Chronic pancreatitis classification: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Chronic pancreatitis}} | {{Chronic pancreatitis}} | ||
{{CMG}} {{AE}} | {{CMG}} {{AE}}{{IQ}} | ||
{{ | |||
==Overview== | ==Overview== | ||
Chronic pancreatitis may be divided based upon underlying [[morphology]] into large-duct type or small-duct type with or without [[calcification]]. The classification systems that have been used | Chronic pancreatitis may be divided based upon underlying [[morphology]] into large-duct type or small-duct type with or without [[calcification]]. The classification systems that have been used for chronic pancreatitis include Marseille, Marseille-Rome system, Cambridge system, TIGAR-O system, ABC grading system and Manchester system. | ||
==Classification== | ==Classification== | ||
=== Classification based upon morphology === | |||
Chronic pancreatitis may be divided based on underlying [[morphology]] into: | Chronic pancreatitis may be divided based on underlying [[morphology]] into: | ||
*Large-duct type | *Large-duct type | ||
*Small-duct type | *Small-duct type | ||
**With [[calcification]] | **With [[calcification]] | ||
**Without [[calcification]] | **Without [[calcification]] | ||
{| class="wikitable" | {| class="wikitable" | ||
!Classification | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Classification system for chronic pancreatitis | ||
!Year | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Year | ||
! | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Key features | ||
|- | |- | ||
|Clinical description | |Clinical description | ||
|1946 | |1946 | ||
| | | | ||
* Description of the clinical presentation of chronic pancreatitis and its association with increased alcohol consumption | * Description of the [[clinical]] presentation of chronic pancreatitis and its association with increased [[alcohol]] consumption | ||
|- | |- | ||
|Marseille | |Marseille | ||
|1963 | |1963 | ||
| | | | ||
* Description of morphologic characteristics and etiological factors of the disease | * Description of [[Morphology|morphologic]] characteristics and [[Etiology|etiological]] factors of the disease | ||
* No discussion of the correlation between anatomic and functional changes | * No discussion of the correlation between [[anatomic]] and functional changes | ||
* No categorization according to disease severity or clinical presentation | * No categorization according to disease severity or [[clinical]] presentation | ||
* No inclusion of pancreatic imaging findings | * No inclusion of [[pancreatic]] imaging findings | ||
|- | |- | ||
|Marseille | |Marseille | ||
|1984 | |1984 | ||
| | | | ||
* Further description and subclassification of morphological changes | * Further description and subclassification of [[Morphology|morphological]] changes | ||
* “Obstructive chronic pancreatitis” listed as distinct form | * “Obstructive chronic pancreatitis” listed as distinct form | ||
* No discussion of the correlation between anatomic and functional changes | * No discussion of the correlation between [[anatomic]] and functional changes | ||
* No categorization according to disease severity or clinical presentation | * No categorization according to disease severity or [[clinical]] presentation | ||
* No inclusion of pancreatic imaging findings | * No inclusion of [[pancreatic]] imaging findings | ||
|- | |- | ||
|Marseille-Rome | |Marseille-Rome | ||
| Line 49: | Line 45: | ||
| | | | ||
* Description of “chronic calcifying” and “chronic [[inflammatory]]” pancreatitis as distinct forms | * Description of “chronic calcifying” and “chronic [[inflammatory]]” pancreatitis as distinct forms | ||
* Description of etiological factors | * Description of [[Etiology|etiological]] factors | ||
* No further elaboration of clinical, functional | * No further elaboration of clinical, functional or imaging criteria | ||
|- | |- | ||
|Cambridge | |Cambridge | ||
|1984 | |1984 | ||
| | | | ||
* Classification of disease severity based on pancreatic imaging criteria ([[ | * Classification of disease severity based on [[pancreatic]] imaging criteria ([[Ultrasound]], [[CT scanning]], [[endoscopic retrograde cholangiopancreatography]]) | ||
* Further discussion of etiological factors, pancreatic function, and testing for [[pancreatic insufficiency]] | * Further discussion of [[Etiology|etiological]] factors, [[pancreatic]] function, and testing for [[pancreatic insufficiency]] | ||
* Morphologic characteristics not clearly defined | * [[Morphology|Morphologic]] characteristics not clearly defined | ||
|- | |- | ||
|Clinical stages | |Clinical stages | ||
|1994 | |1994 | ||
| | | | ||
* Detailed subclassification of chronic pancreatitis with correlation of etiological factors with different morphological forms of the disease | * Detailed subclassification of chronic pancreatitis with correlation of [[Etiology|etiological]] factors with different [[Morphology|morphological]] forms of the disease | ||
* Differentiation of clinical stages of the disease | * Differentiation of [[clinical]] stages of the disease | ||
