Chronic pancreatitis classification

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

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Classification

Chronic pancreatitis may be divided based on underlying morphology into:

• Large-duct type
• Small-duct type
  • With calcification
  • Without calcification.

Classification of chronic pancreatitis	Year	Objectives/Criteria/Definitions
Clinical description	1946	Description of the clinical presentation of chronic pancreatitis and its association with increased alcohol consumption
Marseille	1963	Description of morphologic characteristics and etiological factors of the disease No discussion of the correlation between anatomic and functional changes No categorization according to disease severity or clinical presentation No inclusion of pancreatic imaging findings
Marseille	1984	Further description and subclassification of morphological changes “Obstructive chronic pancreatitis” listed as distinct form No discussion of the correlation between anatomic and functional changes No categorization according to disease severity or clinical presentation No inclusion of pancreatic imaging findings
Marseille-Rome	1988	Description of “chronic calcifying” and “chronic inflammatory” pancreatitis as distinct forms Description of etiological factors No further elaboration of clinical, functional, or imaging criteria
Cambridge	1984
Cambridge stages	1994
Japan Pancreas Society	1997
Zürich Workshop	1997
TIGAR-O	2001
ABC grading system	2002
Manchester system	2006

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.

Hereditary pancreatitis:

• Hereditary pancreatitis is a subtype of chronic pancreatitis.
• It is an autosomal dominant inheritance with 80% of penetrance rate.
• 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:

• It 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.
• 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.

Idiopathic pancreatitis:

• Idiopathic pancreatitis usually includes the non-alcohol induced cases of chronic pancreatitis
• Usually accounts for 30% of cases
• It may be classified into early onset and late-onset forms.
• Contributing factors may include:
  • Concealed alcohol intake
  • Hypersensitivity to alcohol
  • Unreported pancreatic trauma
  • Mutations in the cationic trypsinogen gene and the cystic fibrosis gene