International consensus statements on early chronic Pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with The International Association of Pancreatology, American Pancreatic Association, Japan Pancreas Society, PancreasFest Working Group and European Pancreatic Club.

Published on May 21, 2018in Pancreatology3.629
· DOI :10.1016/J.PAN.2018.05.008
David C. Whitcomb89
Estimated H-index: 89
(University of Pittsburgh),
David C Whitcomb5
Estimated H-index: 5
(University of Pittsburgh)
+ 16 AuthorsJohn P. Neoptolemos125
Estimated H-index: 125
(Heidelberg University)
Sources
Abstract
Abstract Background Chronic pancreatitis (CP) is a progressive inflammatory disorder currently diagnosed by morphologic features. In contrast, an accurate diagnosis of Early CP is not possible using imaging criteria alone. If this were possible and early treatment instituted, the later, irreversible features and complications of CP could possibly be prevented. Method An international working group supported by four major pancreas societies (IAP, APA, JPS, and EPC) and a PancreasFest working group sought to develop a consensus definition and diagnostic criteria for Early CP. Ten statements (S1-10) concerning Early CP were used to gauge consensus on the Early CP concept using anonymous voting with a 9 point Likert scale. Consensus required an alpha ≥0.80. Results No consensus statement could be developed for a definition of Early-CP or diagnostic criteria. There was consensus on 5 statements: (S2) The word “Early” in early chronic pancreatitis is used to describe disease state, not disease duration. (S4) Early CP defines a stage of CP with preserved pancreatic function and potentially reversible features. (S8) Genetic variants are important risk factors for Early CP and can add specificity to the likely etiology, but they are neither necessary nor sufficient to make a diagnosis. (S9) Environmental risk factors can provide evidence to support the diagnosis of Early CP, but are neither necessary nor sufficient to make a diagnosis. (S10) The differential diagnosis for Early CP includes other disorders with morphological and functional features that overlap with CP. Conclusions Morphology based diagnosis of Early CP is not possible without additional information. New approaches to the accurate diagnosis of Early CP will require a mechanistic definition that considers risk factors, biomarkers, clinical context and new models of disease. Such a definition will require prospective validation.
📖 Papers frequently viewed together
192 Citations
38 Citations
460 Citations
References108
Newest
#1Celeste Shelton (University of Pittsburgh)H-Index: 7
#2Chandraprakash Umapathy (University of Pittsburgh)H-Index: 7
Last. David C. Whitcomb (University of Pittsburgh)H-Index: 89
view all 5 authors...
Hereditary pancreatitis (HP), an autosomal dominant disease typically caused by mutations in PRSS1, has a broad range of clinical characteristics and high cumulative risk of pancreatic cancer. We describe survival and pancreatic cancer risk in the largest HP cohort in the US. HP probands and family members prospectively recruited from 1995 to 2013 completed medical and family history questionnaires, and provided blood for DNA testing. Overall survival (until 12/31/2015) was determined from the S...
21 CitationsSource
#1Takamichi Kuwahara (Nagoya University)H-Index: 11
#2Yoshiki Hirooka (Nagoya University)H-Index: 59
Last. Hidemi Goto (Nagoya University)H-Index: 72
view all 14 authors...
BACKGROUND AND AIM Chronic pancreatitis (CP) is sometimes diagnosed at the progressed stage. For the early diagnosis of CP, Endoscopic ultrasonography (EUS) may be a useful method, but its diagnostic criteria are based on subjective judgement. Shear wave elastography (SW-EG) using transabdominal ultrasonography, which quantifies tissue elasticity as an absolute value, may be an objective and non-invasive method for the diagnosis of CP. METHODS Eighty-five patients with known or suspected CP who ...
26 CitationsSource
#1Andrea Párniczky (Boston Children's Hospital)H-Index: 16
#2Maisam Abu-El-Haija (Cincinnati Children's Hospital Medical Center)H-Index: 18
Last. Péter Hegyi (PTE: University of Pécs)H-Index: 48
view all 15 authors...
Abstract Background Pediatric pancreatitis is an underdiagnosed disease with variable etiology. In the past 10–15 years the incidence of pediatric pancreatitis has increased, it is now 3.6–13.3 cases per 100,000 children. Up-to-date evidence based management guidelines are lacking for the pediatric pancreatitis. The European Pancreatic Club, in collaboration with the Hungarian Pancreatic Study Group organized a consensus guideline meeting on the diagnosis and management of pancreatitis in the pe...
29 CitationsSource
A Role for Total Pancreatectomy and Islet Autotransplant in the Treatment of Chronic Pancreatitis
4 CitationsSource
#1Georg Beyer (LMU: Ludwig Maximilian University of Munich)H-Index: 10
#2Ujjwal M. Mahajan (LMU: Ludwig Maximilian University of Munich)H-Index: 6
Last. Julia Mayerle (LMU: Ludwig Maximilian University of Munich)H-Index: 67
view all 14 authors...
Background & Aims The clinical course of chronic pancreatitis is unpredictable. There is no model to assess disease severity or progression or predict patient outcomes. Methods We performed a prospective study of 91 patients with chronic pancreatitis; data were collected from patients seen at academic centers in Europe from January 2011 through April 2014. We analyzed correlations between clinical, laboratory, and imaging data with number of hospital readmissions and in-hospital days over the ne...
