Diagnostic Criteria For Chronic Pancreatitis Research Articles

Current Situation and Problems in Diagnosis of Early Chronic Pancreatitis.

The Japan Pancreas Society introduced the concept of early chronic pancreatitis (ECP) in 2009, but its epidemiology remains unclear. This study investigated challenges in ECP diagnosis. Early chronic pancreatitis was diagnosed in 4 cohorts between April 2019 and November 2021 using the Clinical Diagnostic Criteria for Chronic Pancreatitis 2019. These cohorts included patients with abdominal/back pain, abnormal pancreatic enzyme levels, ECP suspected due to other reasons, and those who underwent endoscopic ultrasonography for other diseases. A total of 2502 cases were analyzed and 150 (40 alcoholic and 110 nonalcoholic) cases with ECP findings on endoscopic ultrasonography were included. Early chronic pancreatitis was confirmed in 14 cases (9%), including 9 (22.5%) alcoholic and 5 (4.5%) nonalcoholic cases. Early chronic pancreatitis was confirmed in 15%, 0%, 2.2%, and 0.13% cases in the 4 cohorts, respectively. Early chronic pancreatitis was confirmed in 10 (48%) of the 21 (14%) cases with pancreatic pain. Early chronic pancreatitis diagnostic rate was low, particularly in nonalcoholic cases, but was slightly higher in cases with pancreatic pain. The diagnostic rate was highest in the abdominal/back pain group. Further studies are required to establish appropriate diagnostic criteria for ECP.

Role of standardized reporting and novel imaging markers in chronic pancreatitis.

This article reviews recent efforts about standardized imaging features and reporting of chronic pancreatitis and recently published or ongoing imaging studies, which aim to establish novel imaging biomarkers for detection of parenchymal changes seen in chronic pancreatitis. New novel MRI techniques are being developed to increase the diagnostic yield of chronic pancreatitis specifically in the early stage. T1 relaxation time, T1 signal intensity ratio and extracellular volume fraction offer potential advantages over conventional cross-sectional imaging, including simplicity of analysis and more objective interpretation of observations allowing population-based comparisons. In addition, standardized definitions and reporting guidelines for chronic pancreatitis based on available evidence and expert consensus have been proposed. These new imaging biomarkers and reporting guidelines are being validated for prognostic/therapeutic assessment of adult patients participating in longitudinal studies of The Consortium for the Study of Chronic Pancreatitis, Diabetes and Pancreatic Cancer. New imaging biomarkers derived from novel MRI sequences promise a new chapter for diagnosis and severity assessment of chronic pancreatitis; a cross-sectional imaging-based diagnostic criteria for chronic pancreatitis combining ductal and parenchymal findings. Standardized imaging findings and reporting guidelines of chronic pancreatitis would enhance longitudinal assessment of disease severity in clinical trials and improve communication between radiologists and pancreatologists in clinical practice.

Background and summary of the clinical diagnostic criteria for chronic pancreatitis 2019

Background and summary of the clinical diagnostic criteria for chronic pancreatitis 2019

Evaluation clinical and biochemical characteristics of patients with chronic pancreatitis

Objective: Chronic pancreatitis is a chronic, progressive, irreversible benign inflammatory process, resulting in structural changes with disorders of functional exocrine and endocrine parenchyma by a fibrotic and inflammatory tissue. Based on clinical characteristics and morphology to diagnose chronic pancreatitis. This study was assessing the clinical, biochemical characteristics of chronic pancreatitis patients; and evaluating the relationship between grade chronic pancreatitis and clinical, biochemical characteristics. Subjects and methods: A cross-sectional study was conducted on 51 patients with chronic pancreatitis diagnosed based on Rosemont Criteria in endoscopic ultrasound and Japanese clinical diagnostic criteria for chronic pancreatitis. Results: The prevalence of male was higher than female (70.5%/29.5%) and most common in the age group of 41 - 60 about 55%. The prevalence of patients with a history of alcohol abuse was highest with 31.3%, smoking cigarette more than 20 pack-years about 4.1%. The clinical characteristics of patients with chronic pancreatitis are highest in abdominal pain about 66.6% and lowest in jaundice about 5.8%. About biochemical characteristics, an increase of amylase, lipase were found in 29.5% and 31.5%, respectively. The diabetes mellitus were found in 25.6%. A statistically significative difference of abdominal pain was found between the chronic pancreatitis and early chronic pancreatitis patients (p=0.0003). Mean level of lipase in chronic pancreatitis patient is 33.7 U/L(3.3-195) and early chronic pancreatitis patient is 53.1 U/L (20.5-109), with significiant difference (p=0.04). Conclusions: Alcohol consumption, heavy smoking and diabetes mellitus were the most important risk factors of chronic pancreatitis. Abdominal pain was constant while hyperamylasemia and hyperlipasemia was found only in 29.5% and 31.5% patients. Rate of abdominal pain and mean level of serum lipase were different between chronic pancreatitis and early chronic pancreatitis patients. Key words: chronic pancreatitis, endoscopic ultrasound

Total pancreatectomy for recurrent acute and chronic pancreatitis: a critical review of patient selection criteria.

