Classification of Early-Onset and Late-Onset Idiopathic Chronic Pancreatitis Needs Reconsideration

Yu Liu,Hui Chen,Hong-Lei Guo,Lei Xin,Teng Wang,Dan Wang,Xiang-Peng Zeng,Zhuan Liao,Di Zhang,Zhi-Jie Cong,Ting Xie,Juan Li,Tao Zhang,Yang Bi ,Zhao‐Shen Li ,Huaiyu Yang ,Hualiang Chen ,Jiayi Ma ,Lingling Zhang ,Yili Cai ,Hao Liang ,Cui Chen,Liang–Hao Hu

doi:10.1038/s41598-020-67306-w

Abstract

Bimodal classification of idiopathic chronic pancreatitis (ICP) into early-onset (<35 years) and late-onset (>35 years) ICP was proposed in 1994 based on a study of 66 patients. However, bimodal distribution wasn’t sufficiently demonstrated. Our objective was to examine the validity and relevance of the age-based bimodal classification of ICP. We analyzed the distribution of age at onset of ICP in our cohort of 1633 patients admitted to our center from January 2000 to December 2013. Classify ICP patients into early-onset ICP(a) and late-onset ICP(a) according to different cut-off values (cut-off value, a = 15, 25, 35, 45, 55, 65 years old) for age at onset. Compare clinical characteristics of early-onset ICP(a) and late-onset ICP(a). We found slightly right skewed distribution of age at onset for ICP in our cohort. There were differences between early-onset and late-onset ICP with respect to basic clinical characteristics and development of key clinical events regardless of the cut off age at onset i.e. 15, 25, 35, 45 or even higher. The validity of the bimodal classification of early-onset and late-onset ICP could not be established in our large patient cohort and therefore such a classification needs to be reconsidered.

Highlights

Idiopathic chronic pancreatitis (ICP) has traditionally been defined as chronic pancreatitis (CP) in the absence of any obvious precipitating factors and family history of the disease
early-onset ICP (EOICP) and late-onset ICP (LOICP) were identified as two different entities due to the two distinct age groups of idiopathic chronic pancreatitis (ICP) patients
The development of key clinical events were more common in LOICPa patients than EOICPa patients except pancreatic stones

Summary

Introduction

Idiopathic chronic pancreatitis (ICP) has traditionally been defined as chronic pancreatitis (CP) in the absence of any obvious precipitating factors (e.g. alcohol abuse) and family history of the disease. They defined patients with age at onset of ICP < 35 years as early-onset ICP (EOICP) and those with age at onset of ICP > 35 years as late-onset ICP (LOICP)[1]. Throughout these years, the classification was applied widely as a standard classification[2]. Bimodal phenomenon was proposed based on a small sample study with only 66 ICP patients. This distribution wasn’t statistically tested[1]. Items Layer P#1 Pfützer RH7 Imoto M8 Bhatia E6 Threadgold J9 Chandak GR10 Chang MC11 Bhasin DK4 Chang YT5 Chang YT5 Gasiorowska A12 Midha S13 Sun C14 Sun C14

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