

Abstract

Background: Chronic pancreatitis (CP) has a heterogeneous aetiology. In the Western world, the predominant cause is alcoholism, while in India tropical chronic pancreatitis (TCP) is thought to be common. TCP has been defined as a form of idiopathic chronic pancreatitis (ICP), with unique epidemiological and clinical features. However, the clinical profile of ICP in India is changing. The aim of our study was to investigate the phenotype of ICP in India compared to the phenotype of ICP in the Western World. Methods: We included CP patients from 3 registries from India, Germany and the Netherlands. We compared data regarding age, age of onset, cause of CP and the presence of CP complications between the 3 cohorts. Results: We included 1919 CP patients; (India n1⁄41033; Germany n1⁄4528; Netherlands n1⁄4358). The majority (68%) of patients were male. Relative to the Western cohorts Indian CP patients were younger, had a younger age of onset and smoked less frequently. The majority of Indian subjects were diagnosed with ICP (65%) (Netherlands 40%, Germany 23%). Endocrine insufficiency and pancreatic calcifications were more frequently seen in Indian ICP patients. Pain was present in the large majority (> 85%) of all CP patients. Conclusions: The phenotype of Indian ICP patients used to be dominated by TCP, but our analysis demonstrates that most of Indian patients now have a form of CP that can be labeled as ICP. Indian patients have younger onset of CP with more endocrine insufficiency and pancreatic calcifications, and there is a shift towards the phenotype of ICP in the Western world.