Is the profile of chronic pancreatitis in India changing?

Excerpt

Chronic pancreatitis (CP) is characterized by irreversible damage to the pancreas that eventually leads to pain and/or exocrine and endocrine insufficiencies [1]. It is usually characterized by a clinical course leading to progressive loss of pancreatic parenchyma, endocrine and exocrine insufficiencies, or formation of stones/calcification in the pancreas [2]. It is a significant health problem worldwide and is associated with considerable morbidity. Prevalence of CP varies widely in different geographic locations. Compared with 10–15/10⁵ prevalence in Western countries, the prevalence of CP is higher in India and some of the other Asian countries [3, 4]. An earlier study [4] from India showed the prevalence of CP to be 125/10⁵. A Chinese study [5] showed increasing prevalence of CP from 3.08/10⁵ in 1996 to 13.52/10⁵ population in 2003, and a nationwide survey in Japan [6] showed the prevalence to be 45/10⁵. The etiology of CP also varies in different countries. Whereas alcohol is the commonest etiology in most of the Western countries, idiopathic chronic pancreatitis (ICP) is the most common type reported from India and China [4]. In earlier reports from India, tropical chronic pancreatitis (TCP) dominated the description of CP [3, 4]. The reported common features of TCP include its onset in childhood and adolescence, prominent association with malnutrition, higher prevalence in population-eating cassava, high prevalence of diabetes mellitus, marked dilatation of pancreatic duct, and formation of pancreatic calculi which are usually large [3, 4]. The disease was reported to have an aggressive course with patients dying in the prime of their lives because of complications related to CP including pancreatic carcinoma [7‐10]. However, the spectrum of CP in India seems to be changing now. As opposed to previous reports of marked ductal dilatation and large calculi, less advanced forms of CP are being diagnosed now; this may be related to the availability of better diagnostic modalities like CT scan and MRCP. It may also be related to changes in the spectrum of the disease. In fact, only about 3.8 % to 5.8 % of patients could satisfy the criteria of the so-called TCP in recent studies [8‐11]. …