THE M-ANNHEIM CLASSIFICATION OF CHRONIC PANCREATITIS - A NEW CLASSIFICATION SYSTEM ACCORDING TO ETIOLOGY, CLINICAL STAGES AND SEVERITY OF THE DISEASE

Abstract

Introduction: Several classification systems of chronic pancreatitis have been proposed to provide a basis for treatment and research. All of these previous classifications were at the height of their respective time and represented the available knowledge in pancreatology at that time. However, none of these classifications provided, at the same time, a simple standardized system for clinical classification of chronic pancreatitis according to etiology, clinical course and severity of the disease, or was consistently useful in directing clinical practice and comparing interinstitutional data. We aimed to develop a new classification system of chronic pancreatitis to provide a framework to study the interaction of various risk factors on the course of the disease. Methods: We reviewed the literature on descriptions of the clinical course of all different forms of chronic pancreatitis, and we reviewed all previous classification systems of the disease. Patients with chronic pancreatitis (n = 25 consecutive patients from clinical practice) were recruited. Results: Based on the current knowledge of acute and chronic pancreatitis, we established the M-ANNHEIM multiple risk factor classification system. The severity of pancreatic inflammation was assessed with a scoring system that includes clinical symptoms and treatment options of chronic pancreatitis. Finally, the new classification system successfully categorized our cohort of patients with chronic pancreatitis according to the disease etiology, the stages and the severity of the disease. Conclusions: The M-ANNHEIM multiple risk factor classification system is simple, objective, accurate and relatively noninvasive and incorporates etiology, different stages of the disease and various degrees of clinical severity. This new classification will be helpful in investigating the impact and interaction of various risk factors on the course of the disease. This system will also facilitate the comparison and combination of interinstitutional data.