Abstract
Chronic pancreatitis (CP) is an end-stage disease with no specific therapy; therefore, an early diagnosis is of crucial importance. In this study, data from 1315 and 318 patients were analysed from acute pancreatitis (AP) and CP registries, respectively. The population from the AP registry was divided into AP (n = 983), recurrent AP (RAP, n = 270) and CP (n = 62) groups. The prevalence of CP in combination with AP, RAP2, RAP3, RAP4 and RAP5 + was 0%, 1%, 16%, 50% and 47%, respectively, suggesting that three or more episodes of AP is a strong risk factor for CP. Laboratory, imaging and clinical biomarkers highlighted that patients with RAP3 + do not show a significant difference between RAPs and CP. Data from CP registries showed 98% of patients had at least one AP and the average number of episodes was four. We mimicked the human RAPs in a mouse model and found that three or more episodes of AP cause early chronic-like morphological changes in the pancreas. We concluded that three or more attacks of AP with no morphological changes to the pancreas could be considered as early CP (ECP).The new diagnostic criteria for ECP allow the majority of CP patients to be diagnosed earlier. They can be used in hospitals with no additional costs in healthcare.
Highlights
Chronic pancreatitis (CP) is an end-stage disease with no specific therapy; an early diagnosis is of crucial importance
There is a large amount of data available on acute pancreatitis (AP) and CP; much less is known about recurrent acute pancreatitis (RAP) and early CP (ECP)
It is not surprising that clinicians of the four major pancreatic associations failed to reach an agreement on diagnostic criteria for ECP
Summary
Chronic pancreatitis (CP) is an end-stage disease with no specific therapy; an early diagnosis is of crucial importance. Early CP (ECP).The new diagnostic criteria for ECP allow the majority of CP patients to be diagnosed earlier They can be used in hospitals with no additional costs in healthcare. The diagnostic criteria for CP only allow us to detect the disease at the end stage, at which around 90% of pancreatic parenchyma is already irreversibly d amaged[6] Another issue is that 68% of cases are caused by alcohol, which negatively influences patients’ compliance with any therapy[7]. The Japan Pancreatic Society (JPS) has already provided a definition of early CP (ECP) They recommend that patients who fail to qualify for a definitive or probable diagnosis of CP, continuously drink more than 80 g/day alcohol and show at least two out of seven characteristic findings on endoscopic ultrasonography (EUS) should be diagnosed with ECP. Another model approaching the transition of AP towards CP is the sentinel acute pancreatitis event (SAPE)[13]
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