Chronic pancreatitis causes: Difference between revisions

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__NOTOC__
__NOTOC__
{{Chronic pancreatitis}}
{{Chronic pancreatitis}}
{{CMG}}
{{CMG}} {{AE}} {{IQ}}


==Overview==
==Overview==
TIGAR-O (toxic metabolite, idiopathic, genetic, autoimmune, recurrent and acute, obstructive) classification system may be used for the [[etiologic]] classification of chronic pancreatitis. [[Toxic]] causes may include use of [[alcohol]], [[tobacco]] [[smoking]], [[hypercalcemia]], [[hyperlipidemia]], [[chronic renal failure]], [[medications]], and [[toxins]]. [[Genetic]] causes may include cationic [[trypsinogen]] [[gene]] (''PRSS1'') [[mutation]], cystic fibrosis transmembrane conductance regulator (''[[Cystic fibrosis transmembrane conductance regulator|CFTR]]'') [[gene mutation]], [[calcium-sensing receptor]] (''CASR'') [[gene mutation]], [[chymotrypsin]] C (''CTRC'') [[gene mutation]], and mutation in the [[SPINK1|pancreatic secretory trypsin inhibitor gene]] (''[[SPINK1]]''). Less common causes may include [[hypertriglyceridemia]], [[scorpion sting]], tropical [[pancreatitis]], and medications such as [[metronidazole]], [[mercaptopurine]], [[valproate]], [[isoniazid]] and [[corticosteroids]].


