Skip to main content
SpringerLink
Log in

Evaluation and Management of Suspected Early Chronic Pancreatitis (ECP)

  • Pancreas and Biliary Tract (O Haluszka and H Gavini, Section Editors)
  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Chronic pancreatitis in the advanced stages leads to significant health care utilization because of the associated complications. Early-stage diagnosis could prevent the development of these complications by appropriate management. In this article, we reviewed the recent evidence pertaining to the diagnosis and management of early chronic pancreatitis (ECP).

Recent Findings

The working group for the International Consensus Guidelines for Chronic Pancreatitis has published consensus-based statements to streamline the diagnosis of ECP. There is no international consensus on the definition and diagnosis of ECP. The Revised Japanese Diagnostic Criteria for ECP based on clinical features and endoscopic ultrasound findings have been proposed. Large prospective cohort studies are needed to develop and validate internationally acceptable diagnostic criteria.

Summary

ECP is recognized as a distinct stage in the development and progression of CP. Consensus-based definitions and diagnostic criteria need to be developed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

AP:

Acute pancreatitis

CP:

Chronic pancreatitis

ECP:

Early chronic pancreatitis

EUS:

Endoscopic ultrasound

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Sarner M, Cotton PB. Classification of pancreatitis. Gut. 1984;25(7):756–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Walsh TN, Rode J, Theis BA, Russell RC. Minimal change chronic pancreatitis. Gut. 1992;33(11):1566–71.

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Ammann RW, Heitz PU, Kloppel GÜ. Course of alcoholic chronic pancreatitis: a prospective clinicomorphological long-term study. Gastroenterology. 1996;111(1):224–31.

    CAS  PubMed  Google Scholar 

  4. Singer MV, Gyr K, Sarles H. Revised classification of pancreatitis: report of the second international symposium on the classification of pancreatitis in Marseille, France, March 28–30, 1984. Gastroenterology. 1985;89(3):683–5.

    CAS  PubMed  Google Scholar 

  5. Klöppel G, Maillet B. Chronic pancreatitis: evolution of the disease. Hepatogastroenterology. 1991;38(5):408–12.

    PubMed  Google Scholar 

  6. Whitcomb DC. Hereditary pancreatitis: new insights into acute and chronic pancreatitis. Gut. 1999;45(3):317–22.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. •• Whitcomb DC, Shimosegawa T, Chari ST, Forsmark CE, Frulloni L, Garg P, et al. International consensus statements on early chronic Pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with The International Association of Pancreatology, American Pancreatic Association, Japan Pancreas Society, PancreasFest Working Group and European Pancreatic Club. Pancreatology. 2018;18(5):516–27 This is a very important article that discusses the consensus statements relating to ECP.

    Google Scholar 

  8. Machicado JD, Yadav D. Epidemiology of recurrent acute and chronic pancreatitis: similarities and differences. Dig Dis Sci. 2017;62(7):1683–91.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Sankaran SJ, Xiao AY, Wu LM, Windsor JA, Forsmark CE, Petrov MS. Frequency of progression from acute to chronic pancreatitis and risk factors: a meta-analysis. Gastroenterology. 2015;149(6):1490–500.

    PubMed  Google Scholar 

  10. Whitcomb DC. What is personalized medicine and what should it replace? Nat Rev Gastroenterol Hepatol. 2012;9(7):418–24.

    PubMed  PubMed Central  Google Scholar 

  11. • Whitcomb DC, Frulloni L, Garg P, Greer JB, Schneider A, Yadav D, et al. Chronic pancreatitis: an international draft consensus proposal for a new mechanistic definition. Pancreatology. 2016;16(2):218–24 This is an important article discussing about the new mechanistic definition for CP.

    PubMed  PubMed Central  Google Scholar 

  12. Whitcomb DC. Peering into the “black box” of the complex chronic pancreatitis syndrome. Pancreas. 2016;45(10):1361–4.

    PubMed  PubMed Central  Google Scholar 

  13. Wiersema MJ, Hawes RH, Lehman GA, Kochman ML, Sherman S, Kopecky KK. Prospective evaluation of endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography in patients with chronic abdominal pain of suspected pancreatic origin. Endoscopy. 1993;25(09):555–64.

