Chronic Pancreatitis in Thai Patients: A Comprehensive Review of 236 Patients from One Institution

Abstract

Background: Reports of chronic pancreatitis (CP) in Thailand are rare. Clinical information is lacking. Objective: To study the etiology, genetics, presentations, clinical courses, complications, treatments, and outcomes of CP in Siriraj Hospital. Materials and Methods: Retrospective study of all CP patients during 2005 to 2018 was done. CP was diagnosed by abdominal radiography, ultrasonography, computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasonography (EUS). Etiology, genetics, presentations, clinical courses, complications, treatments and outcomes were analyzed. Results: There were 236 CP patients. The median follow-up was 37 months. There were 160 patients (68%) with alcoholic CP (ACP), 35 (15%) with early-onset idiopathic CP (E-ICP), 36 (15%) with late-onset idiopathic CP (L-ICP), 1 (0.4%) with tropical CP, 3 (1%) with hereditary pancreatitis (HP) and 1 (0.4%) with obstructive CP. Mean ages of onset were 47, 28 and 60 years in ACP, E-ICP and L-ICP, respectively (p<0.001). Male was predominant in all types of CP (98%, 40% and 56%; p<0.001). Initial presentations were abdominal pain (59%), recurrent acute pancreatitis (RAP, 22%), diabetes (DM, 8%) and steatorrhea (8%). Clinical manifestations during the course were abdominal pain in 89%, 89% and 83% (p = 0.832), RAP in 41%, 48% and 11% (p = 0.001), steatorrhea in 31%, 25% and 25% (p = 0.661), weight loss in 38%, 31% and 44% (p = 0.526), DM in 29%, 37% and 25% (p = 0.502), respectively. Median time to pain relief were 33, 74, and 16 months (p = 0.002). Common complications were pseudocyst (16%) and biliary obstruction (15%). SPINK1 mutation was detected in 83% of E-ICP, 45% of L-ICP and 21% of ACP (p<0.001). PRSS1 mutation was found in all HP. Medical therapy included analgesics (62%), pancreatic enzymes (76%) and antioxidants (9%). Endoscopic therapy was done in 48 patients (20%). Surgery was performed in 31 patients (13%). Conclusion: ACP, E-ICP and L-ICP are common etiologies of CP. Presentations were RAP, abdominal pain, DM and steatorrhea. Painless L-ICP was uncommon. Spontaneous pain relief occurred quickly. SPINK1 mutation was common in ICP. Endoscopic and surgical therapy were required in one-fifth. Keywords: Chronic pancreatitis, Etiology, Genetics, Management, Manifestation, Natural course, Review