==Causes==
==Causes==
The causes of pancreatitis are many but at least 70% of adult cases are associated with chronic alcohol use, and most patients have consumed more than 80 g/day of alcohol over six to twelve years.<ref>{{cite journal |journal=Am Fam Physician |date=2007 |volume=76 |issue=11 |pages=1679–88 |title= Chronic pancreatitis |author= Nair RJ, Lawler L, Miller MR |pmid=18092710 |url=http://www.aafp.org/afp/20071201/1679.html}}</ref><ref>Mitchell RMS et al. Pancreatitis. Lancet 2003; 361: 1447–55</ref>
TIGAR-O (toxic metabolite, idiopathic, genetic, autoimmune, recurrent and acute, obstructive) etiologic classification of chronic pancreatitis includes:
* Major associations with chronic pancreatitis <ref>Mitchell RMS et al. Pancreatitis. Lancet 2003; 361: 1447–55</ref><ref>Frulloni et al. Chronic pancreatitis: Report from a multicenter Italian survey (PanCroInfAISP) on 893 patients. Dig Liver Dis. 2009 Apr;41(4):311-7</ref><ref>Adsay NV et al. Paraduodenal pancreatitis: a clinico-pathologically distinct entity unifying "cystic dystrophy of heterotopic pancreas", "para-duodenal wall cyst", and "groove pancreatitis". Semin Diagn Pathol. 2004 Nov;21(4):247-54. </ref>
{| class="wikitable"
** Alcohol<ref name="pmid11842000">{{cite journal |vauthors=Lu Z, Karne S, Kolodecik T, Gorelick FS |title=Alcohols enhance caerulein-induced zymogen activation in pancreatic acinar cells |journal=Am. J. Physiol. Gastrointest. Liver Physiol. |volume=282 |issue=3 |pages=G501–7 |year=2002 |pmid=11842000 |pmc=2830557 |doi=10.1152/ajpgi.00388.2001 |url=}}</ref><ref name="pmid6725910">{{cite journal |vauthors=Bisceglie AM, Segal I |title=Cirrhosis and chronic pancreatitis in alcoholics |journal=J. Clin. Gastroenterol. |volume=6 |issue=3 |pages=199–200 |year=1984 |pmid=6725910 |doi= |url=}}</ref><ref name="pmid4029715">{{cite journal |vauthors=Wilson JS, Bernstein L, McDonald C, Tait A, McNeil D, Pirola RC |title=Diet and drinking habits in relation to the development of alcoholic pancreatitis |journal=Gut |volume=26 |issue=9 |pages=882–7 |year=1985 |pmid=4029715 |pmc=1432860 |doi= |url=}}</ref><ref name="pmid14576495">{{cite journal |vauthors=Whitcomb DC |title=Genetic predisposition to alcoholic chronic pancreatitis |journal=Pancreas |volume=27 |issue=4 |pages=321–6 |year=2003 |pmid=14576495 |doi= |url=}}</ref><ref name="pmid15753536">{{cite journal |vauthors=Maisonneuve P, Lowenfels AB, Müllhaupt B, Cavallini G, Lankisch PG, Andersen JR, Dimagno EP, Andrén-Sandberg A, Domellöf L, Frulloni L, Ammann RW |title=Cigarette smoking accelerates progression of alcoholic chronic pancreatitis |journal=Gut |volume=54 |issue=4 |pages=510–4 |year=2005 |pmid=15753536 |pmc=1774435 |doi=10.1136/gut.2004.039263 |url=}}</ref><ref name="pmid15089909">{{cite journal |vauthors=Morton C, Klatsky AL, Udaltsova N |title=Smoking, coffee, and pancreatitis |journal=Am. J. Gastroenterol. |volume=99 |issue=4 |pages=731–8 |year=2004 |pmid=15089909 |doi=10.1111/j.1572-0241.2004.04143.x |url=}}</ref>
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Etiology
*** ≥80 g of ethanol consumption a day for at least 5 years
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Causes
*** Most common cause in men
|-
*** Least common cause in women<ref name="pmid21029787">{{cite journal |vauthors=Coté GA, Yadav D, Slivka A, Hawes RH, Anderson MA, Burton FR, Brand RE, Banks PA, Lewis MD, Disario JA, Gardner TB, Gelrud A, Amann ST, Baillie J, Money ME, O'Connell M, Whitcomb DC, Sherman S |title=Alcohol and smoking as risk factors in an epidemiology study of patients with chronic pancreatitis |journal=Clin. Gastroenterol. Hepatol. |volume=9 |issue=3 |pages=266–73; quiz e27 |year=2011 |pmid=21029787 |pmc=3043170 |doi=10.1016/j.cgh.2010.10.015 |url=}}</ref>
|'''Toxic-metabolic'''
** Autoimmunity
|
*** Autoimmune pancreatitis
* [[Alcoholic]]
*** Associated with other systemic disorders (Sjogren syndrome, inflammatory bowel disease, or primary biliary cholangitis)
* [[Tobacco smoking]]
** Obstruction<ref name="pmid9219783">{{cite journal |vauthors=Tarnasky PR, Hoffman B, Aabakken L, Knapple WL, Coyle W, Pineau B, Cunningham JT, Cotton PB, Hawes RH |title=Sphincter of Oddi dysfunction is associated with chronic pancreatitis |journal=Am. J. Gastroenterol. |volume=92 |issue=7 |pages=1125–9 |year=1997 |pmid=9219783 |doi= |url=}}</ref>  
* [[Hypercalcemia]]
*** Fibrotic stenosis of either the papilla of Vater or the main pancreatic duct
* [[Hyperlipidemia]]
*** Trauma
* [[Chronic renal failure]]
*** Pseudocysts
* [[Medications]]—[[phenacetin]] abuse
*** Stones
* [[Toxins]]—[[Organotin compound|organotin compounds]] (e.g. dibutylin dichloride, DBTC)
*** Tumors
|-
*** Pancreas divisum<ref name="pmid7728342">{{cite journal |vauthors=Lehman GA, Sherman S |title=Pancreas divisum. Diagnosis, clinical significance, and management alternatives |journal=Gastrointest. Endosc. Clin. N. Am. |volume=5 |issue=1 |pages=145–70 |year=1995 |pmid=7728342 |doi= |url=}}</ref> <ref name="pmid4043675">{{cite journal |vauthors=Delhaye M, Engelholm L, Cremer M |title=Pancreas divisum: congenital anatomic variant or anomaly? Contribution of endoscopic retrograde dorsal pancreatography |journal=Gastroenterology |volume=89 |issue=5 |pages=951–8 |year=1985 |pmid=4043675 |doi= |url=}}</ref><ref name="pmid8885346">{{cite journal |vauthors=Sherman S, Hawes RH, Savides TJ, Gress FG, Ikenberry SO, Smith MT, Zaidi S, Lehman GA |title=Stent-induced pancreatic ductal and parenchymal changes: correlation of endoscopic ultrasound with ERCP |journal=Gastrointest. Endosc. |volume=44 |issue=3 |pages=276–82 |year=1996 |pmid=8885346 |doi= |url=}}</ref><ref name="pmid8885345">{{cite journal |vauthors=Smith MT, Sherman S, Ikenberry SO, Hawes RH, Lehman GA |title=Alterations in pancreatic ductal morphology following polyethylene pancreatic stent therapy |journal=Gastrointest. Endosc. |volume=44 |issue=3 |pages=268–75 |year=1996 |pmid=8885345 |doi= |url=}}</ref>
|'''Idiopathic'''
** Anatomic variations
|
*** Pancreas divisum
* Early onset
*** Paraduodenal pancreatitis (Cystic dystrophy of the duodenal wall/groove pancreatitis)
* Late onset
** Metabolic or systemic diseases
* Tropical
*** Hypercalcemia
|-
*** Hypertryglyceridemia
|'''Genetic'''
*** Hyperparathyroidism
|
*** Systemic lupus erythematosus
* [https://en.wikipedia.org/wiki/Trypsin_1 Cationic trypsinogen (''PRSS1'')]
** Genetic
* [[Cystic fibrosis transmembrane conductance regulator|Cystic fibrosis transmembrane conductance regulator gene]] (''[[CFTR]]'')
*** CFTR
* [[Calcium-sensing receptor]] [[gene]] (''[[Calcium-sensing receptor|CASR]]'')
*** CTRC
* [https://en.wikipedia.org/wiki/Chymotrypsin-C Chymotrypsin C gene (''CTRC'')]
*** SPINK1 
* [[SPINK1|Pancreatic secretory trypsin inhibitor gene]] (''[[SPINK1]]'')
*** PRSS1 gene mutations
|-
*** Hereditary pancreatitis<ref name="pmid9219780">{{cite journal |vauthors=Sossenheimer MJ, Aston CE, Preston RA, Gates LK, Ulrich CD, Martin SP, Zhang Y, Gorry MC, Ehrlich GD, Whitcomb DC |title=Clinical characteristics of hereditary pancreatitis in a large family, based on high-risk haplotype. The Midwest Multicenter Pancreatic Study Group (MMPSG) |journal=Am. J. Gastroenterol. |volume=92 |issue=7 |pages=1113–6 |year=1997 |pmid=9219780 |doi= |url=}}</ref>
|'''Autoimmune'''
** Idiopathic
|
* Type 1 [[autoimmune]] chronic pancreatitis
* [[IgG4-related systemic disease|IgG4 systemic disease]]
* Type 2 [[autoimmune]] chronic pancreatitis
|-
|'''Recurrent and severe acute pancreatitis'''
|
* Postnecrotic (severe [[acute pancreatitis]])
* Recurrent [[acute pancreatitis]]
* [[Vascular]] diseases/[[ischemia]]
* [[Radiation]] induced
|-
|'''Obstructive'''
|
* [[Pancreas divisum]]
* [[Duct]] obstruction (e.g. [[tumor]])
* Preampullary [[duodenal]] wall [[cysts]]
* Posttraumatic [[pancreatic duct]] [[scars]]
|}
 
