Chronic pancreatitis risk factors

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]

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Overview

The M-ANNHEIM multiple risk factor classification of chronic pancreatitis includes multiple risk factors such as alcohol consumption, nicotine consumption, nutritional factors, hereditary factors, efferent duct factors, immunological factors, miscellaneous and rare metabolic factors. Common risk factors may include alcohol abuse, cigarette smoking, genetic mutations (PRSS1 mutations, SPINK1 mutations, CFTR mutations, and CTRC mutations), obstructive causes and hypercalcemia. Less common risk factors include sphincter of Oddi dysfunction, hyperlipidemia, metabolic diseases such as branched-chain organic aciduria and chronic renal failure.

Risk Factors

The M-ANNHEIM multiple risk factor classification of chronic pancreatitis

Risk factor	Sub-category
Multiple risk factors
Alcohol consumption	Excessive consumption (>80 g/day) Increased consumption (20–80 g/day) Moderate consumption (<20 g/day)
Nicotine consumption	In cigarette smokers: description of nicotine consumption by pack-years
Nutritional factors	Nutrition (e.g., high caloric proportion of fat and protein) Hyperlipidemia
Hereditary factors	Hereditary pancreatitis Familial pancreatitis Early-onset idiopathic pancreatitis Late-onset idiopathic pancreatitis Tropical pancreatitis (possible mutations in the PRSS1, CFTR, or SPINK1 genes)
Efferent duct factors	Pancreas divisum Annular pancreas and other congenital abnormalities of the pancreas Pancreatic duct obstruction (e.g., tumors) Posttraumatic pancreatic duct scars Sphincter of Oddi dysfunction
Immunological Factors	Autoimmune pancreatitis Sjögren syndrome-associated chronic pancreatitis Inflammatory bowel disease-associated chronic pancreatitis Chronic pancreatitis with autoimmune diseases (e.g., primary sclerosing cholangitis, primary biliary cirrhosis)
Miscellaneous and rare metabolic factors	Hypercalcemia and hyperparathyroidism Chronic renal failure Drugs Toxins

Common risk factors

Common risk factors in the development of chronic pancreatitis include:

Alcohol abuse^[1]^[2]^[3]^[4]^[5]^[6]
Cigarette smoking^[7]^[8]^[9]
Genetic mutations:
- PRSS1 mutations
- SPINK1 mutations
- CFTR mutations
- CTRC mutations
Obstructive factors:
- Pancreas divisum
- Gallstones
- Pancreatic duct malunion or obstruction
- Choledocholithiasis
- Pancreatic head tumors
Hypercalcemia

Less common risk factors

Less common risk factors in the development of chronic pancreatitis include:

Sphincter of Oddi dysfunction^[10]
Hyperlipidemia
Metabolic diseases such as branched-chain organic aciduria
Chronic renal failure

References

↑ Lu Z, Karne S, Kolodecik T, Gorelick FS (2002). “Alcohols enhance caerulein-induced zymogen activation in pancreatic acinar cells”. Am. J. Physiol. Gastrointest. Liver Physiol. 282 (3): G501–7. doi:10.1152/ajpgi.00388.2001. PMC 2830557. PMID 11842000.
↑ Bisceglie AM, Segal I (1984). “Cirrhosis and chronic pancreatitis in alcoholics”. J. Clin. Gastroenterol. 6 (3): 199–200. PMID 6725910.
↑ Wilson JS, Bernstein L, McDonald C, Tait A, McNeil D, Pirola RC (1985). “Diet and drinking habits in relation to the development of alcoholic pancreatitis”. Gut. 26 (9): 882–7. PMC 1432860. PMID 4029715.
↑ Whitcomb DC (2003). “Genetic predisposition to alcoholic chronic pancreatitis”. Pancreas. 27 (4): 321–6. PMID 14576495.
↑ Maisonneuve P, Lowenfels AB, Müllhaupt B, Cavallini G, Lankisch PG, Andersen JR, Dimagno EP, Andrén-Sandberg A, Domellöf L, Frulloni L, Ammann RW (2005). “Cigarette smoking accelerates progression of alcoholic chronic pancreatitis”. Gut. 54 (4): 510–4. doi:10.1136/gut.2004.039263. PMC 1774435. PMID 15753536.
↑ Morton C, Klatsky AL, Udaltsova N (2004). “Smoking, coffee, and pancreatitis”. Am. J. Gastroenterol. 99 (4): 731–8. doi:10.1111/j.1572-0241.2004.04143.x. PMID 15089909.
↑ Coté GA, Yadav D, Slivka A, Hawes RH, Anderson MA, Burton FR, Brand RE, Banks PA, Lewis MD, Disario JA, Gardner TB, Gelrud A, Amann ST, Baillie J, Money ME, O’Connell M, Whitcomb DC, Sherman S (2011). “Alcohol and smoking as risk factors in an epidemiology study of patients with chronic pancreatitis”. Clin. Gastroenterol. Hepatol. 9 (3): 266–73, quiz e27. doi:10.1016/j.cgh.2010.10.015. PMC 3043170. PMID 21029787.
↑ Yadav D, Hawes RH, Brand RE, Anderson MA, Money ME, Banks PA, Bishop MD, Baillie J, Sherman S, DiSario J, Burton FR, Gardner TB, Amann ST, Gelrud A, Lawrence C, Elinoff B, Greer JB, O’Connell M, Barmada MM, Slivka A, Whitcomb DC (2009). “Alcohol consumption, cigarette smoking, and the risk of recurrent acute and chronic pancreatitis”. Arch. Intern. Med. 169 (11): 1035–45. doi:10.1001/archinternmed.2009.125. PMID 19506173.
↑ Bourliere M, Barthet M, Berthezene P, Durbec JP, Sarles H (1991). “Is tobacco a risk factor for chronic pancreatitis and alcoholic cirrhosis?”. Gut. 32 (11): 1392–5. PMC 1379175. PMID 1752475.
↑ Tarnasky PR, Hoffman B, Aabakken L, Knapple WL, Coyle W, Pineau B, Cunningham JT, Cotton PB, Hawes RH (1997). “Sphincter of Oddi dysfunction is associated with chronic pancreatitis”. Am. J. Gastroenterol. 92 (7): 1125–9. PMID 9219783.

