Chronic pancreatitis diagnostic criteria

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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]

Diagnostic Criteria

M-ANNHEIM diagnostic criteria for chronic pancreatitis

• The diagnosis usually requires a typical history of chronic pancreatitis (recurrent pancreatitis or abdominal pain).
• The diagnosis for the various forms of chronic pancreatitis can be established by the following features.

Form of chronic pancreatitis	Diagnostic criteria
Definite chronic pancreatitis	Established by one or more of the following additional criteria: Pancreatic calcifications Moderate or marked ductal lesions (according to the Cambridge classification) Marked and persistent exocrine insufficiency defined as pancreatic steatorrhea markedly reduced by enzyme supplementation Typical histology of an adequate histological specimen
Probable chronic pancreatitis	Established by one or more of the following additional criteria: Mild ductal alterations (according to the Cambridge classification) Recurrent or persistent pseudocysts Pathological test of pancreatic exocrine function (such as fecal elastase-1 test, secretin test, secretin–pancreozymin test) Endocrine insufficiency (i.e., abnormal glucose tolerance test)
Borderline chronic pancreatitis	Established as a first episode of acute pancreatitis with or without: A family history of pancreatic disease (i.e., other family members with acute pancreatitis or pancreatic cancer) The presence of M-ANNHEIM risk factors
Pancreatitis associated with alcohol consumption	Requires in addition to the above-mentioned criteria for definite, probable, or borderline chronic pancreatitis one of the following features: History of excessive alcohol intake (>80 g/day for some years in men, smaller amounts in women) or History of increased alcohol intake (20–80 g/day for some years) or History of moderate alcohol intake (<20 g/day for some years)

M-ANNHEIM pancreatic imaging criteria for US, CT, MRI/MRCP, and EUS based on imaging features as defined by the Cambridge classification

Cambridge grading	CT, US, MRI/MRCP	EUS
Normal	Quality study depicting whole gland without abnormal features
Equivocal	One abnormal feature	Four or fewer abnormal features (no differentiation between equivocal and mild)
Mild changes	Two or more abnormal features, but normal main pancreatic duct
Moderate changes	Two or more abnormal features, including minor main Five or more abnormal features pancreatic duct abnormalities (either enlargement between 2 and 4 mm or increased echogenicity of the duct wall)	Five or more abnormal features (no differentiation between moderate and marked)
Marked changes	As above with one or more of the required features of marked changes