=== Common causes===
There are many causes of chronic pancreatitis. At least 70% of adult cases are associated with [[Alcohol abuse|chronic alcohol use]], primarily in patients who consume more than 80 g/day of [[alcohol]] over six to twelve years<ref>{{cite journal |journal=Am Fam Physician |date=2007 |volume=76 |issue=11 |pages=1679–88 |title= Chronic pancreatitis |author= Nair RJ, Lawler L, Miller MR |pmid=18092710 |url=http://www.aafp.org/afp/20071201/1679.html}}</ref><ref>Mitchell RMS et al. Pancreatitis. Lancet 2003; 361: 1447–55</ref>. Common causes of chronic pancreatitis may include:<ref>Mitchell RMS et al. Pancreatitis. Lancet 2003; 361: 1447–55</ref><ref>Frulloni et al. Chronic pancreatitis: Report from a multicenter Italian survey (PanCroInfAISP) on 893 patients. Dig Liver Dis. 2009 Apr;41(4):311-7</ref><ref>Adsay NV et al. Paraduodenal pancreatitis: a clinico-pathologically distinct entity unifying "cystic dystrophy of heterotopic pancreas", "para-duodenal wall cyst", and "groove pancreatitis". Semin Diagn Pathol. 2004 Nov;21(4):247-54. </ref>
* [[Alcohol]]<ref name="pmid11842000">{{cite journal |vauthors=Lu Z, Karne S, Kolodecik T, Gorelick FS |title=Alcohols enhance caerulein-induced zymogen activation in pancreatic acinar cells |journal=Am. J. Physiol. Gastrointest. Liver Physiol. |volume=282 |issue=3 |pages=G501–7 |year=2002 |pmid=11842000 |pmc=2830557 |doi=10.1152/ajpgi.00388.2001 |url=}}</ref><ref name="pmid6725910">{{cite journal |vauthors=Bisceglie AM, Segal I |title=Cirrhosis and chronic pancreatitis in alcoholics |journal=J. Clin. Gastroenterol. |volume=6 |issue=3 |pages=199–200 |year=1984 |pmid=6725910 |doi= |url=}}</ref><ref name="pmid4029715">{{cite journal |vauthors=Wilson JS, Bernstein L, McDonald C, Tait A, McNeil D, Pirola RC |title=Diet and drinking habits in relation to the development of alcoholic pancreatitis |journal=Gut |volume=26 |issue=9 |pages=882–7 |year=1985 |pmid=4029715 |pmc=1432860 |doi= |url=}}</ref><ref name="pmid14576495">{{cite journal |vauthors=Whitcomb DC |title=Genetic predisposition to alcoholic chronic pancreatitis |journal=Pancreas |volume=27 |issue=4 |pages=321–6 |year=2003 |pmid=14576495 |doi= |url=}}</ref><ref name="pmid15753536">{{cite journal |vauthors=Maisonneuve P, Lowenfels AB, Müllhaupt B, Cavallini G, Lankisch PG, Andersen JR, Dimagno EP, Andrén-Sandberg A, Domellöf L, Frulloni L, Ammann RW |title=Cigarette smoking accelerates progression of alcoholic chronic pancreatitis |journal=Gut |volume=54 |issue=4 |pages=510–4 |year=2005 |pmid=15753536 |pmc=1774435 |doi=10.1136/gut.2004.039263 |url=}}</ref><ref name="pmid15089909">{{cite journal |vauthors=Morton C, Klatsky AL, Udaltsova N |title=Smoking, coffee, and pancreatitis |journal=Am. J. Gastroenterol. |volume=99 |issue=4 |pages=731–8 |year=2004 |pmid=15089909 |doi=10.1111/j.1572-0241.2004.04143.x |url=}}</ref>
** ≥80 g of [[ethanol]] consumption every day for at least 5 years
** Most common cause in men
** Least common cause in women<ref name="pmid21029787">{{cite journal |vauthors=Coté GA, Yadav D, Slivka A, Hawes RH, Anderson MA, Burton FR, Brand RE, Banks PA, Lewis MD, Disario JA, Gardner TB, Gelrud A, Amann ST, Baillie J, Money ME, O'Connell M, Whitcomb DC, Sherman S |title=Alcohol and smoking as risk factors in an epidemiology study of patients with chronic pancreatitis |journal=Clin. Gastroenterol. Hepatol. |volume=9 |issue=3 |pages=266–73; quiz e27 |year=2011 |pmid=21029787 |pmc=3043170 |doi=10.1016/j.cgh.2010.10.015 |url=}}</ref>
* [[Autoimmunity]]
** [[Autoimmune pancreatitis]]
** Associated with other [[Systemic diseases|systemic disorders]] ([[Sjogren syndrome]], [[inflammatory bowel disease]], or [[Primary sclerosing cholangitis|primary biliary cholangitis]])<ref name="pmid7129026">{{cite journal |vauthors=Epstein O, Chapman RW, Lake-Bakaar G, Foo AY, Rosalki SB, Sherlock S |title=The pancreas in primary biliary cirrhosis and primary sclerosing cholangitis |journal=Gastroenterology |volume=83 |issue=6 |pages=1177–82 |year=1982 |pmid=7129026 |doi= |url=}}</ref><ref name="pmid8022761">{{cite journal |vauthors=Nishimori I, Yamamoto Y, Okazaki K, Morita M, Onodera M, Kino J, Tamura S, Yamamoto Y |title=Identification of autoantibodies to a pancreatic antigen in patients with idiopathic chronic pancreatitis and Sjögren's syndrome |journal=Pancreas |volume=9 |issue=3 |pages=374–81 |year=1994 |pmid=8022761 |doi= |url=}}</ref>
* Obstruction<ref name="pmid9219783">{{cite journal |vauthors=Tarnasky PR, Hoffman B, Aabakken L, Knapple WL, Coyle W, Pineau B, Cunningham JT, Cotton PB, Hawes RH |title=Sphincter of Oddi dysfunction is associated with chronic pancreatitis |journal=Am. J. Gastroenterol. |volume=92 |issue=7 |pages=1125–9 |year=1997 |pmid=9219783 |doi= |url=}}</ref>