Template:WikiDoc Sources

[pmid11842000-1] Lu Z, Karne S, Kolodecik T, Gorelick FS (2002). “Alcohols enhance caerulein-induced zymogen activation in pancreatic acinar cells”. Am. J. Physiol. Gastrointest. Liver Physiol. 282 (3): G501–7. doi:10.1152/ajpgi.00388.2001. PMC 2830557. PMID 11842000.

[pmid6725910-2] Bisceglie AM, Segal I (1984). “Cirrhosis and chronic pancreatitis in alcoholics”. J. Clin. Gastroenterol. 6 (3): 199–200. PMID 6725910.

[pmid4029715-3] Wilson JS, Bernstein L, McDonald C, Tait A, McNeil D, Pirola RC (1985). “Diet and drinking habits in relation to the development of alcoholic pancreatitis”. Gut. 26 (9): 882–7. PMC 1432860. PMID 4029715.

[pmid14576495-4] Whitcomb DC (2003). “Genetic predisposition to alcoholic chronic pancreatitis”. Pancreas. 27 (4): 321–6. PMID 14576495.

[pmid15753536-5] Maisonneuve P, Lowenfels AB, Müllhaupt B, Cavallini G, Lankisch PG, Andersen JR, Dimagno EP, Andrén-Sandberg A, Domellöf L, Frulloni L, Ammann RW (2005). “Cigarette smoking accelerates progression of alcoholic chronic pancreatitis”. Gut. 54 (4): 510–4. doi:10.1136/gut.2004.039263. PMC 1774435. PMID 15753536.

[pmid15089909-6] Morton C, Klatsky AL, Udaltsova N (2004). “Smoking, coffee, and pancreatitis”. Am. J. Gastroenterol. 99 (4): 731–8. doi:10.1111/j.1572-0241.2004.04143.x. PMID 15089909.

[pmid21029787-7] Coté GA, Yadav D, Slivka A, Hawes RH, Anderson MA, Burton FR, Brand RE, Banks PA, Lewis MD, Disario JA, Gardner TB, Gelrud A, Amann ST, Baillie J, Money ME, O’Connell M, Whitcomb DC, Sherman S (2011). “Alcohol and smoking as risk factors in an epidemiology study of patients with chronic pancreatitis”. Clin. Gastroenterol. Hepatol. 9 (3): 266–73, quiz e27. doi:10.1016/j.cgh.2010.10.015. PMC 3043170. PMID 21029787.

[pmid19506173-8] Yadav D, Hawes RH, Brand RE, Anderson MA, Money ME, Banks PA, Bishop MD, Baillie J, Sherman S, DiSario J, Burton FR, Gardner TB, Amann ST, Gelrud A, Lawrence C, Elinoff B, Greer JB, O’Connell M, Barmada MM, Slivka A, Whitcomb DC (2009). “Alcohol consumption, cigarette smoking, and the risk of recurrent acute and chronic pancreatitis”. Arch. Intern. Med. 169 (11): 1035–45. doi:10.1001/archinternmed.2009.125. PMID 19506173.

[pmid1752475-9] Bourliere M, Barthet M, Berthezene P, Durbec JP, Sarles H (1991). “Is tobacco a risk factor for chronic pancreatitis and alcoholic cirrhosis?”. Gut. 32 (11): 1392–5. PMC 1379175. PMID 1752475.

[pmid9219783-10] Tarnasky PR, Hoffman B, Aabakken L, Knapple WL, Coyle W, Pineau B, Cunningham JT, Cotton PB, Hawes RH (1997). “Sphincter of Oddi dysfunction is associated with chronic pancreatitis”. Am. J. Gastroenterol. 92 (7): 1125–9. PMID 9219783.

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