Clinical Review

ABC of diseases of liver, pancreas, and biliary system: Chronic pancreatitis

BMJ 2001; 322 doi: http://dx.doi.org/10.1136/bmj.322.7287.660 (Published 17 March 2001) Cite this as: BMJ 2001;322:660
  1. P C Bornman,
  2. I J Beckingham

    Chronic pancreatitis has an annual incidence of about one person per 100 000 in the United Kingdom and a prevalence of 3/100 000. In temperate areas alcohol misuse accounts for most cases, and it mainly affects men aged 40-50 years. There is no uniform threshold for alcohol toxicity, but the quantity and duration of alcohol consumption correlates with the development of chronic pancreatitis. Little evidence exists, however, that either the type of alcohol or pattern of consumption is important. Interestingly, despite the common aetiology, concomitant cirrhosis and chronic pancreatitis is rare.

    Aetiology of chronic pancreatitis

    • Alcohol (80-90%)

    • Nutritional (tropical Africa and Asia)

    • Pancreatic duct obstruction (obstructive pancreatitis)

    Acute pancreatitis

    Pancreas divisum

    • Cystic fibrosis

    • Hereditary

    • Idiopathic

    In a few tropical areas, most notably Kerala in southern India, malnutrition and ingestion of large quantities of cassava root are implicated in the aetiology. The disease affects men and women equally, with an incidence of up to 50/1000 population.

    Endoscopic retrograde cholangiopancreatogram showing dilated common bile duct (thick arrow) and main pancreatic ducts (thin arrow) in patient with advanced chronic pancreatitis

    Natural course

    Alcohol induced chronic pancreatitis usually follows a predictable course. In most cases the patient has been drinking heavily (150-200 mg alcohol/day) for over 10 years before symptoms develop. The first acute attack usually follows an episode of binge drinking, and with time these attacks may become more frequent until the pain becomes more persistent and severe. Pancreatic calcification occurs about 8-10 years after the first clinical presentation. Endocrine and exocrine dysfunction may also develop during this time, resulting in diabetes and steatorrhoea. There is an appreciable morbidity and mortality due to continued alcoholism and other diseases that are associated with poor living standards (carcinoma of the bronchus, tuberculosis, and suicide), and patients have an increased risk of developing pancreatic carcinoma. Overall, the life expectancy of patients with …

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