** [[Fibrosis|Fibrotic]] [[stenosis]] of either the [[Ampulla of Vater|papilla of Vater]] or the main [[pancreatic duct]]
** [[Trauma]]
** [[Pseudocyst|Pseudocysts]]
** [[Gallstones]]
** Pancreaticobiliary [[tumors]] ([[pancreatic adenocarcinoma]], [[neuroendocrine tumors]], and intrapapillary [[mucinous]] [[tumors]])
** [[Pancreas divisum]]<ref name="pmid7728342">{{cite journal |vauthors=Lehman GA, Sherman S |title=Pancreas divisum. Diagnosis, clinical significance, and management alternatives |journal=Gastrointest. Endosc. Clin. N. Am. |volume=5 |issue=1 |pages=145–70 |year=1995 |pmid=7728342 |doi= |url=}}</ref><ref name="pmid4043675">{{cite journal |vauthors=Delhaye M, Engelholm L, Cremer M |title=Pancreas divisum: congenital anatomic variant or anomaly? Contribution of endoscopic retrograde dorsal pancreatography |journal=Gastroenterology |volume=89 |issue=5 |pages=951–8 |year=1985 |pmid=4043675 |doi= |url=}}</ref><ref name="pmid8885346">{{cite journal |vauthors=Sherman S, Hawes RH, Savides TJ, Gress FG, Ikenberry SO, Smith MT, Zaidi S, Lehman GA |title=Stent-induced pancreatic ductal and parenchymal changes: correlation of endoscopic ultrasound with ERCP |journal=Gastrointest. Endosc. |volume=44 |issue=3 |pages=276–82 |year=1996 |pmid=8885346 |doi= |url=}}</ref><ref name="pmid8885345">{{cite journal |vauthors=Smith MT, Sherman S, Ikenberry SO, Hawes RH, Lehman GA |title=Alterations in pancreatic ductal morphology following polyethylene pancreatic stent therapy |journal=Gastrointest. Endosc. |volume=44 |issue=3 |pages=268–75 |year=1996 |pmid=8885345 |doi= |url=}}</ref>
* [[Anatomic]] variations
** [[Pancreas divisum]]<ref name="pmid7728342">{{cite journal |vauthors=Lehman GA, Sherman S |title=Pancreas divisum. Diagnosis, clinical significance, and management alternatives |journal=Gastrointest. Endosc. Clin. N. Am. |volume=5 |issue=1 |pages=145–70 |year=1995 |pmid=7728342 |doi= |url=}}</ref><ref name="pmid4043675">{{cite journal |vauthors=Delhaye M, Engelholm L, Cremer M |title=Pancreas divisum: congenital anatomic variant or anomaly? Contribution of endoscopic retrograde dorsal pancreatography |journal=Gastroenterology |volume=89 |issue=5 |pages=951–8 |year=1985 |pmid=4043675 |doi= |url=}}</ref><ref name="pmid8885346">{{cite journal |vauthors=Sherman S, Hawes RH, Savides TJ, Gress FG, Ikenberry SO, Smith MT, Zaidi S, Lehman GA |title=Stent-induced pancreatic ductal and parenchymal changes: correlation of endoscopic ultrasound with ERCP |journal=Gastrointest. Endosc. |volume=44 |issue=3 |pages=276–82 |year=1996 |pmid=8885346 |doi= |url=}}</ref><ref name="pmid8885345">{{cite journal |vauthors=Smith MT, Sherman S, Ikenberry SO, Hawes RH, Lehman GA |title=Alterations in pancreatic ductal morphology following polyethylene pancreatic stent therapy |journal=Gastrointest. Endosc. |volume=44 |issue=3 |pages=268–75 |year=1996 |pmid=8885345 |doi= |url=}}</ref>
** Paraduodenal pancreatitis (cystic [[dystrophy]] of the [[duodenal]] wall/groove pancreatitis)<ref name="pmid20551662">{{cite journal |vauthors=Tezuka K, Makino T, Hirai I, Kimura W |title=Groove pancreatitis |journal=Dig Surg |volume=27 |issue=2 |pages=149–52 |year=2010 |pmid=20551662 |doi=10.1159/000289099 |url=}}</ref>
* [[Metabolic]] or [[systemic]] diseases
** [[Hypercalcemia]]
** [[Hyperparathyroidism]]<ref name="pmid7350371">{{cite journal |vauthors=Bess MA, Edis AJ, van Heerden JA |title=Hyperparathyroidism and pancreatitis. Chance or a causal association? |journal=JAMA |volume=243 |issue=3 |pages=246–7 |year=1980 |pmid=7350371 |doi= |url=}}</ref>
**[[Cystic fibrosis]]<ref name="pmid6617400">{{cite journal |vauthors=Masaryk TJ, Achkar E |title=Pancreatitis as initial presentation of cystic fibrosis in young adults. A report of two cases |journal=Dig. Dis. Sci. |volume=28 |issue=10 |pages=874–8 |year=1983 |pmid=6617400 |doi= |url=}}</ref>
** [[Systemic lupus erythematosus]]<ref name="pmid8425705">{{cite journal |vauthors=Borum M, Steinberg W, Steer M, Freedman S, White P |title=Chronic pancreatitis: a complication of systemic lupus erythematosus |journal=Gastroenterology |volume=104 |issue=2 |pages=613–5 |year=1993 |pmid=8425705 |doi= |url=}}</ref>
** [[Malnutrition]]
* [[Genetic]]
