Atsushi Masamune1, Tatsuhide Nabeshima2, Kazuhiro Kikuta2, Shin Hamada2, Eriko Nakano2, Kiyoshi Kume2, Atsushi Kanno2, Ai Sato3,4, Yuichi Tachibana5, Osamu Inatomi6, Satoshi Yamamoto7, Tsukasa Ikeura8, Seiji Futagami9, Masashi Taguchi10, Keiji Hanada11, Kyoko Shimizu12, Masanobu Kageoka13, Tomotaka Saito14, Takaaki Eguchi15, Kensuke Kubota16, Mamoru Takenaka17, Atsushi Mima18, Atsushi Irisawa3,4, Tetsuhide Ito5, Akira Andoh6, Kazuo Inui7, Yoshifumi Takeyama19, Hiroki Yamaue20, Kazuichi Okazaki8, Tooru Shimosegawa2. 1. Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan. amasamune@med.tohoku.ac.jp. 2. Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan. 3. Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan. 4. Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan. 5. Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 6. Department of Medicine, Shiga University of Medical Science, Otsu, Japan. 7. Department of Gastroenterology, Bantane Hospital, Fujita Health University, Nagoya, Japan. 8. Department of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan. 9. Department of Internal Medicine, Division of Gastroenterology, Nippon Medical School, Tokyo, Japan. 10. Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan. 11. Department of Gastroenterology, JA Onomichi General Hospital, Onomichi, Japan. 12. Department of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. 13. Department of Gastroenterology, Fujieda Municipal Hospital, Fujieda, Japan. 14. Department of Gastroenterology, University of Tokyo, Tokyo, Japan. 15. Department of Gastroenterology and Hepatology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan. 16. Department of Endoscopy, Yokohama City University Hospital, Yokohama, Japan. 17. Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan. 18. Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan. 19. Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan. 20. Second Department of Surgery, Wakayama Medical University, Wakayama, Japan.
Abstract
BACKGROUND: Chronic pancreatitis (CP) is a fibro-inflammatory disease of the pancreas. Early diagnosis and intervention, before CP becomes established and irreversible, are essential to improve the long-term outcomes. The world's first diagnostic criteria for early CP were proposed in Japan in 2009, but their clinical utility remains elusive. This study aimed to clarify whether patients with early CP progress to definite CP. METHODS: This is a multicenter, prospective study. Patients diagnosed as having early CP according to the Japanese diagnostic criteria were prospectively followed for 2 years. Clinical profiles including symptoms, drinking and smoking status, laboratory data, imaging findings and treatments were analyzed. RESULTS: Among the 83 patients who completed the 2-year follow-up period, four (4.8%) patients progressed to definite CP. The diagnosis of 48 (57.8%) patients was unchanged, and that of 31 (37.3%) patients was downgraded. All the four progressive patients were male, alcohol-related, smokers (3 current and 1 ever), and continued drinking. Comparison of the clinical profiles between the progression group (n = 4) and non-progression group (n = 79) revealed that etiology (alcohol-related), smoking status and presence of acute pancreatitis episodes were associated with the progression to definite CP. CONCLUSIONS: The Japanese diagnostic criteria could identify some patients before the progression to definite CP, while the majority of the patients did not progress. TRIAL REGISTRATION NUMBER: UMIN000015992.
BACKGROUND:Chronic pancreatitis (CP) is a fibro-inflammatory disease of the pancreas. Early diagnosis and intervention, before CP becomes established and irreversible, are essential to improve the long-term outcomes. The world's first diagnostic criteria for early CP were proposed in Japan in 2009, but their clinical utility remains elusive. This study aimed to clarify whether patients with early CP progress to definite CP. METHODS: This is a multicenter, prospective study. Patients diagnosed as having early CP according to the Japanese diagnostic criteria were prospectively followed for 2 years. Clinical profiles including symptoms, drinking and smoking status, laboratory data, imaging findings and treatments were analyzed. RESULTS: Among the 83 patients who completed the 2-year follow-up period, four (4.8%) patients progressed to definite CP. The diagnosis of 48 (57.8%) patients was unchanged, and that of 31 (37.3%) patients was downgraded. All the four progressive patients were male, alcohol-related, smokers (3 current and 1 ever), and continued drinking. Comparison of the clinical profiles between the progression group (n = 4) and non-progression group (n = 79) revealed that etiology (alcohol-related), smoking status and presence of acute pancreatitis episodes were associated with the progression to definite CP. CONCLUSIONS: The Japanese diagnostic criteria could identify some patients before the progression to definite CP, while the majority of the patients did not progress. TRIAL REGISTRATION NUMBER: UMIN000015992.
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