title: Clinical and morphological characteristics of sporadic genetically determined pancreatitis as compared to idiopathic pancreatitis: higher risk of pancreatic cancer in CFTR variants.
abstract: OBJECTIVE
  Idiopathic pancreatitis is considered to be a multigenic and multifactorial disease. Genetically determined pancreatitis is associated with mutations in the PRSS1,SPINK1 and CFTR genes. This study aimed at examining the clinical and morphological characteristics of patients diagnosed with genetically determined sporadic pancreatitis.
  
  
  METHODS
  Inclusion criteria were the presence of PRSS1,CFTR or SPINK1 gene mutations in patients with idiopathic recurrent or chronic pancreatitis. Patients with hereditary pancreatitis were excluded. Age- and sex-matched patients with idiopathic pancreatitis and negative genetic testing served as controls (n = 68).
  
  
  RESULTS
  Genetic testing was performed in 351 probands referred to our centre since 1999. Sixty-one patients (17.4%) carried at least 1 detected mutation in 1 of the 3 tested genes (34 CFTR, 10 PRSS1 and 13 SPINK1 mutations), and 4 patients showed a combination of mutations. Follow-up has been currently extended to a median of 5 years (range 1-40). Similar clinical features were noted in the case and matched groups except for an earlier age of onset of pancreatic symptoms and a higher incidence of pancreatic cancer in the case group and in patients with CFTR mutations compared to the control group (p < 0.05). The standardized incidence ratio, the ratio of observed to expected pancreatic cancers, averaged 26.5 (95% confidence interval 8.6-61.9). All pancreatic cancer patients were smokers.
  
  
  CONCLUSIONS
  Clinical parameters of patients with sporadic idiopathic pancreatitis and gene mutations are similar to those of age- and sex-matched patients without gene mutations, except for the age of pancreatic disease onset. A significantly higher occurrence of pancreas cancer was observed in the case group, particularly in those patients carrying CFTR mutations. We therefore suggest to include patients with CFTR variants presenting with risk factors in a screening and surveillance programme and to strongly advise them to stop smoking.
authors.affiliation: Hepato-Gastroenterology Department, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Coralie
authors.initials: C
authors.lastname: Hamoir
authors.forename: Xavier
authors.initials: X
authors.lastname: Pepermans
authors.forename: Hubert
authors.initials: H
authors.lastname: Piessevaux
authors.forename: Anne
authors.initials: A
authors.lastname: Jouret-Mourin
authors.forename: Birgit
authors.initials: B
authors.lastname: Weynand
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Habyalimana
authors.forename: Teresinha
authors.initials: T
authors.lastname: Leal
authors.forename: André
authors.initials: A
authors.lastname: Geubel
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Gigot
authors.forename: Pierre H
authors.initials: PH
authors.lastname: Deprez
mesh_terms: D000230:Adenocarcinoma / Q000235:genetics*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002352:Carrier Proteins / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D019005:Cystic Fibrosis Transmembrane Conductance Regulator / Q000235:genetics*; D018572:Disease-Free Survival; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000235:genetics*; D050500:Pancreatitis, Chronic / Q000235:genetics* / Q000601:surgery; D012008:Recurrence; D014357:Trypsin / Q000235:genetics; D014359:Trypsin Inhibitor, Kazal Pancreatic; D055815:Young Adult
chemical_list: C505032:CFTR protein, human; D002352:Carrier Proteins; C486642:SPINK1 protein, human; D019005:Cystic Fibrosis Transmembrane Conductance Regulator; D014359:Trypsin Inhibitor, Kazal Pancreatic; C489303:PRSS1 protein, human; D014357:Trypsin