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Background: Early-onset idiopathic chronic pancreatitis (EOICP) is a disease that affects young individuals. Data on pregnancy outcomes in EOICP are limited. Aim: To assess the pregnancy outcomes in patients with EOICP and the effect of pregnancy on the course of EOICP. Methods: Patients with EOICP with disease onset before their pregnancy were recruited. Data regarding demographic variables, disease duration, pregnancy outcomes, and course of illness were noted. Results: 50 patients were included in the study contributing to a total of 86 pregnancies. The mean age of onset of symptoms and at the time of delivery was 17.95 (5.71) and 23.44 (4.28) years, respectively. Gestational diabetes (GD) and gestational hypertension (GH) noted in one (1.5%) each. 3 (4.5%) pregnancies were preterm. 19 (22.1%) pregnancies did not have successful outcomes (7 (8.1%) were induced abortions). 12 (15.2%) pregnancies had spontaneous pregnancy losses. 8 (10.1%) were spontaneous abortions and 4 (5.1%) were stillbirths. Of 67 successful pregnancies, 33 (49.3%) pregnancies were delivered by LSCS. Compared to average rates of LSCS in India, this was significantly higher (21.5% vs 49.3%—p ≤ 0.001). The average birth weight was 2.87 (0.48) kg. There was one (1.5%) neonatal death. Compared to the published Indian data, there was no significant difference in the incidence of spontaneous pregnancy losses, GD, GH, preterm labor, and birth weight. Pancreatic pain was reported by 21 (42%) women in total 27 (31.4%) pregnancies. There was no difference in maternal or fetal outcomes between pregnancies with or without pancreatic pain. There were no pancreatitis-related complications reported during the pregnancies. Conclusion: The present study shows that mothers affected with EOICP have pregnancy outcomes similar to healthy women in India. [ABSTRACT FROM AUTHOR]

Background and Aims: Chronic pancreatitis (CP) is a fibroinflammatory syndrome of the pancreas associated with pain and poor quality of life. It has toxic and genetic risk factors but can also be idiopathic. The natural history of idiopathic CP (ICP) is not well-known. Therefore, we studied clinical characteristics and outcomes of these patients followed in our Pancreas Center. Methods: Review of CP patients between January 1, 2016, and April 30, 2021. Patients were divided into 2 groups based on diagnosis, ICP vs non-ICP. CP patients with a smoking history were placed in the non-ICP group. Statistical analysis was performed to identify differences in demographics, comorbidities, complications, controlled medications, and resource utilization. Results: Out of 450 patients, 101 (22%) were diagnosed with ICP and 349 (78%) were non-ICP. ICP patients were mainly female (59.4% vs 40.5%; P = .005), had less comorbid anxiety (10.5% vs 22.1%; P = .002), depression (24.2% vs 35.8%; P < .001), disability (13% vs 16.3%; P = .021), exocrine pancreatic insufficiency (45.3% vs 62.6%; P = .004), splanchnic vein thrombosis (1.04% vs 14.9%; P < .001), pseudocysts (16.7% vs 41.6%; P < .001), and biliary obstruction (3.12% vs 19.2%; P < .001). They underwent less abdominal imaging (2.63 vs 3.42; P = .048) and endoscopic retrograde cholangiopancreatography (0.88 vs 1.32; P = .030). They also had less opioid use (29.6% vs 54.4%; P < .001), gabapentinoid use (34% vs 52.3%; P = .002), and celiac blocks (7.22% vs 16.1%; P < .041). Conclusion: Our study demonstrates that the clinical course of ICP is less morbid compared to non-ICP. This study specifically removes smoking, a significant risk factor for CP, to study a truly idiopathic cohort.

