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CHRONIC PANCREATITIS IN SOUTH EAST AND SOUTH ASIA (CPSEASA): IS IT DIFFERENT FROM WEST?

Misbah Unnisa 1

Affiliations

1 Asian Institute of Gastroenterology (AIG) Hospitals, Hyderabad, India

Summary

AI Generated

A multicenter database of 1212 chronic pancreatitis patients from South and Southeast Asia reveals demographic and clinical features distinct from Western cohorts, including younger age at presentation, higher prevalence of idiopathic etiology, and increased diabetes rates.

Mean patient age was 37.2 years with 70.5% male, substantially younger than European (44 years) and USA (49 years) cohorts; idiopathic etiology was most common at 59.8%, followed by alcohol at 30.1%, contrasting with Western data where alcohol predominates.
Painful chronic pancreatitis occurred in 84.24% of patients with episodic pain pattern (31.9%) slightly more common than continuous (29.2%); diabetes was present in 41.2% of patients, significantly higher than the 28-29% reported in Western cohorts.
Dilatation of the main pancreatic duct was found in 76.6% and parenchymal calcification in 57.8% of patients; approximately 50% developed MPD calculus, 9% had MPD strictures, and 5% developed inflammatory pancreatic mass lesions.
Among the 45.9% who underwent interventions, endotherapy with ESWL was performed in 37.4% and surgery in 7.4%; pain relapse after initial treatment occurred in 57.9%, while improvements in glycemic control and nutritional status were observed in 46% and 44.3% respectively.
This ongoing study recruited patients from India, Bangladesh, Myanmar, Nepal, Malaysia, Sri Lanka, and Thailand between September 2020 and April 2023, representing one of the few large multicenter chronic pancreatitis cohorts from the region.

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Abstract

Introduction

Chronic pancreatitis (CP) is a multifactorial disease. Even though the disease frequency in India and other Asian nations are higher compared to the west, not much published literature with a large cohort exists from this region.

Aims & Methods

Aim: The aim of the study was to develop a database on Chronic Pancreatitis in South-East and South Asia (CPSEASA) to evaluate the demography, environmental risk factors and clinical characteristics of CP in south and southeastern Asia.
Methods: In this ongoing study, 1212 patients were recruited between September 2020 - April 2023 from India (3 sites) and one site each from Bangladesh, Myanmar, Nepal, Malaysia, Sri Lanka and Thailand. We recorded data on demographic details, environmental risk factors, clinical signs and symptoms (including disease duration and pain patterns), family history, morphological finding, patient awareness about the disease, therapeutic interventions and its outcomes in a structured questionnaire. The study approach is mainly based on North American Pancreatitis Study 2 (NAPS2). Continuous data were expressed as mean with standard deviation (SD) and categorical data as proportions.

Results

A total of 1212 patients were included. Mean (SD) age of patients was 37.2 ± 13.91 with males 855 (70.5%). Dravidian 337 (27.5%) was the most prevalent ethnicity, followed by Indo-Aryans 333 (27.5) and North East with 78 (6.4%). Most patients 291 (24.2%) belonged to upper middle. The most common etiology was idiopathic 725 (59.8%), followed by alcohol 365 (30.1%) and smoking 291 (24%). Disease duration of CP (years) was 40 ± 106.05 and acute exacerbations was developed in 406 (33.49%) patients. 1021 (84.24%) of patients had painful CP with a maximum VAS pain score of 7.15 ± 3.02 with the most prominent pain patterns were episodic 387 (31.9%) than continuous 354 (29.2%). Change in character of pain over time was experienced in 192 (15.8%) patients. Other important clinical manifestations included were weight loss 781 (64.4%), back pain 765 (63.3%) and diabetes 497 (41.2%). Dilatation of MPD 928 (76.6%) and parenchymal calcification 699 (57.8%) were the two most frequent morphological abnormalities seen. Normal home-cooked food with frequent fat restriction was commonly consumed in 712 (58.6%) patients. In terms of treatment received, 379 (31.27%) patients reported using analgesics and 254 (20.9%) were prescribed with neuromodulators. Around 557 (45.9%) patients underwent interventions includes endotherapy with ESWL in 454 (37.4%) and surgical procedures in 89 (7.4%) cases. Most patients 912 (75.2%) were adhered to medical treatment. Short-term relief lasting between 3 to 6 months was experienced by 493 (40.7%), while 702 (57.9%) patients experienced pain relapse after initial treatment. Improvement in glycemic control and nutritional status was observed in 557 (46%) and 537 (44.3%) patients respectively.

Variables	CPSEASA (n=1212)	Europe (n=56)	USA (NAPS 2) (n=521)
Mean age (Mean ± SD)	37.2 ± 13.91	44 ± 12.5	49 ± 39, 60
Male (n, %)	855 (70.5)	46 (82.1)	283 (53)
Etiology
Alcohol (n, %)	365 (30.1)	38 (68)	240 (45)
Idiopathic (n, %)	725 (59.8)	15 (27)	154 (29)
Pain pattern
Episodic (n, %)	387 (31.9)	31 (55)	18 (34.6)
Continuous (n, %)	354 (29.2)	25 (45)	25 (40.1)
Diabetes (n, %)	497 (41.2)	16 (29)	37 (28.4)

Conclusion

Our data demonstrate that among the few multicenter study from South and Southeast Asia to report several features of CP is different, which distinguishes the epidemiologic trends from those of the West.

References

1. Whitcomb DC, Yadav D, Adam S, Hawes RH, Brand RE, Anderson MA, Money ME, Banks PA, Bishop MD, Baillie J, Sherman S, DiSario J, Burton FR, Gardner TB, Amann ST, Gelrud A, Lo SK, DeMeo MT, Steinberg WM, Kochman ML, Etemad B, Forsmark CE, Elinoff B, Greer JB, O'Connell M, Lamb J, Barmada MM; North American Pancreatic Study Group. Multicenter approach to recurrent acute and chronic pancreatitis in the United States: the North American Pancreatitis Study 2 (NAPS2). Pancreatology. 2008;8(4-5):520-31. doi: 10.1159/000152001. Epub 2008 Sep 3. PMID: 18765957; PMCID: PMC2790781.

Conference

UEG Week Copenhagen 2023

Topics

Pancreas

Submission format

Abstract

Session

Acute and chronic pancreatitis (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Affiliations

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Postgraduate Teaching Programme Barcelona 2026

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Surgery Radiology & Imaging Endoscopy

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Dysplastic lesions: Challenges and pitfalls for the endoscopist and the surgeon

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