Guidelines for the Diagnostic Cross Sectional Imaging and Severity Scoring of Chronic Pancreatitis

Frøkjær, Jens Brøndum; Akisik, Fatih; Farooq, Ahmed; Akpinar, Burcu; Dasyam, Anil K.; Drewes, Asbjørn Mohr; Haldorsen, Ingfrid Salvesen; Morana, Giovanni; Neoptolemos, John P.; Olesen, Søren Schou; Petrone, Maria Chiara; Sheel, Andrea; Shimosoegawa, Tooru; Whitcomb, David C.

doi:10.1016/j.pan.2018.08.012

Cited by 84 publications

(63 citation statements)

References 78 publications

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“…Second, no distinction between calcifications located in the main pancreatic duct (and thus amendable to endoscopic treatment) and peripheral located (side-branch) calcifications were made. However, the exact localization of calcifications is often difficult to ascertain in a clinical scenario without additional second line imaging modalities such as MRCP or EUS, which was not available for this large cohort of patients 7 . Finally, our findings are restricted to an adult Western population dominated by alcohol and smoking related CP and thus need further elaboration in pediatric populations and in populations with different etiological risk factor profiles 42 .…”

Section: Study Limitationsmentioning

confidence: 99%

“…Review of imaging studies (CT, MRCP, transabdominal and endoscopic US) was performed as part of routine clinical practice at the individual sites by radiologists, clinical pancreatologists or endoscopic ultrasonographers, and information on pancreatic calcifications was registered in the database. No distinction was made between ductal and peripheral located (side-branch) calcifications as this is often difficult to ascertain in a clinical scenario without additional second line imaging modalities such as MRCP or EUS 7 . Hence, the majority of patients only had one imaging modality registered at the time of study inclusion (typically a CT) and, as such, complementary imaging data sets were not available for most patients.…”

Section: Patient Assessment Parametersmentioning

confidence: 99%

“…The presence of pancreatic calcifications is a common finding in patients with chronic pancreatitis (CP) and has been included in most past and current systems for disease classification [1][2][3][4][5][6] . The finding of pancreatic calcifications on cross-sectional imaging thus provides a useful radiological biomarker that in a relevant clinical context can be used to establish a diagnosis of CP 7 . Notwithstanding the clinical usefulness of pancreatic calcifications in the context of CP diagnosis, the underlying pathophysiological process is still uncertain and it remains unclear why some patients develop calcifications while others do not [8][9][10][11] .…”

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Pancreatic calcifications associate with diverse aetiological risk factors in patients with chronic pancreatitis: A multicentre study of 1500 cases

et al. 2019

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Objective: Pancreatic calcifications is a common finding in patients with chronic pancreatitis (CP), but the underlying pathophysiology is incompletely understood. Past studies for risk factors of calcifications have generally been focused on single parameters or limited by small sample sizes. The aim of this study was to explore several patient and disease characteristics and their associations with pancreatic calcifications in a large cohort of CP patients with diverse etiological risk factors. Methods: This was a multicenter, cross-sectional study including 1509 patients with CP from the Scandinavian and Baltic countries. Patient and disease characteristics were compared for patients with calcifications (n=912) vs. without calcifications (n=597). Multivariable logistic regression was performed to assess the parameters independently associated with calcifications. Results: The mean age of patients was 53.9±14.5 years and 1006 (67%) were men. The prevalence of calcifications was 60.4% in the overall patient cohort, but highly variable between patients with different etiological risk factors (range: 2-69%). On multivariate analysis, alcoholic etiology (OR 1.76 [95% CI, 1.39-2.24]; p<0.001) and smoking (OR 1.77 [95% CI, 1.39-2.26], p<0.001) were positively associated with the presence of calcifications, while an autoimmune etiology was negatively associated with calcifications (OR 0.15 [95% CI, 0.08-0.27], p<0.001). Patients with pancreatic calcifications were more likely to have undergone pancreatic duct stenting (OR 1.59 [95%CI, 1.16-2.19], p=0.004). Conclusion: The presence of pancreatic calcifications is associated with etiological risk factors in patients with CP. This observation attest to the understanding of CP as a complex disease and may have implications for disease classification.