    CAS  PubMed  Google Scholar 

  14. Hernandez LV, Catalano MF. EUS in the diagnosis of early-stage chronic pancreatitis. Best Pract Res Clin Gastroenterol. 2010;24(3):243–9.

    PubMed  Google Scholar 

  15. Bolado F, Prieto C, Vila JJ, Fernandez-Urien I, Forga L, Zozaya JM. Chronic pancreatitis-like changes detected by endoscopic ultrasound in type 1 diabetics are not associated with gastrointestinal symptoms or nutritional deficiencies. Pancreas. 2017;46(1):102–5.

    CAS  PubMed  Google Scholar 

  16. Sahai AV, Mishra G, Penman ID, Williams D, Wallace MB, Hadzijahic N, Pearson A, VanVelse A, Hoffman BJ, Hawes RH. EUS to detect evidence of pancreatic disease in patients with persistent or nonspecific dyspepsia. Gastrointestinal endoscopy. 2000;52(2):153–9.

  17. Hashimoto S, Futagami S, Yamawaki H, Kaneko K, Kodaka Y, Wakabayashi M, Sakasegawa N, Agawa S, Higuchi K, Akimoto T, Ueki N. Epigastric pain syndrome accompanying pancreatic enzyme abnormalities was overlapped with early chronic pancreatitis using endosonography. Journal of clinical biochemistry and nutrition. 2017:17–41.

  18. Lariño-Noia J, de la Iglesia D, Iglesias-García J, Macías F, Nieto L, Bastón I, et al. Morphological and functional changes of chronic pancreatitis in patients with dyspepsia: a prospective, observational, cross-sectional study. Pancreatology. 2018;18(3):280–5.

    PubMed  Google Scholar 

  19. Catalano MF, Sahai A, Levy M, Romagnuolo J, Wiersema M, Brugge W, et al. EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc. 2009;69(7):1251–61.

    PubMed  Google Scholar 

  20. Petrone MC, Terracciano F, Perri F, Carrara S, Cavestro GM, Mariani A, et al. Pancreatic abnormalities detected by endoscopic ultrasound (EUS) in patients without clinical signs of pancreatic disease: any difference between standard and Rosemont classification scoring? Pancreatology. 2014;14(3):227–30.

    PubMed  Google Scholar 

  21. • Shimosegawa T, Kataoka K, Kamisawa T, Miyakawa H, Ohara H, Ito T, et al. The revised Japanese clinical diagnostic criteria for chronic pancreatitis. J Gastroenterol. 2010;45(6):584–91 This is an important article that defines the first criteria for ECP.

    PubMed  Google Scholar 

  22. Masamune A, Kikuta K, Nabeshima T, Nakano E, Hirota M, Kanno A, et al. Nationwide epidemiological survey of early chronic pancreatitis in Japan. J Gastroenterol. 2017;52(8):992–1000.

    PubMed  Google Scholar 

  23. • Masamune A, Nabeshima T, Kikuta K, Hamada S, Nakano E, Kume K, et al. Prospective study of early chronic pancreatitis diagnosed based on the Japanese diagnostic criteria. J Gastroenterol. 2019;54(10):928–35 This article is prospective cohort study based on the Japanese diagnostic criteria.

    PubMed  Google Scholar 

  24. Yadav D, O'connell M, Papachristou GI. Natural history following the first attack of acute pancreatitis. Am J Gastroenterol. 2012;107(7):1096–103.

    PubMed  Google Scholar 

  25. Sheel AR, Baron RD, Sarantitis I, Ramesh J, Ghaneh P, Raraty MG, et al. The diagnostic value of Rosemont and Japanese diagnostic criteria for ‘indeterminate’, ‘suggestive’,‘possible’ and ‘early’ chronic pancreatitis. Pancreatology. 2018;18(7):774–84.

    PubMed  Google Scholar 

  26. Czakó L. Diagnosis of early-stage chronic pancreatitis by secretin-enhanced magnetic resonance cholangiopancreatography. J Gastroenterol. 2007;42(17):113–7.

    PubMed  Google Scholar 

  27. Tirkes T, Fogel EL, Sherman S, Lin C, Swensson J, Akisik F, et al. Detection of exocrine dysfunction by MRI in patients with early chronic pancreatitis. Abdom Radiol (NY). 2017;42(2):544–51.

