Vallath Balakrishnan, Ambika Gopalakrishnan Unnikrishnan, Varghese Thomas, Gourdas Choudhuri, Peda Veeraraju, Shivram Prasad Singh, Pramod Garg, Cannore Ganesh Pai, Raveendranathan Nair Sobhana Devi, Deepak Bhasin, Venkataraman Jayanthi, Narayanan Premalatha, Ashok Chacko, Premashish Kar, Ramesh Roop Rai, Ramesh Rajan, Narayanan Subhalal, Rajiv Mehta, Sri Prakash Mishra, Manisha Dwivedi, Kattoor Ramakrishnan Nair Vinayakumar, Ashok Kumar Jain, Kalidas Biswas, Sunil Mathai, Jaison Varghese, Hariharan Ramesh, Thomas Alexander, Jacob Philip, Vigna Venugopal Raj, Ankarath Vinodkumar, Srikanth Mukevar, Prabha Sawant, Prem Nair, Harish Kumar, Surendran Sudhindran, Puneet Dhar, Othayil Vayoth Sudheer, Karimassery Ramaiyer Sundaram, Bailuru Vishwanath Tantri, Devinder Singh, Thekkayil Rajindra Nath
Context Chronic pancreatitis is common in India. However, its risk factors are not clear. There is sparse data on the current prevalence of tropical pancreatitis in India. Objective To undertake a prospective nationwide study of the risk factors and clinical profile of chronic pancreatitis. Setting Thirty-two major centers from different regions of India contributed data on 1,086 patients to a common online website (www.ipans.org). Main outcome measures Risk factors, clinical features complications and treatment of chronic pancreatitis. Results Of the 1,086 subjects, complete data on risk factors were available for 1,033 subjects. Idiopathic pancreatitis was the most common form of pancreatitis (n=622; 60.2%) and alcoholic chronic pancreatitis accounted for about a third of the cases (n=400; 38.7%); the rest (n=11; 1.1%) had rare risk factors. Smoking and cassava intake were documented in 292 (28.3%) and 189 (18.3%) subjects, respectively. Using well-defined criteria, only 39 (3.8%)cases could be labeled as ‘tropical pancreatitis’. Pain occurred in 971 patients (94.0%). Four hundred and eighteen (40.5%) subjects had diabetes mellitus. Of alcohol consumers, alcoholism and female gender were independent risk factors for diabetes in subjects with chronic pancreatitis (OR=1.48, P=0.003; and OR=1.75, P<0.001, respectively). The most common complications were pseudocysts (15.8%) and biliary obstruction (8.2%). Pancreatic cancer occurred in 42 subjects (4.1%). Ultrasound detected calculi in 69.7%, ductal dilatation in 63.4% and atrophy in 27.3%. The majority of patients were on medical therapy (n=849; 82.2%); endotherapy and surgery accounted for the rest. About 50% percent of the patients with diabetes required insulin (198/418). Conclusions In this first nationwide prospective survey of chronic pancreatitis in India, idiopathic pancreatitis was the most common form, followed by alcoholic pancreatitis. The classical form of tropical chronic pancreatitis is becoming less common.