Critical review of the indications for total pancreatectomy and highlight limitations in current diagnostic criteria for chronic pancreatitis. The diagnosis of noncalcific chronic pancreatitis remains controversial because of an overreliance on nonspecific imaging and laboratories findings. Endoscopic ultrasound, s-magnetic resonance cholangiopancreatography, and/or endoscopic pancreatic function testing are often used to diagnose noncalcific chronic pancreatitis despite the fact that there is no gold standard for this condition. Abdominal pain is not specific for chronic pancreatitis and is more likely to be encountered in patients with functional gastrointestinal disorders based on the high incidence of these conditions. The duration of pain and opioid analgesic use results in central sensitization that adversely affects pain outcomes after total pancreatectomy. An alcoholic cause is associated with poorer pain outcomes after total pancreatectomy. The lack of a gold standard for noncalcific chronic pancreatitis limits the diagnostic accuracy of imaging and laboratory tests. The pain of chronic pancreatitis is nonspecific and is affected by duration, preoperative opioid use, and cause. These factors will need to be considered in the development of future selection criteria for this morbid surgery.

The seventh nationwide epidemiological survey for chronic pancreatitis in Japan: Clinical significance of smoking habit in Japanese patients

ObjectivesA nationwide survey was conducted to clarify the epidemiological features of patients with chronic pancreatitis (CP) in Japan. MethodsIn the first survey, both the prevalence and the incidence of CP in 2011 were estimated. In the second survey, the clinicoepidemiological features of the patients were clarified by mailed questionnaires. Patients were diagnosed by the Japanese diagnostic criteria for chronic pancreatitis 2009. ResultsThe estimated annual prevalence and incidence of CP in 2011 were 52.4/100,000 and 14.0/100,000, respectively. The sex ratio (male/female) of patients was 4.6, with a mean age of 62.3 years. Alcoholic (67.5%) was the most common and idiopathic (20.0%) was the second most common cause of CP. Comorbidity with diabetes mellitus (DM) and pancreatic calcifications (PC) occurred more frequent in ever smokers independently of their drinking status. Among patients without drinking habit, the incidences of DM and PC were significantly higher in ever smokers than in never smokers. The multiple logistic regression analysis revealed smoking was an independent factor of DM and PC in CP patients: DM, Odds ratio (OR) 1.644, 95% confidence interval (CI) 1.202 to 2.247 (P = 0.002): PC, OR 2.010, 95% CI 1.458 to 2.773 (P < 0.001). On the other hand, smoking was not identified as an independent factor for the appearance of abdominal pain by this analysis. ConclusionThe prevalence of Japanese patients with CP has been increasing. Smoking was identified as an independent factor related to DM and PC in Japanese CP patients.

PMO-106 The role of endoscopic ultrasound in identifying chronic pancreatitis: a comparison pathological specimens

IntroductionImaging diagnostic criteria for chronic pancreatitis (CP) have long been debated. Patients with CP frequently undergo Endoscopic Ultrasound (EUS) as part of their diagnostic pathway, but it is unclear if...

The Usefulness of the Revised Diagnostic Criteria for Chronic Pancreatitis in Japan Compared With the Present Criteria

The usefulness of the revised diagnostic criteria for chronic pancreatitis (CP) in Japan was compared with the present criteria by examining 125 patients with CP and suspected CP. Out of 78 definite CP diagnosed by the present criteria, 71 (91.0 %) was similarly diagnosed as definite CP by the revised criteria, whereas 7 (9.0 %) shifted to probable CP. On the other hand, out of 27 probable CP by the present criteria, 4 (14.8 %) shifted to definite CP and 19 (70.4 %) to early-stage CP. Furthermore, 9 of 11 suspected CP by the present criteria were diagnosed as early-stage CP (70.4 %). It is suggested that the validity of the revised criteria was confirmed. Moreover, it was useful also for picking up early-stage CP.