    Google Scholar 

  28. Trikudanathan G, Walker SP, Munigala S, Spilseth B, Malli A, Han Y, et al. Diagnostic performance of contrast-enhanced MRI with secretin-stimulated MRCP for non-calcific chronic pancreatitis: a comparison with histopathology. Am J Gastroenterol. 2015;110(11):1598–606.

    CAS  PubMed  Google Scholar 

  29. Frøkjær JB, Akisik F, Farooq A, Akpinar B, Dasyam A, Drewes AM, et al. Guidelines for the diagnostic cross sectional imaging and severity scoring of chronic pancreatitis. Pancreatology. 2018;18(7):764–73.

    PubMed  Google Scholar 

  30. Ketwaroo G, Brown A, Young B, Kheraj R, Sawhney M, Mortele KJ, et al. Defining the accuracy of secretin pancreatic function testing in patients with suspected early chronic pancreatitis. Am J Gastroenterol. 2013;108(8):1360–6.

    PubMed  PubMed Central  Google Scholar 

  31. Conwell DL, Zuccaro G Jr, Vargo JJ, Trolli PA, VanLente F, Obuchowski N, et al. An endoscopic pancreatic function test with synthetic porcine secretin for the evaluation of chronic abdominal pain and suspected chronic pancreatitis. Gastrointest Endosc. 2003;57(1):37–40.

    PubMed  Google Scholar 

  32. Stevens T, Dumot JA, Parsi MA, Zuccaro G, Vargo JJ. Combined endoscopic ultrasound and secretin endoscopic pancreatic function test in patients evaluated for chronic pancreatitis. Dig Dis Sci. 2010;55(9):2681–7.

    PubMed  Google Scholar 

  33. Kothari D, Ketwaroo G, Sawhney MS, Freedman SD, Sheth SG. Comparison of combined endoscopic ultrasonography and endoscopic secretin testing with the traditional secretin pancreatic function test in patients with suspected chronic pancreatitis: a prospective crossover study. Pancreas. 2017;46(6):770–5.

    CAS  PubMed  Google Scholar 

  34. Shibukawa G, Irisawa A. Diagnostic efficacy of a brand-new endoscopic ultrasound processor for early-stage chronic pancreatitis. Dig Endosc. 2015;27:75.

    PubMed  Google Scholar 

  35. Itoh Y, Itoh A, Kawashima H, Ohno E, Nakamura Y, Hiramatsu T, et al. Quantitative analysis of diagnosing pancreatic fibrosis using EUS-elastography (comparison with surgical specimens). J Gastroenterol. 2014;49(7):1183–92.

    Google Scholar 

  36. Kuwahara T, Hirooka Y, Kawashima H, Ohno E, Ishikawa T, Kawai M, et al. Quantitative diagnosis of chronic pancreatitis using EUS elastography. J Gastroenterol. 2017;52(7):868–74.

    Google Scholar 

  37. Kuwahara T, Hirooka Y, Kawashima H, Ohno E, Ishikawa T, Yamamura T, et al. Usefulness of shear wave elastography as a quantitative diagnosis of chronic pancreatitis. J Gastroenterol Hepatol. 2018;33(3):756–61.

    Google Scholar 

  38. Sanz-Rubio D, Martin-Burriel I, Gil A, Cubero P, Forner M, Khalyfa A, et al. Stability of circulating exosomal miRNAs in healthy subjects. Sci Rep. 2018;8:10306.

    PubMed  PubMed Central  Google Scholar 

  39. Guo XY, Xiao F, Li J, Zhou YN, Zhang WJ, Sun B, et al. Exosomes and pancreatic diseases: status, challenges, and hopes. Int J Biol Sci. 2019;15(9):1846–60.

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Xin L, Gao J, Wang D, Lin JH, Liao Z, Ji JT, et al. Novel blood-based microRNA biomarker panel for early diagnosis of chronic pancreatitis. Sci Rep. 2017;7:40019.

    CAS  PubMed  PubMed Central  Google Scholar 

  41. Whitcomb DC. Pancreatitis: TIGAR-O version 2 risk/etiology checklist with topic reviews, updates, and use primers. Clin Transl Gastroenterol. 2019;10(6).