* Linkage of pancreatic imaging findings and functional testing with stages of the disease | * Linkage of [[pancreatic]] imaging findings and functional testing with stages of the disease | ||
|- | |- | ||
|Japan Pancreas Society | |Japan Pancreas Society | ||
|1997 | |1997 | ||
| | | | ||
* Description of clinical presentation and classification of disease in “definite” and “probable” chronic pancreatitis according to imaging findings, functional testing, and histological examination | * Description of clinical presentation and classification of disease in “definite” and “probable” chronic pancreatitis according to imaging findings, functional testing, and [[Histology|histological examination]] | ||
|- | |- | ||
|Zürich Workshop | |Zürich Workshop | ||
|1997 | |1997 | ||
| | | | ||
* Description of clinical presentation and classification of disease in “definite” and “probable” chronic pancreatitis according to imaging findings, functional testing, and histological examination | * Description of clinical presentation and classification of disease in “definite” and “probable” chronic pancreatitis according to imaging findings, functional testing, and [[Histology|histological examination]] | ||
|- | |- | ||
|TIGAR-O | |TIGAR-O | ||
|2001 | |2001 | ||
| | | | ||
* Detailed categorization of etiological risk factors | * Detailed categorization of [[Etiology|etiological]] risk factors | ||
|- | |- | ||
|ABC grading system | |ABC grading system | ||
| Line 92: | Line 82: | ||
* Disease grading according to clinical criteria, but limited separation of different disease severities | * Disease grading according to clinical criteria, but limited separation of different disease severities | ||
* Not all clinical presentations can be categorized | * Not all clinical presentations can be categorized | ||
|- | |- | ||
|Manchester system | |Manchester system | ||
| Line 99: | Line 88: | ||
* Disease grading according to clinical criteria, but limited separation of different disease severities | * Disease grading according to clinical criteria, but limited separation of different disease severities | ||
* Not all clinical presentations can be categorized | * Not all clinical presentations can be categorized | ||
|} | |} | ||
=== Classification of pancreatitis based upon area of involvement and etiology === | |||
There are various forms of chronic pancreatitis based upon the area of involvement and etiology are as follows: | |||
==== Groove pancreatitis: ==== | ==== Groove pancreatitis: ==== | ||
| Line 125: | Line 116: | ||
==== Tropical pancreatitis: ==== | ==== Tropical pancreatitis: ==== | ||
* | *Tropical pancreatitis is one of the most common causes of chronic pancreatitis in tropical areas including south India. | ||
*It was thought to be caused by cassava fruit but no longer associated with it and has no clear etiology.<ref name="pmid8200268">{{cite journal |vauthors=Sarles H, Augustine P, Laugier R, Mathew S, Dupuy P |title=Pancreatic lesions and modifications of pancreatic juice in tropical chronic pancreatitis (tropical calcific diabetes) |journal=Dig. Dis. Sci. |volume=39 |issue=6 |pages=1337–44 |year=1994 |pmid=8200268 |doi= |url=}}</ref> | *It was thought to be caused by cassava fruit but no longer associated with it and has no clear etiology.<ref name="pmid8200268">{{cite journal |vauthors=Sarles H, Augustine P, Laugier R, Mathew S, Dupuy P |title=Pancreatic lesions and modifications of pancreatic juice in tropical chronic pancreatitis (tropical calcific diabetes) |journal=Dig. Dis. Sci. |volume=39 |issue=6 |pages=1337–44 |year=1994 |pmid=8200268 |doi= |url=}}</ref> | ||
*It usually affects children leading to early adulthood death due to [[endocrine]] and [[exocrine]] dysfunction. | *It usually affects children leading to early adulthood death due to [[endocrine]] and [[exocrine]] dysfunction. | ||
| Line 131: | Line 122: | ||
==== Idiopathic pancreatitis: ==== | ==== Idiopathic pancreatitis: ==== | ||
*[[Idiopathic pancreatitis]] usually includes the non-alcohol induced cases of chronic pancreatitis | *[[Idiopathic pancreatitis]] usually includes the non-alcohol induced cases of chronic pancreatitis. | ||
* | *It usually accounts for 30% of cases of pancreatitis. | ||
*It | *It can be divided into early onset and late-onset forms. | ||
*Contributing factors may include: | *Contributing factors towards idiopathic pancreatitis may include: | ||
**Concealed alcohol intake | **Concealed alcohol intake | ||
**[[Hypersensitivity]] to alcohol | **[[Hypersensitivity]] to alcohol | ||
Latest revision as of 17:58, 30 January 2018
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Risk calculators and risk factors for Chronic pancreatitis classification |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]
Overview
Chronic pancreatitis may be divided based upon underlying morphology into large-duct type or small-duct type with or without calcification. The classification systems that have been used for chronic pancreatitis include Marseille, Marseille-Rome system, Cambridge system, TIGAR-O system, ABC grading system and Manchester system.
