Descriptive study of chronic calcific pancreatitis in Sri Lanka

Abstract

Objectives To describe the potential risk factors, clinical features, biochemical and radiological features, and management of chronic calcific pancreatitis.Design Cross-sectional descriptive study.Setting Tertiary care general hospital.Patients Fifty patients with pancreatic calcification referred to the Colombo South Teaching Hospital, and 50 agematched controls from healthy relatives or friends of the patients.Measurement Height and weight measurements, immunoreactive insulin levels and trypsin levels of duodenal aspirates were estimated. Plain abdominal xray and ultrasonography were performed.Intervention Endoscopic retrograde cholangiopancreaticography (ERCP) was attempted on all patients during which duodenal aspirates were collected. Success rates of ERCP and response to endotherapeutic procedures were recorded.Results Twenty two of the 50 chronic calcific pancreatitis (CP) patients were diagnosed to have chronic alcoholic calcific pancreatitis (CACP). Mean age of the CACP patients was significantly higher than that of the chronic calcific pancreatitis of the tropics (CCPT) patients. Severe malnutrition (BMI < 20), frequent consumption of Manihot esculenta (manioc, cassava) and a high consumption of chilli or pepper were identified as possible risk factors for both alcoholic and non-alcoholic CP. Onset of diabetes occurred at a much younger age in the CCPT group than in the CACP group. Mean serum insulin was significantly higher in the CCPT group than in the CACP group and duodenal trypsin level was significantly lower in the CCPT than in CACP group.Conclusions Our results confirm the existence of both alcoholic (CACP) and non-alcoholic (CCPT) types of chronic calcific pancreatitis in Sri Lanka. A larger study is required to confirm the associated risk factors such as Manihot esculenta and foods with a high content of chilli or pepper. IntroductionChronic pancreatitis (CP) is a disease that can lead to many serious complications such as jaundice, duodenal obstruction, pseudocyst, haemorrhage, diabetes, and cancer of the pancreas [1,2]. Presence of pancreatic calculi is a hallmark of chronic pancreatitis [3 ]. Chronic alcohol abuse is the most common cause of chronic calcific pancreatitis in the west [3,4], although only 5-10% of alcoholics develop CP. This suggests that other factors are important in its pathogenesis [5]. An idiopathic, nonalcoholic form of chronic calcific pancreatitis, referred to as chronic calcific pancreatitis of the tropics (CCPT), has been reported from south India and other tropical and sub-tropical regions of the world [6]. CCPT is the most common cause of CP in India [4,7,8]. CCPT is characterised by recurrent abdominal pain and extensive pancreatic calcification in younger age groups. Genetic predisposition, malnutrition, cyanogenic alkaloids derived from Manihot esculenta and other sources have been implicated as important risk factors associated with the pathogenesis of this condition [9][10][11]. However, malnutrition and M. esculenta consumption as risk factors for ...

Clinical characteristics and quality of life among Sri Lankan patients with chronic pancreatitis

“…A previous study on CP in Sri Lanka was conducted during 2001 to 2003 among 50 patients with chronic calcific pancreatitis. 4 The patient age and male predominance was comparable to the findings of the present study. Around 44% of patients in that previous study had a history of alcohol consumption whereas the proportion in our study was much higher (62%).…”

“…Persistent dyspepsia, steatorrhea, and jaundice were present in 42.7%, 57.3%, and 54.4% of patients, respectively. A multidisciplinary approach that includes a pain management specialist, psychiatrist, and social worker may be needed to control 4 The patient age and male predominance was comparable to the findings of the present study. Around 44% of patients in that previous study had a history of alcohol consumption whereas the proportion in our study was much higher (62%).…”

“…In that past study, the prevalence of diabetes was 22% in the group with alcoholic pancreatitis and 43% in the non-alcoholic group, which was considerably lower than the proportions in the present study (70%). The authors of the previous study showed that the onset of diabetes was earlier in the non-alcoholic group than in the alcoholic group; 4 the symptom profile and QOL were not studied. 4 …”

“…The authors of the previous study showed that the onset of diabetes was earlier in the non-alcoholic group than in the alcoholic group; 4 the symptom profile and QOL were not studied. 4 QOL in Sri Lankan patients with CP has not been previously studied. Among our study participants, QOL was moderate to poor, with the lowest QOL scores for pain and overall symptom subscales.…”

“…Only one previous study conducted over 15 years ago describes the clinical characteristics of CP in Sri Lanka. 4 Furthermore, QOL in Sri Lankan patients with CP has not been studied previously. Therefore, we aimed to describe the clinical characteristics and analyze QOL among patients with CP in a resource-limited setting, and to identify its contributing factors.…”