American Pancreatic Association practice guidelines for chronic pancreatitis

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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]

American Pancreatic Association Practice Guidelines in Chronic Pancreatitis: Evidence-Based Report on Diagnostic Guidelines

Epidemiology and Risk Factors:

Recommendation	Evidence Level	Strength of Recommendation
Data on population-based estimates of CP are emerging.	Low	Conditional
A small fraction of patients progress from AP to CP.	Moderate	Conditional
Alcohol and smoking are independent risk factors for CP. Both are associated with disease progression, and their risks are likely multiplicative.	High	Strong
The spectrum of risk factors for CP has broadened.	Low	Conditional
Genetic discoveries are rapidly uncovering new susceptibility factors. Knowledge of gene and gene-environment interactions may translate into new diagnostic and treatment paradigms.	Moderate	Strong

Pathologic Definitions:

The usual level of evidence statements are generally not used in anatomic pathology.

Recommendation
Chronic pancreatitis is characterized by atrophy and fibrosis of the exocrine tissue with or without chronic inflammation.
Scarring of the parenchyma may be focal, patchy, or diffuse.
Progressive fibrosis and atrophy may lead to exocrine insufficiency (steatorrhea) followed by endocrine insufficiency (diabetes).
Autoimmune pancreatitis can mimic pancreas carcinoma.

Ultrasound and Computed Tomography:

Recommendation	Evidence Level	Strength of Recommendation
Ultrasound and CT are best for the late findings of CP but are limited in the diagnosis of early or mild pancreatitis.	Moderate	Conditional
Intraductal pancreatic calcifications are the most specific and reliable sonographic and CT signs of CP.	Moderate	Strong
Computed tomography is helpful for the diagnosis of complications of CP.	Moderate	Strong
Computed tomography is helpful for diagnosis of other conditions that can mimic CP.	Low	Conditional