P. Layer et al., THE DIFFERENT COURSES OF EARLY-ONSET AND LATE-ONSET IDIOPATHIC AND ALCOHOLIC CHRONIC-PANCREATITIS, Gastroenterology, 107(5), 1994, pp. 1481-1487
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.