Regional Variations in Distribution, Diagnosis and Treatment of Chronic Pancreatitis in Mainland China: A Systematic Review of Case Articles Over 40 Years

Abstract

Background: Epidemiological data regarding the regional differences in chronic pancreatitis (CP) from the mainland of China is lacking. We aimed to gather and combine the information concerning the regional distribution, diagnosis and treatment of CP, in addition to the risk factors associated with pancreatic cancer (PaCa) and death from published articles. Methods: Case articles on CP published in three English and four Chinese databases from January 1979 to December 2018 were analysed. Findings: A total of 4,452 cases articles (containing 161,243 CP cases) were included. Almost all relevant departments of 1,557 hospitals participated in the writing of CP articles and approximately 67.2% of hospitals wrote only one article. The etiologies, symptoms, treatments, and number of cases with PaCa varied from region to region. Surgical treatment was more common in underdeveloped areas. Endoscopic therapy was mainly concentrated in developed areas and was also associated with non-alcoholic CP. PaCa detected during hospitalization was mainly related to jaundice (r = 0.35, P = 0.000), pain (r = 0.31, P = 0.000), diabetes (r = 0.20, P = 0.000), biliary diseases (r = 0.36, P = 0.000), alcoholic CP (r = 0.30, P = 0.000), conservative treatment (r = 0.37, P = 0.000) and surgical treatment (r = 0.21, P = 0.000). PaCa detected during follow-up was primarily associated with idiopathic CP (r = 0.26, P = 0.000), alcoholic CP (r = 0.23, P = 0.000), endoscopy therapy (r = 0.3, P = 0.000) and surgical treatment (r = 0.24, P = 0.000). Death during hospitalization was only related to surgery. Interpretation: Many regions have gradually formed their own unique characteristics in terms of the diagnosis and treatment of CP. However, the level of diagnosis and treatment of CP in many areas still needs to be improved. The problem of uneven distribution of medical resources needs to be resolved. Funding Statement: None. Declaration of Interests: The authors declare that there are no competing interests associated with the manuscript.