Asian chronic pancreatitis: The common and the unique

Abstract

Chronic pancreatitis (CP) is a disabling condition worldwide that presents as pain, maldigestion, and diabetes. It is usually perceived as alcohol related, or classified as idiopathic otherwise. However, this is true only for Western countries. Asian CP comprises not only alcohol-related CP but also tropical pancreatitis (TP). Tropical pancreatitis is a unique entity commonly found in South Asia. It shares similar presentations with other CPs for pain and maldigestion. However, its diabetes is more ketosis resistant. Non-surgical approach like endoscopic therapy plus extracoporeal shock wave lithotripsy provides better outcome for TP than other CPs, because of its less strictured pancreatic duct that is more amenable to endoscopic stone clearance. Diagnosis of CP in Asia mainly relies on image studies such as ultrasonography Ϯ computed tomography (CT) scan, and non-invasive tests on fecal chymotrypsin, serum trypsin, and serum pancreatic isoamylase. Endoscopic ultrasonography and intestinal tubing tests are used mainly in some research centers. Autoimmune pancreatitis (AIP) is another CP originated from Asia in large series and subsequently being recognized in the West. AIP patients seldom present with maldigestion until the disease progresses to a very late stage and this occurs in less than one third of patients. In contrast, AIP is usually presented as pseudotumor of the pancreatic head, causing obstructive jaundice. Immunoglobulin G4 level is typically elevated in AIP and can be used as a marker for responsiveness. Without a need of surgery, steroids are the standard treatment. Those who relapse and are resistant to steroids should be placed on long-term immunosuppressive agents.

Analytically validated protein biomarkers of chronic pancreatitis and pancreatic cancer for potential clinical diagnosis with mass spectrometry

“…Half of the patients with CP in China, India, and Japan were considered as idiopathic. Tropical pancreatitis is a form of idiopathic CP and affects young adults with the characteristics of diabetes and large calculi . Other toxic causes of CP include cigarette smoke, volatile hydrocarbons, and regular contact with kerosene or paraffin.…”

“…Tropical pancreatitis is a form of idiopathic CP and affects young adults with the characteristics of diabetes and large calculi. 12 Other toxic causes of CP include cigarette smoke, volatile hydrocarbons, and regular contact with kerosene or paraffin. Smoking is an independent risk factor of CP and smoking increases the risk of CP in a dose-dependent manner.…”

Pancreatitis autoinmune

“…Su prevalencia no está bien definida, hablándose de un 15% de las pancreatitis crónicas en las series médicas y un 26% de los procesos pancreáticos benignos en las series quirúrgicas 2 . Su distribución geográfica es mundial, aunque es más frecuente en los países asiáticos 3 .…”

Autoimmune Pancreatitis Accompanied by Eosinophilic Cholecystitis Diagnosed After Surgery: Report of a Case with Histopathological, Radiological, and Clinical Approach

“…6 In more than half of AIP patients, anticarbonic anhydrase II and anti-lactoferrin levels may be elevated. 12 An autoimmune pathogenesis has been proposed because the condition is occasionally associated with autoantibodies or other autoimmune-associated diseases. 6 Zamboni et al have reported Sjögren's syndrome being the most frequent autoimmune disease in patients with AIP.…”