** [[Cystic fibrosis transmembrane conductance regulator|Cystic fibrosis transmembrane conductance regulator gene]] (''[[CFTR]]'')<ref name="pmid9725922">{{cite journal |vauthors=Cohn JA, Friedman KJ, Noone PG, Knowles MR, Silverman LM, Jowell PS |title=Relation between mutations of the cystic fibrosis gene and idiopathic pancreatitis |journal=N. Engl. J. Med. |volume=339 |issue=10 |pages=653–8 |year=1998 |pmid=9725922 |doi=10.1056/NEJM199809033391002 |url=}}</ref><ref name="pmid9725921">{{cite journal |vauthors=Sharer N, Schwarz M, Malone G, Howarth A, Painter J, Super M, Braganza J |title=Mutations of the cystic fibrosis gene in patients with chronic pancreatitis |journal=N. Engl. J. Med. |volume=339 |issue=10 |pages=645–52 |year=1998 |pmid=9725921 |doi=10.1056/NEJM199809033391001 |url=}}</ref><ref name="pmid16193325">{{cite journal |vauthors=Bishop MD, Freedman SD, Zielenski J, Ahmed N, Dupuis A, Martin S, Ellis L, Shea J, Hopper I, Corey M, Kortan P, Haber G, Ross C, Tzountzouris J, Steele L, Ray PN, Tsui LC, Durie PR |title=The cystic fibrosis transmembrane conductance regulator gene and ion channel function in patients with idiopathic pancreatitis |journal=Hum. Genet. |volume=118 |issue=3-4 |pages=372–81 |year=2005 |pmid=16193325 |doi=10.1007/s00439-005-0059-z |url=}}</ref><ref name="pmid11729110">{{cite journal |vauthors=Noone PG, Zhou Z, Silverman LM, Jowell PS, Knowles MR, Cohn JA |title=Cystic fibrosis gene mutations and pancreatitis risk: relation to epithelial ion transport and trypsin inhibitor gene mutations |journal=Gastroenterology |volume=121 |issue=6 |pages=1310–9 |year=2001 |pmid=11729110 |doi= |url=}}</ref><ref name="pmid25033378">{{cite journal |vauthors=LaRusch J, Jung J, General IJ, Lewis MD, Park HW, Brand RE, Gelrud A, Anderson MA, Banks PA, Conwell D, Lawrence C, Romagnuolo J, Baillie J, Alkaade S, Cote G, Gardner TB, Amann ST, Slivka A, Sandhu B, Aloe A, Kienholz ML, Yadav D, Barmada MM, Bahar I, Lee MG, Whitcomb DC |title=Mechanisms of CFTR functional variants that impair regulated bicarbonate permeation and increase risk for pancreatitis but not for cystic fibrosis |journal=PLoS Genet. |volume=10 |issue=7 |pages=e1004376 |year=2014 |pmid=25033378 |pmc=4102440 |doi=10.1371/journal.pgen.1004376 |url=}}</ref>
** [https://en.wikipedia.org/wiki/Chymotrypsin-C Chymotrypsin C gene (''CTRC'')]
** [[SPINK1|Pancreatic secretory trypsin inhibitor gene]] (''[[SPINK1]]'') <ref name="pmid10835640">{{cite journal |vauthors=Witt H, Luck W, Hennies HC, Classen M, Kage A, Lass U, Landt O, Becker M |title=Mutations in the gene encoding the serine protease inhibitor, Kazal type 1 are associated with chronic pancreatitis |journal=Nat. Genet. |volume=25 |issue=2 |pages=213–6 |year=2000 |pmid=10835640 |doi=10.1038/76088 |url=}}</ref> <ref name="pmid18059268">{{cite journal |vauthors=Rosendahl J, Witt H, Szmola R, Bhatia E, Ozsvári B, Landt O, Schulz HU, Gress TM, Pfützer R, Löhr M, Kovacs P, Blüher M, Stumvoll M, Choudhuri G, Hegyi P, te Morsche RH, Drenth JP, Truninger K, Macek M, Puhl G, Witt U, Schmidt H, Büning C, Ockenga J, Kage A, Groneberg DA, Nickel R, Berg T, Wiedenmann B, Bödeker H, Keim V, Mössner J, Teich N, Sahin-Tóth M |title=Chymotrypsin C (CTRC) variants that diminish activity or secretion are associated with chronic pancreatitis |journal=Nat. Genet. |volume=40 |issue=1 |pages=78–82 |year=2008 |pmid=18059268 |pmc=2650829 |doi=10.1038/ng.2007.44 |url=}}</ref>
** Cationic trypsinogen (''PRSS1'')
** [[Hereditary pancreatitis]]<ref name="pmid9219780">{{cite journal |vauthors=Sossenheimer MJ, Aston CE, Preston RA, Gates LK, Ulrich CD, Martin SP, Zhang Y, Gorry MC, Ehrlich GD, Whitcomb DC |title=Clinical characteristics of hereditary pancreatitis in a large family, based on high-risk haplotype. The Midwest Multicenter Pancreatic Study Group (MMPSG) |journal=Am. J. Gastroenterol. |volume=92 |issue=7 |pages=1113–6 |year=1997 |pmid=9219780 |doi= |url=}}</ref>
** [[Calcium-sensing receptor]] (''[[Calcium-sensing receptor|CASR]]'') [[gene]]
* [[Idiopathic]]
* [[Iatrogenic]]
** Post [[Endoscopic retrograde cholangiopancreatography|ERCP]] [[pancreatitis]]
 