Classification
Classification based upon morphology
Chronic pancreatitis may be divided based on underlying morphology into:
- Large-duct type
- Small-duct type
- With calcification
- Without calcification
| Classification system for chronic pancreatitis | Year | Key features |
|---|---|---|
| Clinical description | 1946 | |
| Marseille | 1963 |
|
| Marseille | 1984 |
|
| Marseille-Rome | 1988 |
|
| Cambridge | 1984 |
|
| Clinical stages | 1994 |
|
| Japan Pancreas Society | 1997 |
|
| Zürich Workshop | 1997 |
|
| TIGAR-O | 2001 |
|
| ABC grading system | 2002 |
|
| Manchester system | 2006 |
|
Classification of pancreatitis based upon area of involvement and etiology
There are various forms of chronic pancreatitis based upon the area of involvement and etiology are as follows:
Groove pancreatitis:
Groove pancreatitis is a form of segmental pancreatitis that involves confinement of the inflammation process to the groove between the duodenum, common bile duct, and head of the pancreas without any involvement of the head of pancreas.[1]
Hereditary pancreatitis:
- Hereditary pancreatitis is a subtype of chronic pancreatitis.
- It is an autosomal dominant inheritance with 80% of penetrance rate. [2]
- It usually involves mutation in cationic trypsinogen gene (PRSS1) resulting in loss of autoregulation of activated trypsin.
- Symptoms usually develop <20 year of age and often <5yr age.
- It is associated with an increased risk of pancreatic adenocarcinoma.
- The management is similar to the other causes of chronic pancreatitis.
Autoimmune pancreatitis (AIP):
- Autoimmune pancreatitis may be seen on the continuum of IgG4 related sclerosing diseases.
- It usually presents as obstructive jaundice or acute recurrent pancreatitis.
- The underlying pathology involves bile duct or pancreatic duct compression due to pancreatic swelling and ductal strictures leading to obstructive jaundice or acute recurrent pancreatitis presentation.
- Elevated immunoglobulin IgG4 levels are usually seen on lab analysis.
- Imaging findings include:
- Focal or diffuse pancreatic enlargement
- Narrowed pancreatic duct
- Corticosteroid therapy results in rapid and marked improvement in clinical and radiographic features.
Tropical pancreatitis:
- Tropical pancreatitis is one of the most common causes of chronic pancreatitis in tropical areas including south India.
- It was thought to be caused by cassava fruit but no longer associated with it and has no clear etiology.[3]
- It usually affects children leading to early adulthood death due to endocrine and exocrine dysfunction.
- Serine protease inhibitor SPINK1 mutations are identified in some of the patients.[4][5]
Idiopathic pancreatitis:
- Idiopathic pancreatitis usually includes the non-alcohol induced cases of chronic pancreatitis.
- It usually accounts for 30% of cases of pancreatitis.
- It can be divided into early onset and late-onset forms.
- Contributing factors towards idiopathic pancreatitis may include:
- Concealed alcohol intake
- Hypersensitivity to alcohol
- Unreported pancreatic trauma
- Mutations in the cationic trypsinogen gene and the cystic fibrosis gene
References
- ↑ Tezuka K, Makino T, Hirai I, Kimura W (2010). "Groove pancreatitis". Dig Surg. 27 (2): 149–52. doi:10.1159/000289099. PMID 20551662.
- ↑ Sossenheimer MJ, Aston CE, Preston RA, Gates LK, Ulrich CD, Martin SP, Zhang Y, Gorry MC, Ehrlich GD, Whitcomb DC (1997). "Clinical characteristics of hereditary pancreatitis in a large family, based on high-risk haplotype. The Midwest Multicenter Pancreatic Study Group (MMPSG)". Am. J. Gastroenterol. 92 (7): 1113–6. PMID 9219780.
- ↑ Sarles H, Augustine P, Laugier R, Mathew S, Dupuy P (1994). "Pancreatic lesions and modifications of pancreatic juice in tropical chronic pancreatitis (tropical calcific diabetes)". Dig. Dis. Sci. 39 (6): 1337–44. PMID 8200268.
- ↑ Bhatia E, Choudhuri G, Sikora SS, Landt O, Kage A, Becker M, Witt H (2002). "Tropical calcific pancreatitis: strong association with SPINK1 trypsin inhibitor mutations". Gastroenterology. 123 (4): 1020–5. PMID 12360463.
- ↑ Schneider A, Suman A, Rossi L, Barmada MM, Beglinger C, Parvin S, Sattar S, Ali L, Khan AK, Gyr N, Whitcomb DC (2002). "SPINK1/PSTI mutations are associated with tropical pancreatitis and type II diabetes mellitus in Bangladesh". Gastroenterology. 123 (4): 1026–30. PMID 12360464.