Chronic pancreatitis: a changing etiology?

In 1998, Lankisch and Banks reported that the prevalence of chronic pancreatitis appeared to be in the range of 3-10 per 100,000 people in many parts of the world [1]. They also emphasized that the most important medical problems associated with the disease included abdominal pain, steatorrhea, diabetes mellitus and the possibility that chronic pancreatitis may be considered a premalignant condition [2, 3]. In 2002, in a well-written review, Banks pointed out that the two important forms were alcoholic and tropical pancreatitis [4]. There is no doubt that that, in Western countries, alcohol is the most frequent associated factor of chronic pancreatitis, that alcoholic chronic pancreatitis presents clinically in young adults of 30-40 years of age, with a higher prevalence of the male gender, that the histological lesions are chronic “ab initio” and that, from a clinical point of view, the disease is characterized by recurrent attacks of abdominal pain. In Western countries, in the period from 1940 to 2003, alcohol frequency increased as an etiological factor of chronic pancreatitis from 19 [5] to 50% [6] and even up to 80% [7, 8]. The results of the latter study regarding the etiology of chronic pancreatitis were subsequently confirmed by others in Europe [9, 10, 11, 12, 13, 14, 15, 16] as well as in Brazil [17], Australia [18] and South Africa [19]. On the other hand, four consecutive surveys carried out in Japan (from 1979 to 1977, from 1978 to 1984, in 1994, and in 1999, respectively) [20] showed that alcohol as an etiological factor accounted for fewer than 60% of the cases of chronic pancreatitis in this country. The study of Sarles et al. [8] reported that India is the most characteristic country in which patients with chronic pancreatitis were mainly malnourished in childhood, assuming a low fat and low protein diet; they were also not alcoholics. Thus, this particular form of the disease was named “tropical pancreatitis”. Subsequent studies from India and Africa confirmed this finding as was reported in the review article published by Mohan et al. in 2003 [21].