Japanese Clinical Diagnostic Criteria for Chronic Pancreatitis 2009

In Japan, we have used the diagnostic criteria for chronic pancreatitis (CP), which were revised by the Japan Pancreas Society in 2001, with adding the MRI findings to the 1995 clinical diagnostic criteria for CP. The former diagnostic criteria were for advanced CP making them unlikely to help improve the prognosis of CP patients. In addition, they became unsuitable for the current clinical practice because of the involvement of diagnostic items which had not yet been available in our country such as tests for exocrine pancreatic function. After cooperative efforts by The Research Committee for the Intractable Pancreatic Diseases supported by the Japan Ministry of Health, Labor and Welfare, the Japan Pancreas Society and the Japanese Society of Gastroenterology to revise the former criteria, new diagnostic criteria for CP were finalized here and published in the "Suizo". The most prominent feature of the new criteria is the incorporation of the concept of early chronic pancreatitis. It will be a clinical challenge to improve the prognosis CP patients by early interventional treatments based on early diagnosis. The natural history of early CP will be revealed through the prospective following of patients diagnosed by the new diagnostic criteria.

Histological Examination

A definite histological finding is as follows: the pancreatic parenchyma shows destruction and there is fibrosis in the interlobular area with a nodular/cirrhosis-like pattern. A probable histological finding is destruction of the pancreatic parenchyma with fibrosis in the interlobular or inter-and intralobular areas. However, interlobular fibrosis alone was not adopted for the definite criteria, but belongs to the probable criteria, because a nodular or cirrhosis-like pattern is necessary. Although inter-and intralobular fibrosis is a characteristic of obstructive pancreatitis, it is only a probable histological finding in cases with patchy distribution. We should not make a diagnosis of "chronic pancreatitis" only because there is no carcinoma in the resected specimen. Hence, the clinical diagnostic criteria for chronic pancreatitis 2009 were composed more briefly and definitely than the former criteria.

Definition and Classification of Chronic Pancreatitis

Chronic pancreatitis is defined as a continuing inflammatory disease of the pancreas characterized by irreversible morphologic changes that typically cause pain and/or permanent loss of function in the revised diagnostic criteria for chronic pancreatitis. As autoimmune pancreatitis improves morphologically and functionally with steroid therapy, and obstructive pancreatitis recovers when the obstruction is removed, the revised criteria excluded the two diseases from the definition of chronic pancreatitis and treated them as chronic inflammation of the pancreas. The revised criteria divided chronic pancreatitis etiologically into alcoholic and nonalcoholic chronic pancreatitis. According to the specificity of the diagnostic findings, chronic pancreatitis was diagnosed as definite or probable chronic pancreatitis. To diagnose chronic pancreatitis earlier, the concept of early chronic pancreatitis was defined in the revised criteria. Further prospective study is necessary to verify the revised criteria.

The revised Japanese clinical diagnostic criteria for chronic pancreatitis

In Japan, we are now using the clinical diagnostic criteria for chronic pancreatitis (CP) that were revised in 2001 to add the findings of magnetic resonance cholangiopancreatography to the criteria compiled by the Japan Pancreas Society (JPS) in 1995. Because the current criteria are set for diagnosing advanced CP, they are unlikely to improve patients' prognoses. In addition, they seem unsuitable for current clinical practice because exocrine pancreatic function tests, which have become obsolete in Japan, are included in the diagnostic factors. For these reasons, the Research Committee on Intractable Pancreatic Diseases supported by the Ministry of Health, Labour and Welfare of Japan, the JPS and the Japanese Society of Gastroenterology have revised the criteria. The revised criteria are unique in that they contain an introduction to the concept of early CP. It is a challenge aimed at improvement of the long-term prognosis of CP patients by early diagnosis and therapeutic intervention in this disease. We need to determine and clarify the clinico-pathological outcome of early CP by a prospective long-term follow-up of the patients in this category.

Long-Term Prognosis of Acute Pancreatitis in Japan

This study was undertaken to evaluate the long-term prognosis of acute pancreatitis (AP) in Japan and to identify factors that predict major complications. In 1987, 2533 patients with moderate or severe acute pancreatitis were registered in a national survey in Japan. Follow-up studies were done in 2000 and in 2004 to evaluate recurrence of acute pancreatitis, transition to chronic pancreatitis, development of diabetes mellitus, and mortality. The relationship between incidence of complications and alcohol consumption during follow-up period was also analyzed. Valid replies were obtained from 714 cases in 2000 and 450 cases in 2004. Recurrence of acute pancreatitis occurred in 145 cases, and the recurrence rate was significantly higher in alcoholic pancreatitis compared with other etiologies. A transition to chronic pancreatitis occurred frequently in alcoholic pancreatitis and inversely correlated with existence of pancreatic necrosis in the initial disease. Complication with diabetes mellitus and the transition to chronic pancreatitis strongly correlated with persistent alcohol intake during follow-up period. During the follow-up period, 199 patients died, and 43 died of malignant disease. Recurrence of acute pancreatitis and a transition to chronic pancreatitis frequently occurred in alcoholic pancreatitis. Transition to chronic pancreatitis was inversely correlated with the existence of pancreatic necrosis at the initial presentation. Mortality as a result of malignant disease was not excessive in the patients with history of acute pancreatitis.

