Abstract
BackgroundThe 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.AimTo 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.MethodsDiagnostic requirements will include one clinical criterion, in combination with well defined imaging or functional abnormalities.ResultsA 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.ConclusionA 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.
Highlights
Chronic pancreatitis is a heterogeneous disorder with a clinical spectrum that encompasses pain, loss of exocrine pancreatic function, diabetes mellitus and various complications usually involving organs adjacent to the pancreas[1,2])
In suggesting a new classification of CP, we propose a definition of chronic pancreatitis and disease staging based on key clinical features in association with various findings obtained in current imaging techniques
As a hypothesis we suggest that chronic pancreatitis begins with episodes of acute inflammation with or without clinical appearance, analagous to the acute, often clinically in apparent evolution of hepatitis from an acute into a chronic disease state
Summary
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
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