Background: Tobacco smoking is a known risk factor for progression of chronic pancreatitis (CP). Aim: We compare clinical outcomes of CP patients with current or former smoking with those who have never smoked. Methods: We reviewed all patients with followed at our Pancreas Center from 2016 to 2021, comparing the demographics, clinical features, comorbidities, outcomes, and resource utilization between smokers and non-smokers. Results: Of 439 CP patients, 283 were smokers (125 current, 158 former). Significantly more smokers were men (58.3% vs 40.4%), with alcoholic CP (45.5% vs 12.1%), chronic abdominal pain (77.7% vs 65.4%), anxiety and depression (22.6% vs 14.1% and 38.9% vs 23.1%), and with more local pancreatic complications [splanchnic vein thrombosis (15.7% vs 5.13%), pseudocyst (42.7% vs 23.7%), biliary obstruction (20.5% vs 5.88%)], exocrine pancreatic insufficiency (65.8% vs 46.2%), hospitalizations (2.59 vs 1.75 visits), and emergency department visits (8.96% vs 3.25%). Opioid and neuromodulator use were significantly higher (59.2% vs 30.3% and 58.4% vs 31.2%). Current smokers had worse outcomes than former smokers. Multivariate analysis controlling for multiple factors identified smoking as an independent predictor of chronic abdominal pain (OR 2.49, CI 1.23–5.04, p = 0.011), opioid (OR 2.36, CI 1.35–4.12, p = 0.002), neuromodulators (OR 2.55, CI 1.46–4.46, p = 0.001), and non-opioid-controlled medications (OR 2.28, CI 1.22–4.30, p = 0.01) use, as well as splanchnic vein thromboses (OR 2.65, CI 1.02–6.91, p = 0.045) and biliary obstruction (OR 4.12, CI 1.60–10.61, p = 0.003). Conclusion: CP patients who smoke or formerly smoked have greater morbidity and worse outcomes than non-smokers. [ABSTRACT FROM AUTHOR]

Aim: To study polymorphisms in glutathione-S-transferases (GST-T1, GST-M1, GST-P1) and uridine-5′-diphosphate-glucuronosyl-transferases (UGT1A7) genes and the risk of developing chronic pancreatitis (CP) associated with these polymorphisms. Methods: This study included 49 alcoholic and 51 idiopathic chronic pancreatitis patients, 50 alcohol addicts and 50 healthy controls. Polymorphism(s) in GST-T1 and GST-M1 genes were assessed by multiplex polymerase chain reaction (PCR), while PCR–radiofrequency lesioning (RFLP) was employed to assess the same in GST-P1 and UGT1A7 genes. The differences in polymorphism frequency between groups and the risk of developing pancreatitis were assessed by the odds ratio. Results: Strong association of the null genotype of GST-T1 with CP susceptibility was observed. Alcoholics with the Val allele of GST-P1 have higher chances of having pancreatitis. Idiopathic pancreatitis patients with higher age at the onset of pain were found to have the null genotype of GST-M1. Conclusion: Alcoholics with the null genotype of the GST-T1 gene and the Valine allele of the GST-P1 gene are at a higher risk of developing CP. Thus, genotyping of these genes may serve as an important screening tool for the identification of high-risk groups among alcoholics. [ABSTRACT FROM AUTHOR]

Background/Aims The prevalence and natural history of SPINK1, PRSS1, and CFTR mutations in idiopathic pancreatitis (ICP) are not well-documented. This study evaluates the prevalence, genetic and clinical characteristics, and long-term outcomes of gene-associated chronic pancreatitis (GCP) compared to alcoholic chronic pancreatitis (ACP). Methods From January 1997 to July 2023, a cohort of 711 ICP patients underwent DNA testing for SPINK1, PRSS1, and CFTR mutations. A propensity score-matched analysis was conducted to compare GCP to ACP patients at a 1:3 ratio. Results Gene mutations were identified in 23.2% of idiopathic pancreatitis patients, with SPINK1 being the most common mutation (70%). GCP patients experienced significantly more pancreatic pain (89.3% vs. 70.7%) and had a shorter median time to symptom onset (26.2 years vs. 42.6 years) compared to ACP patients. Pancreatic cancer was observed in 3.6% of GCP patients, with a cumulative risk reaching 16.7% by age 70, while the incidence was lower in ACP patients. Although GCP patients exhibited higher cumulative risks, the hazard ratio for gene mutation status was not statistically significant (HR: 1.53). However, a Cambridge classification grade ＞3 was a significant predictor of pancreatic cancer outcomes (HR: 4.58, p=0.034). Conclusion GCP patients exhibit distinct clinical characteristics and outcomes compared to ACP patients, necessitating individualized evaluation and management strategies. Given the significant cumulative risk of pancreatic cancer in GCP, early and regular surveillance is recommended, particularly for those with higher Cambridge classification grades. [ABSTRACT FROM AUTHOR]

