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Midha et al should be applauded for their comprehensive study on chronic pancreatitis (CP) in India.1 We thank them for validating our earlier observations on idiopathic chronic pancreatitis (ICP) patients.2 Their proposed hypothesis ‘chronic pancreatitis previously classified as tropical calcific pancreatitis (TCP) represented idiopathic chronic pancreatitis in India’ is interesting, as the absence of a known aetiological factor (idiopathic) has been a major diagnostic criterion for TCP. While it is understandable that the classical clinical picture of TCP, that had malnutrition as an important component, is changing due to improved economy, it may not be appropriate to comment retrospectively that …

We read with interest the article by Midha et al 1 and correspondence by various authors on the interesting and challenging topic of idiopathic chronic pancreatitis (ICP) in India. At the outset we would like to congratulate the authors of this good study. We had earlier published a study, which somehow escaped the attention of the authors in their initial study and also later in correspondence, where we had shown that the clinical profile of ICP in North India differs from that of classical tropical pancreatitis (TP) with a higher frequency of pain and a lower frequency of diabetes, pancreatic calcification and intraductal calculi.2 In our study of 155 patients with chronic pancreatitis (CP), ICP was the most common form of CP (41.3%).2 When …

I read with interest the paper by Midha et al 1 which brings a new perspective on non-alcoholic chronic pancreatitis in India which raises some concerns. The term ‘tropical pancreatitis’ was used to denote a form of chronic pancreatitis unassociated with alcohol abuse which occurred in the tropics and subtropics. The subtropics, by definition, denote geographic areas adjacent to the tropical zone (usually 20–40° latitude) where daytime temperatures remain above 10°C for >8 months of the year. India's geographic latitudinal extent is 6.74678°N to 37.09681°N and daytime temperatures do exceed 10°C for >8 months, and hence qualifies as being ‘tropical’. In the study, the definition for chronic pancreatitis is vague. Our own preference is to use four criteria: …

I read the article on idiopathic chronic pancreatitis (ICP) in India in which there was reference to tropical chronic pancreatitis (TCP).1 TCP was a form of ICP first described in the 1960s in the south-western state of Kerala in India.2 Even though the aetiology of this new condition was unknown, the clinical features of the new entity of chronic pancreatitis (CP) in young malnourished non-alcoholic subjects in poor tropical countries was so distinctive that, to distinguish it from alcoholic chronic pancreatitis (ACP), the term ‘TCP’ came into usage without much thought into its aetiological connotation and was accepted by the medical community. …