A Population-Based Evaluation of the Natural History of Chronic Pancreatitis

Date:	2018 Jan
PMID:	29221631
Category:	2
Authors:	Jorge D Machicado 1, Suresh T Chari 2, Lawrence Timmons 2, Gong Tang 3, Dhiraj Yadav 4
Abstract:

Background: Based on reports from tertiary care centers, chronic pancreatitis (CP) is considered to be a painful and debilitating disease frequently requiring invasive interventions. Our primary aim was to assess the natural course of CP in a population-based cohort using endoscopic and surgical interventions as surrogates for disease aggressiveness.

Methods: We identified all patients (n = 89, alcoholic [ACP = 46], non-alcoholic [NACP] = 43) with newly diagnosed definite CP from Olmsted County, Minnesota between 1977 and 2006. Patients were followed until death or censoring. Medical records were reviewed at time of diagnosis and during each follow-up. Both lifetime proportions and cumulative incidence since the initial manifestation of CP were estimated and compared. Survival was estimated with Kaplan-Meier methodology.

Results: Median age at CP diagnosis was 56 years (IQR, 48-67) and 56% were male. During median follow-up of 10 years, 68 (76%) experienced pancreatic pain, but only 27 (30%) needed any invasive therapeutic intervention: 23% had endotherapy and 11% had pancreatic surgery. During the clinical course, when compared with NACP, ACP patients had significantly more (all p < 0.05) pain (87 vs. 65%), recurrent acute pancreatitis (44 vs. 23%), pseudocysts (41 vs. 16%), cumulative incidence of exocrine insufficiency (60 vs. 21%), and annual hospitalizations after CP diagnosis (0.79 vs. 0.25). The cumulative risk of diabetes, calcifications, surgery and overall survival was similar in ACP and NACP.

Conclusions: Our study suggests that CP at a population level may have a milder course than that reported from tertiary centers. We confirm that ACP has a more severe phenotype than NACP.

Copyright © 2017 IAP and EPC. Published by Elsevier B.V. All rights reserved.

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Acknowledgements:

The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute, the National Institute of Health, or the National Institute of Diabetes and Digestive and Kidney Diseases.

The Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer (CPDPC) Research Consortia is supported and funded by grants from the National Cancer Institute and the National Institute of Diabetes and Digestive and Kidney Diseases under the following award numbers:

Project Number:	Awardee Organization
U01DK108326	Baylor College of Medicine
U01DK108314	Cedars-Sinai Medical Center
U01DK108332	Indiana University
U01DK108323	Kaiser Foundation Research Institute
U01DK108288	Mayo Clinic
U01DK108327	Ohio State University
U01DK108300	Stanford University
U01DK108320	University of Florida
U01DK108306	University of Pittsburgh
U01DK108328	University of Texas MD Anderson Cancer Center