Impact of etiology on the painful early stage of chronic pancreatitis:: A long-term prospective study

Background and Aim: This prospective study was aimed to investigate the impact of etiology on the pain profile in relation to alterations of function and morphology from early to advanced chronic pancreatitis (CP). Methods: Our mixed medico-surgical cohort comprised 265 patients with alcoholic (ACP), 21 with idiopathic Juvenile" (IJCP), 46 with idiopathic,senile" (ISCP) and 11 with hereditary CP (HPCP). The patients were followed regularly from onset of disease according to the protocol published previously. Results: Males predominated in ACP, IJCP, ISCP (>71 %) but not in HP (46%). Age at onset (median) was 10, 23, 36 and 62 years in HP, IJCP, ACP and ISCP, respectively. Follow-up from disease onset ranged from 14 to 36 years. The progression to late-stage CP, documented by exocrine insufficiency (86 - 100%) and calcification (80 - 91 %) lasted 2 to 5-fold longer in HP/IJCP compared to ACP. Early stage CP, characterized by recurrent pancreatitis prevailed in >= 90% of patients, except for those with ISCP (48 %), and lasted up to 5-fold longer in HP/IJCP compared to ACP. Surgery for severe pain was required for ACP/ IJCP in 57 % of the patients compared to < 27 % in HP/ISCP. Permanent pain relief regularly occurred in late-stage CP irrespective of etiology and surgery. Conclusion: The clinical profile of the 4,,etiological" subgroups is predictably different in the painful early (precalcific) CP stage.