=== Less common causes: ===
*Tropical pancreatitis:
**Tropical pancreatitis is one of the most common causes of chronic pancreatitis in tropical areas including South India, Africa, and South America.
**Tropical pancreatitis was thought to be caused by Cassava fruit but is 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>
**[[Nutritional deficiencies]] especially the [[micronutrients]] such as [[zinc]], [[copper]], and [[selenium]] may be involved in the [[pathogenesis]] of tropical pancreatitis.
**Tropical pancreatitis usually affects children leading to early adulthood death due to [[endocrine]] and [[exocrine]] dysfunction.
**[[SPINK1|Pancreatic secretory trypsin inhibitor gene]] (''[[SPINK1]]'') mutations are identified in a few patients.<ref name="pmid12360463">{{cite journal |vauthors=Bhatia E, Choudhuri G, Sikora SS, Landt O, Kage A, Becker M, Witt H |title=Tropical calcific pancreatitis: strong association with SPINK1 trypsin inhibitor mutations |journal=Gastroenterology |volume=123 |issue=4 |pages=1020–5 |year=2002 |pmid=12360463 |doi= |url=}}</ref><ref name="pmid12360464">{{cite journal |vauthors=Schneider A, Suman A, Rossi L, Barmada MM, Beglinger C, Parvin S, Sattar S, Ali L, Khan AK, Gyr N, Whitcomb DC |title=SPINK1/PSTI mutations are associated with tropical pancreatitis and type II diabetes mellitus in Bangladesh |journal=Gastroenterology |volume=123 |issue=4 |pages=1026–30 |year=2002 |pmid=12360464 |doi= |url=}}</ref>
*[[Hypertriglyceridemia]]<ref name="pmid213719">{{cite journal |vauthors=Cox DW, Breckenridge WC, Little JA |title=Inheritance of apolipoprotein C-II deficiency with hypertriglyceridemia and pancreatitis |journal=N. Engl. J. Med. |volume=299 |issue=26 |pages=1421–4 |year=1978 |pmid=213719 |doi=10.1056/NEJM197812282992601 |url=}}</ref>
*Scorpion sting
*Drugs:
**[[Metronidazole]]
**[[Mercaptopurine]]
**[[Valproate]]
**[[Isoniazid]]
**[[Corticosteroids]]


