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Global epidemiology and holistic prevention of pancreatitis

Abstract

Knowledge of pancreatitis in the 20th century was shaped predominantly by animal data and clinical trials. Several large general population-based cohort studies and comprehensive systematic literature reviews in the 21st century have had a major effect on our understanding of pancreatitis and its sequelae. This Review provides precise and up-to-date data on the burden of acute pancreatitis, chronic pancreatitis and post-pancreatitis diabetes mellitus. Exocrine pancreatic insufficiency and altered bone metabolism following pancreatitis are also discussed. Furthermore, the article introduces a framework for the holistic prevention of pancreatitis with a view to providing guidance on strategies and intervention objectives at primary, secondary and tertiary levels. Concerted efforts by not only gastroenterologists and surgeons but also primary care physicians, endocrinologists, radiologists, pain specialists, dietitians, epidemiologists and public health specialists will be required to reduce meaningfully the burden of pancreatitis and its sequelae over the ensuing decades.

Key points

  • Per 100,000 people in the general population, the yearly global incidence of acute pancreatitis is 34 cases, chronic pancreatitis is 10 cases and post-pancreatitis diabetes mellitus is 6 cases.

  • The global transition rate from the first episode of acute pancreatitis to a recurrent episode is ~20% and, from recurrent acute pancreatitis to chronic pancreatitis, the rate is ~35%.

  • Acute pancreatitis (including its non-necrotizing form) leads to a number of sequelae long after clinical resolution and, hence, should no longer be considered a self-limited disease.

  • Post-pancreatitis diabetes mellitus is the most frequent sequelae of pancreatitis, caused by acute and recurrent acute pancreatitis in ~80% and chronic pancreatitis in ~20% of cases.

  • Patients with pancreatitis have a greater than twofold higher lifetime risk of developing new onset diabetes than individuals in the general population without a history of pancreatitis.

  • The holistic prevention of pancreatitis (HPP) concept postulates that primary, secondary and tertiary prevention strategies need to be systematically employed to lessen the effect of pancreatitis and its sequelae.

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Fig. 1: Incidence of pancreatitis in the general population.
Fig. 2: Frequency of transition from first episode of acute pancreatitis to chronic pancreatitis through recurrent acute pancreatitis.
Fig. 3: Diagnostic algorithm to identify individuals with PPDM.
Fig. 4: Epidemiology of diabetes of the exocrine pancreas.
Fig. 5: The holistic prevention of pancreatitis framework.

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Acknowledgements

M.S.P. is supported by the Royal Society of New Zealand in the form of a Rutherford Discovery Fellowship. D.Y. is supported by the National Cancer Institute and National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number U01 DK108306. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Nature Reviews Gastroenterology & Hepatology thanks H. van Santwoort and the other anonymous reviewer(s) for their contribution to the peer review of this work.

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Petrov, M.S., Yadav, D. Global epidemiology and holistic prevention of pancreatitis. Nat Rev Gastroenterol Hepatol 16, 175–184 (2019). https://doi.org/10.1038/s41575-018-0087-5

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