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Section: Study Limitationsmentioning

confidence: 99%

Section: Patient Assessment Parametersmentioning

confidence: 99%

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Pancreatic calcifications associate with diverse aetiological risk factors in patients with chronic pancreatitis: A multicentre study of 1500 cases

et al. 2019

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“…In patients with CP, MRCP is often performed as second-level imaging technique to investigate the pancreatic ductal system 82. MRCP not only is superior to CT scan to diagnose subtle ductal changes but also allows a semiquantitative assessment of pancreatic exocrine function when coupled with secreting injection (S-MRCP).…”

Section: Introductionmentioning

confidence: 99%

<p>Exocrine pancreatic insufficiency: prevalence, diagnosis, and management</p>

Capurso¹,

Traini²,

Piciucchi³

et al. 2019

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Exocrine pancreatic insufficiency (EPI) is a condition caused by reduced or inappropriate secretion or activity of pancreatic juice and its digestive enzymes, pancreatic lipase in particular. EPI can result in clinical manifestation and biochemical alterations causing reduced quality of life and life-threating complications. EPI is common in pancreatic disorders, where it should be suspected and actively investigated, and in many extrapancreatic conditions. There are various tests available to diagnose EPI, with indirect, noninvasive ones, such as concentration of fecal elastase being more commonly employed. Administration of pancreatic enzymes replacement therapy remains the mainstay of EPI treatment. The present review article will discuss current evidence regarding the prevalence of EPI, the available tests to diagnose it and its treatment.

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“…Also, older epidemiological studies are likely to provide outdated incidence and prevalence estimates due to changes in patterns of smoking and alcohol consumption over recent decades along with an increased use of modern cross-sectional imaging that can detect CP at earlier stages than previous diagnostic methods. 13,14 Taken together, such changes in risk factor exposure and diagnostic practice may result in changes in incidence and prevalence. This information is important to inform healthcare decision-makers and to project resource allocation for patient management and research.…”

Section: Introductionmentioning

confidence: 99%

Time trends in incidence and prevalence of chronic pancreatitis: A 25‐year population‐based nationwide study

et al. 2021

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Background Updated population-based estimates on incidence and prevalence of chronic pancreatitis are scarce. Methods We used nationwide healthcare registries to identify all Danish patients diagnosed with chronic pancreatitis and computed crude and standardised incidence rates and prevalence estimates in 1994–2018. Incidence and prevalence were evaluated in relation to patients age and gender, aetiology (alcoholic vs non-alcoholic) and smoking and alcohol consumption in the general Danish population. Results The mean incidence rate of chronic pancreatitis during the study period was 12.6 per 100,000 person years for the total population, for women it was 8.6 per 100,000 person years and for men it was 16.7 per 100,000 person years. The standardised incidence rate was stable from from 1994 through 2018, remaining at 12.5 per 100,000 person years in the last observation period (2014–2018). The point prevalence of chronic pancreatitis in 2016 was 153.9 per 100,000 persons. A gradual increase in standardised prevalence estimates was observed during the study period from 126.6 in 1996 to 153.9 in 2016. The mean age at chronic pancreatitis diagnosis increased from 52.1 to 60.0 years during the study period. Conclusion The prevalence of chronic pancreatitis is increasing in the Danish population despite a stable incidence level. Improved management strategies and changes in the underlying patient population may explain these observations.

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Guidelines for the Diagnostic Cross Sectional Imaging and Severity Scoring of Chronic Pancreatitis

Cited by 84 publications

References 78 publications

Pancreatic calcifications associate with diverse aetiological risk factors in patients with chronic pancreatitis: A multicentre study of 1500 cases

Pancreatic calcifications associate with diverse aetiological risk factors in patients with chronic pancreatitis: A multicentre study of 1500 cases

<p>Exocrine pancreatic insufficiency: prevalence, diagnosis, and management</p>

Time trends in incidence and prevalence of chronic pancreatitis: A 25‐year population‐based nationwide study

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