==References==
==References==

Latest revision as of 14:28, 31 January 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]

Overview

TIGAR-O (toxic metabolite, idiopathic, genetic, autoimmune, recurrent and acute, obstructive) classification system may be used for the etiologic classification of chronic pancreatitis. Toxic causes may include use of alcohol, tobacco smoking, hypercalcemia, hyperlipidemia, chronic renal failure, medications, and toxins. Genetic causes may include cationic trypsinogen gene (PRSS1) mutation, cystic fibrosis transmembrane conductance regulator (CFTR) gene mutation, calcium-sensing receptor (CASR) gene mutation, chymotrypsin C (CTRC) gene mutation, and mutation in the pancreatic secretory trypsin inhibitor gene (SPINK1). Less common causes may include hypertriglyceridemia, scorpion sting, tropical pancreatitis, and medications such as metronidazole, mercaptopurine, valproate, isoniazid and corticosteroids.

Causes

TIGAR-O (toxic metabolite, idiopathic, genetic, autoimmune, recurrent and acute, obstructive) etiologic classification of chronic pancreatitis includes:

Etiology Causes
Toxic-metabolic
Idiopathic
  • Early onset
  • Late onset
  • Tropical
Genetic
Autoimmune
Recurrent and severe acute pancreatitis
Obstructive

Common causes

There are many causes of chronic pancreatitis. At least 70% of adult cases are associated with chronic alcohol use, primarily in patients who consume more than 80 g/day of alcohol over six to twelve years[1][2]. Common causes of chronic pancreatitis may include:[3][4][5]

Less common causes:

