Chronic pancreatitis. A prospective nationwide study of 1,086 subjects from India.
BACKGROUND
Chronic pancreatitis is common in India. However, its risk factors are not clear. There is sparse data on the current prevalence of tropical pancreatitis in India.


OBJECTIVE
To undertake a prospective nationwide study of the risk factors and clinical profile of chronic pancreatitis.


METHODS
Thirty-two major centers from different regions of India contributed data on 1,086 patients to a common online website (www.ipans.org).


METHODS
Risk factors, clinical features complications and treatment of chronic pancreatitis.


RESULTS
Of the 1,086 subjects, complete data on risk factors were available for 1,033 subjects. Idiopathic pancreatitis was the most common form of pancreatitis (n=622; 60.2%) and alcoholic chronic pancreatitis accounted for about a third of the cases (n=400; 38.7%); the rest (n=11; 1.1%) had rare risk factors. Smoking and cassava intake were documented in 292 (28.3%) and 189 (18.3%) subjects, respectively. Using well-defined criteria, only 39 (3.8%)cases could be labeled as 'tropical pancreatitis'. Pain occurred in 971 patients (94.0%). Four hundred and eighteen (40.5%) subjects had diabetes mellitus. Of alcohol consumers, alcoholism and female gender were independent risk factors for diabetes in subjects with chronic pancreatitis (OR=1.48, P=0.003; and OR=1.75, P<0.001, respectively). The most common complications were pseudocysts (15.8%) and biliary obstruction (8.2%). Pancreatic cancer occurred in 42 subjects (4.1%). Ultrasound detected calculi in 69.7%, ductal dilatation in 63.4% and atrophy in 27.3%. The majority of patients were on medical therapy (n=849; 82.2%); endotherapy and surgery accounted for the rest. About 50% percent of the patients with diabetes required insulin (198/418).


CONCLUSIONS
In this first nationwide prospective survey of chronic pancreatitis in India, idiopathic pancreatitis was the most common form, followed by alcoholic pancreatitis. The classical form of tropical chronic pancreatitis is becoming less common.
Balakrishnan
Vallath
V
Amrita Institute of Medical Sciences, Cochin, India. vbalakrishnan@aims.amrita.edu
Unnikrishnan
Ambika Gopalakrishnan
AG
Thomas
Varghese
V
Choudhuri
Gourdas
G
Veeraraju
Peda
P
Singh
Shivram Prasad
SP
Garg
Pramod
P
Pai
Cannore Ganesh
CG
Devi
Raveendranathan Nair Sobhana
RN
Bhasin
Deepak
D
Jayanthi
Venkataraman
V
Premalatha
Narayanan
N
Chacko
Ashok
A
Kar
Premashish
P
Rai
Ramesh Roop
RR
Rajan
Ramesh
R
Subhalal
Narayanan
N
Mehta
Rajiv
R
Mishra
Sri Prakash
SP
Dwivedi
Manisha
M
Vinayakumar
Kattoor Ramakrishnan Nair
KR
Jain
Ashok Kumar
AK
Biswas
Kalidas
K
Mathai
Sunil
S
Varghese
Jaison
J
Ramesh
Hariharan
H
Alexander
Thomas
T
Philip
Jacob
J
Raj
Vigna Venugopal
VV
Vinodkumar
Ankarath
A
Mukevar
Srikanth
S
Sawant
Prabha
P
Nair
Prem
P
Kumar
Harish
H
Sudhindran
Surendran
S
Dhar
Puneet
P
Sudheer
Othayil Vayoth
OV
Sundaram
Karimassery Ramaiyer
KR
Tantri
Bailuru Vishwanath
BV
Singh
Devinder
D
Nath
Thekkayil Rajindra
TR