改訂基準に対する意見と今後の展開

改訂基準に対する意見と今後の展開

慢性膵炎臨床診断基準2009

慢性膵炎臨床診断基準2009

診断基準の概要と経緯

わが国でこれまで使用されてきた慢性膵炎の臨床診断基準は，1995年に日本膵臓学会が作成した診断基準にMRCP所見を加えて改訂した2001年のものであった．旧診断基準は，進行した慢性膵炎の診断基準であり，患者予後の改善につながりにくく，すでに施行不能な外分泌検査法が診断項目に含まれるなど現状にそぐわなくなっていた．厚生労働省難治性膵疾患に関する調査研究班，日本膵臓学会，日本消化器病学会は，慢性膵炎臨床診断基準の改訂を行い，「膵臓」の本号に公表することになった．新基準「慢性膵炎臨床診断基準2009」の最大の特徴は，早期慢性膵炎の概念を取り入れたことである．早期診断，早期治療による患者予後の改善を目指した試みであるが，早期慢性膵炎の自然史については今後，この群の追跡調査によって明らかとなる．

現行基準と改訂基準の比較―2．現行基準との比較-その2―

現行基準と改訂基準の比較―2．現行基準との比較-その2―

Chronic pancreatitis in Japan: epidemiology, prognosis, diagnostic criteria, and future problems

Chronic pancreatitis is a chronic clinical disorder characterized by irreversible damage to the pancreas and the development of histologic evidence of inflammation and fibrosis, and eventually the destruction and permanent loss of exocrine and endocrine tissue. A nationwide survey in Japan revealed an increase in the total number of patients treated for chronic pancreatitis from 32 000 in 1994 to 42 000 in 1999. The overall prevalence and the incidence rate of chronic pancreatitis also increased, from 28.5 and 5.4, respectively, in 1994 to 32.91 and 5.77 per 100 000 population, respectively, in 1999. Diagnostic criteria for chronic pancreatitis in Japan were proposed by the Japan Pancreas Society in 1995 and revised in 2001. The criteria were established to rule out false-positive cases and to confidently diagnose definite and probable cases of chronic pancreatitis, and thus easily detect advanced chronic pancreatitis, but the criteria are unable to lead to the early diagnosis of chronic pancreatitis. Cancer is the major cause of death in patients with chronic pancreatitis in Japan (49.6% of all deaths in patients with chronic pancreatitis). Clarification of the mechanisms by which possible chronic pancreatitis progresses to probable or definite chronic pancreatitis, and to pancreatic cancer, is an important research goal. Because even chronic pancreatitis defined as irreversible appears to be reversible for some time in its clinical course, there is an urgent need to develop methods for diagnosing reversible chronic pancreatitis, and to prevent the transition from chronic pancreatitis to pancreatic cancer.

Assessment of Exocrine Pancreatic Dysfunction in Chronic Pancreatitis

The clinical diagnosis of chronic pancreatitis is usually based on imaging studies, pancreatic function tests, and the presence of characteristic clinical features. In Japan, diagnostic criteria for chronic pancreatitis were established in 1995. The secretin test (a duodenal intubation test) and the combination of noninvasive tests, N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BT-PABA) and fecal chymotrypsin (FCT), have been recommended for evaluating exocrine pancreatic function in patients with chronic pancreatitis. In the present study, the diagnostic value of these two noninvasive tests was compared to the secretin test. Although noninvasive tests are less sensitive and specific for determining exocrine pancreatic dysfunction than the secretin test, greater reliability for diagnosing chronic pancreatitis can be obtained by performing the BT-PABA and FCT simultaneously. Assessment of exocrine pancreatic function is important not only to diagnose chronic pancreatitis but also to decide a treatment method with pancreatic enzyme preparation.

Criteria for pancreatic disease diagnosis in Japan: diagnostic criteria for chronic pancreatitis.

Chronic pancreatitis was not a clinical entity until around 1960 in Japanese gastroenterology. The diagnosis of chronic pancreatitis had been vague and difficult to ascertain. The diagnostic criteria for chronic pancreatitis were first proposed in 1971, and they were subsequently revised in 1983. Patient numbers of chronic pancreatitis were summed by national surveys under each of the common diagnostic criteria. Total patient number and incidence rate of chronic pancreatitis are recognized as increasing throughout Japan, based on results of two national surveys of chronic pancreatitis. The diagnostic criteria for chronic pancreatitis in Japan were again revised in 1995, because the 1983 criteria were too complicated, and there had been more recent progress in clinical investigations of the pancreas. The essential revised points of the Diagnostic Criteria, 1995, are introduced in this review along with some discussion.