  42. Gibo J, Ito T, Kawabe K, Hisano T, Inoue M, Fujimori N, et al. Camostat mesilate attenuates pancreatic fibrosis via inhibition of monocytes and pancreatic stellate cells activity. Lab Investig. 2005;85(1):75–89.

    CAS  PubMed  Google Scholar 

  43. Yamawaki H, Futagami S, Kaneko K, Agawa S, Higuchi K, Murakami M, et al. Camostat mesilate, pancrelipase, and rabeprazole combination therapy improves epigastric pain in early chronic pancreatitis and functional dyspepsia with pancreatic enzyme abnormalities. Digestion. 2019;99(4):283–92.

    CAS  PubMed  Google Scholar 

  44. Siriwardena A, Mason J. Reply: ANTICIPATE study. Gastroenterology. 2013;144(3):e20–1.

    PubMed  Google Scholar 

  45. Siriwardena AK, Mason JM, Sheen AJ, Makin AJ, Shah NS. Antioxidant therapy does not reduce pain in patients with chronic pancreatitis: the ANTICIPATE study. Gastroenterology. 2012;143(3):655–63.

    CAS  PubMed  Google Scholar 

  46. Zhou D, Wang W, Cheng X, Wei J, Zheng S. Antioxidant therapy for patients with chronic pancreatitis: a systematic review and meta-analysis. Clin Nutr. 2015;34(4):627–34.

    CAS  PubMed  Google Scholar 

  47. Rustagi T, Njei B. Antioxidant therapy for pain reduction in patients with chronic pancreatitis: a systematic review and meta-analysis. Pancreas. 2015;44(5):812–8.

    CAS  PubMed  Google Scholar 

  48. Nadella S, Ciofoaia V, Cao H, Kallakury B, Tucker RD, Smith JP. Cholecystokinin receptor antagonist therapy decreases inflammation and fibrosis in chronic pancreatitis. Dig Dis Sci. 2019;9:1–9.

    Google Scholar 

  49. Gryshchenko O, Gerasimenko JV, Gerasimenko OV, Petersen OH. Ca2+ signals mediated by bradykinin type 2 receptors in normal pancreatic stellate cells can be inhibited by specific Ca2+ channel blockade. J Physiol. 2016;594(2):281–93.

    CAS  PubMed  Google Scholar 

  50. Gryshchenko O, Gerasimenko JV, Peng S, Gerasimenko OV, Petersen OH. Calcium signalling in the acinar environment of the exocrine pancreas: physiology and pathophysiology. J Physiol. 2018;596(14):2663–78.

    CAS  PubMed  PubMed Central  Google Scholar 

  51. Serrano J, Andersen DK, Forsmark CE, Pandol SJ, Feng Z, Srivastava S, et al. Consortium for the study of chronic pancreatitis, diabetes, and pancreatic cancer: from concept to reality. Pancreas. 2018;47(10):1208–12.

    PubMed  PubMed Central  Google Scholar 

  52. Yadav D, Park WG, Fogel EL, Li L, Chari ST, Feng Z, et al. PROspective Evaluation of Chronic Pancreatitis for EpidEmiologic and Translational StuDies: rationale and study design for PROCEED from the Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer. Pancreas. 2018;47(10):1229–38.

    PubMed  PubMed Central  Google Scholar 

  53. Lowe ME, Andersen DK, Caprioli RM, Choudhary J, Cruz-Monserrate Z, Dasyam AK, et al. Precision medicine in pancreatic disease—knowledge gaps and research opportunities: summary of a National Institute of Diabetes and Digestive and Kidney Diseases Workshop. Pancreas. 2019;48(10):1250–8.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of Nevada Las Vegas School of Medicine, 1701 West Charleston Blvd., Las Vegas, NV, 89102, USA

    Mahendran Jayaraj, Ranjit Makar & Gordon Ohning

Authors
  1. Mahendran Jayaraj
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ranjit Makar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gordon Ohning
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mahendran Jayaraj.

Ethics declarations

Conflict of Interest

The authors declared that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki Declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Pancreas and Biliary Tract

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jayaraj, M., Makar, R. & Ohning, G. Evaluation and Management of Suspected Early Chronic Pancreatitis (ECP). Curr Gastroenterol Rep 22, 40 (2020). https://doi.org/10.1007/s11894-020-00778-y

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11894-020-00778-y

Keywords

Search

Navigation