21 CitationsSource
#1Jianfeng Tu (NU: Nanjing University)H-Index: 8
#2Jingzhu Zhang (NU: Nanjing University)H-Index: 4
Last. Jieshou Li (NU: Nanjing University)H-Index: 58
view all 10 authors...
Patients could develop endocrine and exocrine pancreatic insufficiency after acute pancreatitis (AP), but the morbidity, risk factors and outcome remain unclear. The aim of the present study was to evaluate the incidence of endocrine and exocrine pancreatic insufficiency after AP and the risk factors of endocrine pancreatic insufficiency through a long-term follow-up investigation. Follow-up assessment of the endocrine and exocrine function was conducted for the discharged patients with AP episo...
23 CitationsSource
#1Andres Carrion (UTHSC: University of Tennessee Health Science Center)H-Index: 1
#2Drucy Borowitz (UB: University at Buffalo)H-Index: 41
Last. Dennis C. Stokes (UTHSC: University of Tennessee Health Science Center)H-Index: 24
view all 8 authors...
ABSTRACTThe effect of ivacaftor in patients with cystic fibrosis (CF) with recurrent pancreatitis is unknown. We conducted a multicenter retrospective study of patients with CF taking ivacaftor who had a history of recurrent pancreatitis. During the first 3 months of therapy, only 1 of the 6 patient
23 CitationsSource
#1Asbjørn Mohr Drewes (AAU: Aalborg University)H-Index: 78
#2Stefan A.W. Bouwense (Radboud University Nijmegen)H-Index: 23
Last. Dhiraj Yadav (University of Pittsburgh)H-Index: 52
view all 19 authors...
Abdominal pain is the foremost complication of chronic pancreatitis (CP). Pain can be related to recurrent or chronic inflammation, local complications or neurogenic mechanisms with corresponding changes in the nervous systems. Both pain intensity and the frequency of pain attacks have been shown to reduce quality of life in patients with CP. Assessment of pain follows the guidelines for other types of chronic pain, where the multidimensional nature of symptom presentation is taken into consider...
81 CitationsSource
#1Ruben Hernaez (BCM: Baylor College of Medicine)H-Index: 24
#2Aaron P. Thrift (BCM: Baylor College of Medicine)H-Index: 28
5 CitationsSource
#1Melena D. BellinH-Index: 41
#2David C. Whitcomb (University of Pittsburgh)H-Index: 89
Last. Dhiraj Yadav (University of Pittsburgh)H-Index: 52
view all 24 authors...
Patient and Disease Characteristics Associated With the Presence of Diabetes Mellitus in Adults With Chronic Pancreatitis in the United States
39 CitationsSource
Cited By55
Newest
Source
#1Jorge D. MachicadoH-Index: 13
#2Dhiraj YadavH-Index: 52
Source
Source
#1David C. WhitcombH-Index: 89
view all 1 authors...
Source
#1Ishani Shah (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 2
#2Sunil A Sheth (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 32
Last. Darshan Kothari (Duke University)H-Index: 5
view all 0 authors...
Patients with chronic pancreatitis often experience severe, unrelenting abdominal pain, which can significantly impact their quality of life. Pain control, therefore, remains central to the overall management of chronic pancreatitis. Most of the strategies aimed at treating the pain of chronic pancreatitis are based on expert opinion and vary from one institution to another, as there are no uniform guidelines to direct a stepwise approach towards achieving this goal. In this editorial, we commen...
Source
Increasingly acute and chronic pancreatitis (AP and CP) are considered a continuum of a single entity. Nonetheless, if, after flare-up, the pancreas shows no residual inflammation, it is classified as AP. CP is characterised by a long cycle of worsening and waning glandular inflammation without the pancreas ever returning to its baseline structure or function. According to the International Consensus Guidelines on Early Chronic Pancreatitis, pancreatic inflammation must last at least 6 months be...
Source
#2Grzegorz OraczH-Index: 12
view all 3 authors...
Chronic pancreatitis (CP) is a progressive, irreversible inflammatory disorder of the pancreas, which results from interrelations between different genetic and environmental factors. Genetic variants are the primary cause of the disease in early-onset nonalcoholic CP patients. Novel CP-associated genes are continuously emerging from genetic studies on CP cohorts, providing important clues for distinct mechanisms involved in CP development. On the basis of functional studies, the genetic alterati...
Source
Source
#1Tarek El-Hamoly (University of Debrecen)H-Index: 2
#2Zoltán Hajnády (University of Debrecen)H-Index: 1
Last. László Virág (University of Debrecen)H-Index: 63
view all 13 authors...
Chronic pancreatitis (CP) is an inflammatory disease of the pancreas characterized by ductal obstructions, tissue fibrosis, atrophy and exocrine and endocrine pancreatic insufficiency. However, our understanding is very limited concerning the disease’s progression from a single acute inflammation, via recurrent acute pancreatitis (AP) and early CP, to the late stage CP. Poly(ADP-ribose) polymerase 1 (PARP1) is a DNA damage sensor enzyme activated mostly by oxidative DNA damage. As a co-activator...
Source
#1Jordan Swensson (IUPUI: Indiana University – Purdue University Indianapolis)
#1Jordan Swensson (IU: Indiana University)H-Index: 4
Last. Temel Tirkes (IUPUI: Indiana University – Purdue University Indianapolis)H-Index: 4
view all 6 authors...
Secretin-enhanced MRCP (S-MRCP) has advantages over standard MRCP for imaging of the pancreaticobiliary tree. Through the use of secretin to induce fluid production from the pancreas and leveraging...
Source