References

  1. ↑ Nair RJ, Lawler L, Miller MR (2007). "Chronic pancreatitis". Am Fam Physician. 76 (11): 1679–88. PMID 18092710.
  2. ↑ Mitchell RMS et al. Pancreatitis. Lancet 2003; 361: 1447–55
  3. ↑ Mitchell RMS et al. Pancreatitis. Lancet 2003; 361: 1447–55
  4. ↑ Frulloni et al. Chronic pancreatitis: Report from a multicenter Italian survey (PanCroInfAISP) on 893 patients. Dig Liver Dis. 2009 Apr;41(4):311-7
  5. ↑ Adsay NV et al. Paraduodenal pancreatitis: a clinico-pathologically distinct entity unifying "cystic dystrophy of heterotopic pancreas", "para-duodenal wall cyst", and "groove pancreatitis". Semin Diagn Pathol. 2004 Nov;21(4):247-54.
  6. ↑ Lu Z, Karne S, Kolodecik T, Gorelick FS (2002). "Alcohols enhance caerulein-induced zymogen activation in pancreatic acinar cells". Am. J. Physiol. Gastrointest. Liver Physiol. 282 (3): G501–7. doi:10.1152/ajpgi.00388.2001. PMC 2830557. PMID 11842000.
  7. ↑ Bisceglie AM, Segal I (1984). "Cirrhosis and chronic pancreatitis in alcoholics". J. Clin. Gastroenterol. 6 (3): 199–200. PMID 6725910.
  8. ↑ Wilson JS, Bernstein L, McDonald C, Tait A, McNeil D, Pirola RC (1985). "Diet and drinking habits in relation to the development of alcoholic pancreatitis". Gut. 26 (9): 882–7. PMC 1432860. PMID 4029715.
  9. ↑ Whitcomb DC (2003). "Genetic predisposition to alcoholic chronic pancreatitis". Pancreas. 27 (4): 321–6. PMID 14576495.
  10. ↑ Maisonneuve P, Lowenfels AB, Müllhaupt B, Cavallini G, Lankisch PG, Andersen JR, Dimagno EP, Andrén-Sandberg A, Domellöf L, Frulloni L, Ammann RW (2005). "Cigarette smoking accelerates progression of alcoholic chronic pancreatitis". Gut. 54 (4): 510–4. doi:10.1136/gut.2004.039263. PMC 1774435. PMID 15753536.
  11. ↑ Morton C, Klatsky AL, Udaltsova N (2004). "Smoking, coffee, and pancreatitis". Am. J. Gastroenterol. 99 (4): 731–8. doi:10.1111/j.1572-0241.2004.04143.x. PMID 15089909.
  12. ↑ Coté GA, Yadav D, Slivka A, Hawes RH, Anderson MA, Burton FR, Brand RE, Banks PA, Lewis MD, Disario JA, Gardner TB, Gelrud A, Amann ST, Baillie J, Money ME, O'Connell M, Whitcomb DC, Sherman S (2011). "Alcohol and smoking as risk factors in an epidemiology study of patients with chronic pancreatitis". Clin. Gastroenterol. Hepatol. 9 (3): 266–73, quiz e27. doi:10.1016/j.cgh.2010.10.015. PMC 3043170. PMID 21029787.
  13. ↑ Epstein O, Chapman RW, Lake-Bakaar G, Foo AY, Rosalki SB, Sherlock S (1982). "The pancreas in primary biliary cirrhosis and primary sclerosing cholangitis". Gastroenterology. 83 (6): 1177–82. PMID 7129026.
  14. ↑ Nishimori I, Yamamoto Y, Okazaki K, Morita M, Onodera M, Kino J, Tamura S, Yamamoto Y (1994). "Identification of autoantibodies to a pancreatic antigen in patients with idiopathic chronic pancreatitis and Sjögren's syndrome". Pancreas. 9 (3): 374–81. PMID 8022761.
  15. ↑ Tarnasky PR, Hoffman B, Aabakken L, Knapple WL, Coyle W, Pineau B, Cunningham JT, Cotton PB, Hawes RH (1997). "Sphincter of Oddi dysfunction is associated with chronic pancreatitis". Am. J. Gastroenterol. 92 (7): 1125–9. PMID 9219783.
  16. ↑ 16.0 16.1 Lehman GA, Sherman S (1995). "Pancreas divisum. Diagnosis, clinical significance, and management alternatives". Gastrointest. Endosc. Clin. N. Am. 5 (1): 145–70. PMID 7728342.
  17. ↑ 17.0 17.1 Delhaye M, Engelholm L, Cremer M (1985). "Pancreas divisum: congenital anatomic variant or anomaly? Contribution of endoscopic retrograde dorsal pancreatography". Gastroenterology. 89 (5): 951–8. PMID 4043675.
  18. ↑ 18.0 18.1 Sherman S, Hawes RH, Savides TJ, Gress FG, Ikenberry SO, Smith MT, Zaidi S, Lehman GA (1996). "Stent-induced pancreatic ductal and parenchymal changes: correlation of endoscopic ultrasound with ERCP". Gastrointest. Endosc. 44 (3): 276–82. PMID 8885346.
  19. ↑ 19.0 19.1 Smith MT, Sherman S, Ikenberry SO, Hawes RH, Lehman GA (1996). "Alterations in pancreatic ductal morphology following polyethylene pancreatic stent therapy". Gastrointest. Endosc. 44 (3): 268–75. PMID 8885345.
  20. ↑ Tezuka K, Makino T, Hirai I, Kimura W (2010). "Groove pancreatitis". Dig Surg. 27 (2): 149–52. doi:10.1159/000289099. PMID 20551662.
  21. ↑ Bess MA, Edis AJ, van Heerden JA (1980). "Hyperparathyroidism and pancreatitis. Chance or a causal association?". JAMA. 243 (3): 246–7. PMID 7350371.
  22. ↑ Masaryk TJ, Achkar E (1983). "Pancreatitis as initial presentation of cystic fibrosis in young adults. A report of two cases". Dig. Dis. Sci. 28 (10): 874–8. PMID 6617400.
  23. ↑ Borum M, Steinberg W, Steer M, Freedman S, White P (1993). "Chronic pancreatitis: a complication of systemic lupus erythematosus". Gastroenterology. 104 (2): 613–5. PMID 8425705.
  24. ↑ Cohn JA, Friedman KJ, Noone PG, Knowles MR, Silverman LM, Jowell PS (1998). "Relation between mutations of the cystic fibrosis gene and idiopathic pancreatitis". N. Engl. J. Med. 339 (10): 653–8. doi:10.1056/NEJM199809033391002. PMID 9725922.
  25. ↑ Sharer N, Schwarz M, Malone G, Howarth A, Painter J, Super M, Braganza J (1998). "Mutations of the cystic fibrosis gene in patients with chronic pancreatitis". N. Engl. J. Med. 339 (10): 645–52. doi:10.1056/NEJM199809033391001. PMID 9725921.
  26. ↑ Bishop MD, Freedman SD, Zielenski J, Ahmed N, Dupuis A, Martin S, Ellis L, Shea J, Hopper I, Corey M, Kortan P, Haber G, Ross C, Tzountzouris J, Steele L, Ray PN, Tsui LC, Durie PR (2005). "The cystic fibrosis transmembrane conductance regulator gene and ion channel function in patients with idiopathic pancreatitis". Hum. Genet. 118 (3–4): 372–81. doi:10.1007/s00439-005-0059-z. PMID 16193325.
  27. ↑ Noone PG, Zhou Z, Silverman LM, Jowell PS, Knowles MR, Cohn JA (2001). "Cystic fibrosis gene mutations and pancreatitis risk: relation to epithelial ion transport and trypsin inhibitor gene mutations". Gastroenterology. 121 (6): 1310–9. PMID 11729110.
  28. ↑ LaRusch J, Jung J, General IJ, Lewis MD, Park HW, Brand RE, Gelrud A, Anderson MA, Banks PA, Conwell D, Lawrence C, Romagnuolo J, Baillie J, Alkaade S, Cote G, Gardner TB, Amann ST, Slivka A, Sandhu B, Aloe A, Kienholz ML, Yadav D, Barmada MM, Bahar I, Lee MG, Whitcomb DC (2014). "Mechanisms of CFTR functional variants that impair regulated bicarbonate permeation and increase risk for pancreatitis but not for cystic fibrosis". PLoS Genet. 10 (7): e1004376. doi:10.1371/journal.pgen.1004376. PMC 4102440. PMID 25033378.
  29. ↑ Witt H, Luck W, Hennies HC, Classen M, Kage A, Lass U, Landt O, Becker M (2000). "Mutations in the gene encoding the serine protease inhibitor, Kazal type 1 are associated with chronic pancreatitis". Nat. Genet. 25 (2): 213–6. doi:10.1038/76088. PMID 10835640.
  30. ↑ Rosendahl J, Witt H, Szmola R, Bhatia E, Ozsvári B, Landt O, Schulz HU, Gress TM, Pfützer R, Löhr M, Kovacs P, Blüher M, Stumvoll M, Choudhuri G, Hegyi P, te Morsche RH, Drenth JP, Truninger K, Macek M, Puhl G, Witt U, Schmidt H, Büning C, Ockenga J, Kage A, Groneberg DA, Nickel R, Berg T, Wiedenmann B, Bödeker H, Keim V, Mössner J, Teich N, Sahin-Tóth M (2008). "Chymotrypsin C (CTRC) variants that diminish activity or secretion are associated with chronic pancreatitis". Nat. Genet. 40 (1): 78–82. doi:10.1038/ng.2007.44. PMC 2650829. PMID 18059268.
  31. ↑ 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.
  32. ↑ 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.
  33. ↑ 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.
  34. ↑ 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.
  35. ↑ Cox DW, Breckenridge WC, Little JA (1978). "Inheritance of apolipoprotein C-II deficiency with hypertriglyceridemia and pancreatitis". N. Engl. J. Med. 299 (26): 1421–4. doi:10.1056/NEJM197812282992601. PMID 213719.


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