Chronic pancreatitis (CP) is a serious disorder which can have a severe impact on the quality of life in addition to life-threatening long-term sequelae. CP is a progressive inflammatory disease of the pancreas characterized by irreversible morphological changes typically causing pain and/or permanent loss of function. Long-term CP complications include diabetes mellitus and pancreatic cancer. It is estimated an overall incidence of 2 to 200 cases per 100,000 inhabitants per year and prevalence of 13 to 52 per 100,000 populations in the world [5]. Globally is the most frequent pancreatic pathology with a mortality of 0.09 deaths (95% CI 0.02-0.47) per 100 000 person-years for chronic pancreatitis [5].
Epidemiologic descriptions of CP have changed over time. In the first half of the 20th century, the presence of epigastric calcifications on plain radiography was the mainstay for the diagnosis of CP. The focus of reports from 1950-1990's was to describe the clinical profile and natural history in a series of patients. In the 1970s, abdominal ultrasound, endoscopic retrograde cholangiopancreatography, and computed tomography emerged as diagnostic tests for CP. In 1983, a group of experts met in Cambridge, and developed a grading system using these diagnostic modalities to define CP. CT quickly became the modality of choice for diagnosis because it was noninvasive and widely available. With continuing advances in technology over the past 30 years, high resolution CT, magnetic resonance imaging, and endoscopic ultrasound have evolved as important tools in the evaluation of CP[4]. In the past decades, studies have also focused on describing population distributions of CP, its risk based on the presence of environmental and genetic risk factors, impact of CP on quality of life, and frequency and factors that affect the evolution of acute and recurrent acute pancreatitis to CP. Thus, we connect the increasing in incidence and prevalence not only with it real increasing but with the development of the diagnostic technology also.
The number of studies examining the population distributions of CP is scarce, and it is important to note that these data are not available from large parts of the world. This is probably related to difficulties in conducting such studies due to establishing an accurate diagnosis, and the focus of earlier studies to describe the clinical profile and natural history of the disease. The results of the most representative studies on the incidence of CP are very poor and show some variability based on study design and country. The latest survey is represented in studies of the United States, Japan and Spain (among European countries). In the United States the incidence of CP has increased modestly from 3.3 during 1940-1969 to 4.3 per 100,000 in 1997-2006 [2,4]. The incidence in European countries ranges from 5 to 26 per 100,000 inhabitants. In Asia, seven separate surveys from Japan show a trend towards a much greater increase in the incidence of CP (from 2 to 14/100,000) [3]. In some regions there is a higher incidence as in India with an incidence of 114 to 200 per 100,000 inhabitants. [4]
The prevalence of CP shows high variability. In recent studies the prevalence ranges around 40-50 per 100,000 population. A Chinese study showed increasing prevalence of CP from 3.1 per 100,000 in 1996 to 13.5 per 100,000 population in 2003. The 7 nationwide epidemiological surveys conducted in Japan, have demonstrated increasing prevalence of CP from 28.5 per 100,000 in 1994 to 52.4 per 100,000 in 2011. A much higher prevalence of idiopathic CP, termed earlier as ‘tropical pancreatitis’ was reported from Southern India in up to 126 per 100,000 population in 1994 [4].
The mean or median age at time of study enrollment or diagnosis in most published studies show little variation over time and by geography. The mean age in European studies was 40 years in 1970-1990s and more recently between 50-55 years. In Japan, the mean age reported in 1960s was 48 years, and most recently 59 years in 2007 [3,4].
In most studies, 60-80% of CP patients are male, and population studies show higher incidence and prevalence of CP in men when compared with women. Differences in sex and age distribution is primarily related to the etiology of CP. Alcohol is the most common cause of CP in age group of 35-54 years. A greater risk of alcoholic pancreatitis in men when compared with women is believed to be primarily related to higher prevalence of heavy drinking [4]. However, results of recent studies suggest that genetic factors also play an important role in this difference. Non-alcoholic etiologies are more evenly distributed in men and women. Genetic causes are more common in patients diagnosed earlier in life (<35 years of age), whereas idiopathic CP has a bimodal age distribution [4].
In Ukraine the CP prevalence ranges around 4,6 cases per 10 000 population. A death rate in case of CP presents about 5 %, and at presence of necrotizing CP arrives at over 20 % (up to 40 %). Among the patients that survived, about 65 % remain invalids [7]. Detail analysis over the regions of Ukraine educed 5 territories with the very high indexes of prevalence of CP pathology: Kyiv, Odesa, Dnepropetrovsk, Vinnytsya and Khmelnytsk regions. It is important to underline the circumstance, that the level of prevalence in some areas and administrative territories considerably differs from indexes on Ukraine on the whole. Negative changes are most expressed in relation to CP is fixed in the adult population of the Mykolaiv and Poltava regions. The increase rate of prevalence of pathology in these areas is higher than average in a country in 2,0 and 1,8 times accordingly [6]. Another problem that is important to realize, that objective official statistical figures in Ukraine not fully reflect the real picture. Thus, the high prevalence of CP needs closer examination of its risk factors such as the ecological, climatic and other features of regionsas well as medical and social factors.
References:
- Dominguez-Munoz JE, Lucendo A, Carballo LF, Iglesias-Garcia J and Tenias JM. A Spanish multicenter study to estimate the prevalence and incidence of chronic pancreatitis and its complications. Rev Esp Enferm Dig 106(4): 239-245, 2014.PMID: 25075654.
- Dudekula A, Munigala S, Zureikat AH and Yadav D. Operative Trends for Pancreatic Diseases in the USA: Analysis of the Nationwide Inpatient Sample from 1998-2011. J Gastrointest Surg 20(4): 803-811, 2016.PMID: 26791389.
- Hirota M, Shimosegawa T, Masamune A, Kikuta K, Kume K, Hamada S, et al. The seventh nationwide epidemiological survey for chronic pancreatitis in Japan: clinical significance of smoking habit in Japanese patients. Pancreatology 14(6): 490-496, 2014.PMID: 25224249.
- Machicado, Jorge D. Rebours, Vinciane. Yadav, Dhiraj Epidemiology of Chronic Pancreatitis. //Version 1.0, July 28, 2016. - Pancreapedia: Exocrine Pancreas Knowledge Base, DOI: 10.3998/panc.2016.13
- Morales MJ. Chronic Pancreatitis: Current Concepts. SM Pancreat Disord Ther. 2017; 1(1): 1001. https://www.researchgate.net/publication/321680229_Chronic_Pancreatitis_Current_Concepts
- Стасенко Т. Панкреатит — компетенція експертів Український медичний часопис on-line 3 (113) – V/VI 2016 : https://www.umj.com.ua/article/96846/pankreatit-kompetenciya-ekspertiv
- Сучасні принципи діагностики та лікування гострого панкреатиту/Методичний посібник: МОЗ України, КЛКМШМД, Український НПЦ ЕМД та МК.- Київ, 2006 р.- 29 с.