Objectives: Steatorrhea, a sign of severe pancreatic exocrine insufficiency (PEI), is related to consequences caused by pancreatitis. This study aimed to identify predictors and to construct a nomogram for steatorrhea in idiopathic chronic pancreatitis (ICP). Methods: ICP patients admitted to our hospital from January 2000 to December 2013 were enrolled in this retrospective–prospective cohort study and randomly assigned to the training and validation cohorts. The cumulative rate of steatorrhea was calculated. A Cox proportional hazard regression model was used to identify predictors for steatorrhea and construct the nomogram. Internal and external validation of the nomogram was then performed. Results: There were 1633 ICP patients enrolled, with a median follow‐up duration of 9.8 years and 20.8% (339/1633) of patients developed steatorrhea following onset of ICP. Steatorrhea was observed in 93, 115, and 133 patients at 1, 3, and 5 years following diagnosis of CP, with a cumulative rate of 6.5% (95% confidence interval [CI] 5.1%–7.9%), 8.0% (95% CI 6.2%–9.8%), and 9.3% (95% CI 6.6%–12.0%), respectively. Male sex (hazard ratio [HR] 2.479, P < 0.001), diabetes mellitus at/before diagnosis of ICP (HR 2.274, P = 0.003), and aged less than 18 years at onset of ICP (HR 0.095, P < 0.001) were identified risk factors for steatorrhea. Initial manifestations were associated with development of steatorrhea. The nomogram was proven to have good concordance indexes. Conclusions: We identified predictors and developed a nomogram for predicting steatorrhea in ICP. It was recommended that high‐risk populations be followed up closely, which might contribute to the early diagnosis and treatment of PEI. [ABSTRACT FROM AUTHOR]

Tropical chronic pancreatitis (TCP) is a special variant of idiopathic chronic pancreatitis that is seen mainly in tropical countries. Although the prevalence of tropical pancreatitis is high in southern India, it is reported from most parts of India. It occurs usually in young people, involves the main pancreatic duct, and results in large ductal calculi with high incidence of diabetes and malignancy. Recent reports suggest that the presentation is changing. The age of onset is older and the disease course seems to be milder. The etiology is not known, but genetic mutations and environmental factors are likely causes. This article is a narrative review of the recent trends in the etiopathogenesis and management of tropical calcific pancreatitis (TCP). Extensive literature search was done from PubMed and Ovid. Article was prepared by reviewing full-text articles and abstracts related to chronic calcific pancreatitis (CCP) and TCP. [ABSTRACT FROM AUTHOR]

Background and Aims: Chronic pancreatitis (CP) is a fibroinflammatory syndrome of the pancreas associated with pain and poor quality of life. It has toxic and genetic risk factors but can also be idiopathic. The natural history of idiopathic CP (ICP) is not well-known. Therefore, we studied clinical characteristics and outcomes of these patients followed in our Pancreas Center., Methods: Review of CP patients between January 1, 2016, and April 30, 2021. Patients were divided into 2 groups based on diagnosis, ICP vs non-ICP. CP patients with a smoking history were placed in the non-ICP group. Statistical analysis was performed to identify differences in demographics, comorbidities, complications, controlled medications, and resource utilization., Results: Out of 450 patients, 101 (22%) were diagnosed with ICP and 349 (78%) were non-ICP. ICP patients were mainly female (59.4% vs 40.5%; P  = .005), had less comorbid anxiety (10.5% vs 22.1%; P  = .002), depression (24.2% vs 35.8%; P < .001), disability (13% vs 16.3%; P  = .021), exocrine pancreatic insufficiency (45.3% vs 62.6%; P  = .004), splanchnic vein thrombosis (1.04% vs 14.9%; P < .001), pseudocysts (16.7% vs 41.6%; P < .001), and biliary obstruction (3.12% vs 19.2%; P < .001). They underwent less abdominal imaging (2.63 vs 3.42; P  = .048) and endoscopic retrograde cholangiopancreatography (0.88 vs 1.32; P  = .030). They also had less opioid use (29.6% vs 54.4%; P < .001), gabapentinoid use (34% vs 52.3%; P  = .002), and celiac blocks (7.22% vs 16.1%; P < .041)., Conclusion: Our study demonstrates that the clinical course of ICP is less morbid compared to non-ICP. This study specifically removes smoking, a significant risk factor for CP, to study a truly idiopathic cohort., (© 2023 The Authors.)