Incidence, Prevalence, Etiology, and Prognosis of First-Time Chronic Pancreatitis in Young Patients: A Nationwide Cohort Study

Jøergensen, Maiken Thyregod; Brusgaard, Klaus; Crüger, Dorthe Gylling; Gerdes, Anne–Marie; Muckadell, Ove B Schaffalitzky de

doi:10.1007/s10620-009-1118-4

Cited by 43 publications

(27 citation statements)

References 38 publications

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“…A recent study from Denmark, a temperate country, has shown that >50% of young patients (<30 years of age) with CP had either SPINK1 and/or CFTR gene mutations 8. This study has actually lent support to the notion that there are many overlapping features and similarities between idiopathic CP in the eastern and western world 1 8.…”

supporting

confidence: 56%

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Garg

Midha

Khajuria

et al. 2010

Gut

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supporting

confidence: 56%

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Garg

Midha

Khajuria

et al. 2010

Gut

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“…Several genetic mutations have been described. In a Danish study, the cationic trypsinogen gene (PRSS1), serine protease inhibitor Kazal type 1 (SPINK1), and the cystic fibrosis transmembrane conductance regulator gene (CFTR) were present in up to 50% of patients with idiopathic chronic pancreatitis [20]. Some genetic mutations (eg, SPINK1) have been associated with relapsing pancreatitis, but are not common findings in those with an initial/sentinel attack of pancreatitis in the North American population [21].…”

Section: Genetic Factorsmentioning

confidence: 99%

Recurrent and Relapsing Pancreatitis

Guda

Romagnuolo

Freeman

2011

Curr Gastroenterol Rep

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Recurrent acute pancreatitis is a common clinical problem. Most cases of pancreatitis are identified by a careful history and physical examination. Despite advanced evaluation, the cause is not apparent in about 10% of cases. The etiology of recurrent acute pancreatitis appears to be multifactorial, with genetic and environmental influences playing a significant role. The strength of evidence for certain etiologies is highly variable, and natural history data are limited. Controversy exists regarding the most appropriate diagnostic and therapeutic approach. Recurrent acute pancreatitis often represents a continuum with chronic pancreatitis.

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“…The 2 studies in this issue of the Journal from southern India have again emphasized that the clinical profile of TP is much different from that reported earlier and in sync with the idiopathic CP reported elsewhere [20]. The Manipal group diagnosed TP by excluding other causes of CP, suggesting that this was idiopathic CP.…”

mentioning

confidence: 60%

Chronic pancreatitis in India: untying the nutritional knot

Garg

2011

Indian J Gastroenterol

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Nutrition is central to human existence from sustenance of cellular life to powering its myriad functions. Contrasting images of Haitian or Ugandan malnourished children and Westerner obese kids mirror not only the economic reality of a nation but also the propensity to diseases albeit of opposite polarity from Kwashiorkor/Marasmus to metabolic syndrome with equal implications for health outcomes. In addition to specific nutritional deficiency states such as scurvy and rickets, indirect effects of nutrition on human health are of greater importance.In this context, astute clinical observations in 1960s brought attention to a rather typical form of chronic pancreatitis (CP) in Kerala [1]. The picture of a young malnourished patient with chronic calcific pancreatitis and diabetes evoked much interest. Since one of its most peculiar features was malnutrition (undernutrition), it was soon implicated in its etiopathogenesis. At a time when the basic structure of DNA was just about making the headlines, genetic mutation as the cause of disease was not even on the agenda outside of Mendelian disorders. Malnutrition thus made the cut being the striking clinical feature. Since the disease was reported mainly from tropical countries, which ironically were much poorer and undernourished than their temperate counterparts, the term 'tropical pancreatitis' (TP) was coined for want of a more defining terminology.Protein deficient and high carbohydrate diet was thus implicated in the etiopathogenesis of the thus coined TP. Sandhyamani et al. [2] showed that high carbohydrate and low protein diet, either comprising of cornstarch or cassava, resulted in ductal changes with mucoid metaplasia and parenchymal atrophy in an animal model of bonnet monkey. However, pancreatic changes were rather different from those typically seen in CP and the animals predominantly developed vascular and cardiac changes-features not observed in CP patients. Furthermore, severe malnutrition has been shown to result in pancreatic atrophy and insufficiency and not CP thus disproving the nutritional hypothesis [3]. Since cassava was a staple diet in Kerala, it gained the status of a co-culprit as a logical extension of the nutritional hypothesis. The cassava hypothesis has also been discarded because: (i) cassava consumption was not found as a risk factor in case-control studies including one from Kerala [4], (ii) patients with the TP were reported from areas where cassava was not consumed [5], and (iii) long-term cassava consumption did not produce diabetes or pancreatitis in a rat model [6].Even though the association of malnutrition with CP was consistent, not many clinical studies examined the cause and effect relationship. Our group first showed that malnutrition was an effect and not a cause of CP. In a prospective study of 120 patients with idiopathic CP, only 20.6% were underweight before the onset of the disease while 67% lost weight following the disease suggesting that malnutrition was an effect and not a cause of CP [5]. A recent study by Sathi...

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Incidence, Prevalence, Etiology, and Prognosis of First-Time Chronic Pancreatitis in Young Patients: A Nationwide Cohort Study

Abstract: The prevalence of CP, especially in women, increased over time. Genetic causes that partly or totally could explain the CP were found in 54.90% (95% CI (40.45-68.62)) of those with idiopathic CP, as a minimum estimation 1.9% (95% CI (1.00-3.47)) of the total cohort had HP.

Cited by 43 publications

References 38 publications

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Recurrent and Relapsing Pancreatitis

Chronic pancreatitis in India: untying the nutritional knot

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