THE DIFFERENT COURSES OF EARLY-ONSET AND LATE-ONSET IDIOPATHIC AND ALCOHOLIC CHRONIC-PANCREATITIS

Background/Aims: Compared with alcoholic pancreatitis, little is known about the natural history of idiopathic pancreatitis. Two hundred for ty-nine patients with alcoholic pancreatitis and 66 patients with idio pathic chronic pancreatitis seen at our institution between 1976 and 1 982 were investigated. Methods: Records were analyzed retrospectively from the onset of symptomatic disease, and patients were followed up p rospectively until 1985. Patients with early-onset (n = 25) and late-o nset (n = 41) idiopathic chronic pancreatitis had a median age at onse t of symptoms of 19 and 56 years, respectively. Results: The gender di stribution was nearly equal in idiopathic chronic pancreatitis, but 72 % of patients with alcoholic pancreatitis were men (P = 0.001 vs. idio pathic). In early-onset idiopathic pancreatitis, calcification and exo crine and endocrine insufficiency developed more slowly than in late-o nset idiopathic and alcoholic pancreatitis (P = 0.03). However, in ear ly idiopathic chronic pancreatitis, pain frequently occurred initially (P = 0.003 vs. late and alcoholic) and was more severe (P = 0.04 vs. tate and alcoholic). In late-onset idiopathic pancreatitis, pain was a bsent in nearly 50% of patients. Conclusions: There are two distinct f orms of idiopathic chronic pancreatitis. Patients with early-onset pan creatitis have initially and thereafter a long course of severe pain b ut slowly develop morphological and functional pancreatic damage, wher eas patients with late-onset pancreatitis have a mild and often a pain less course. Both forms differ from alcoholic pancreatitis in their eq ual gender distribution and a much slower rate of calcification.