Establishing the diagnosis can be challenging. Individual patient symptoms and objective diagnostics individually provide a probability of chronic pancreatitis, but a diagnosis usually requires a combination of features. Several diagnostic criteria have been proposed, but none are universally accepted. In patients with older-onset disease, autoimmune pancreatitis[13]Kamisawa T, Yoshiike M, Egawa N, et al. Chronic pancreatitis in the elderly in Japan. Pancreatology. 2004;4(3-4):223-7.
http://www.ncbi.nlm.nih.gov/pubmed/15148441?tool=bestpractice.com
and pancreatic cancer should be considered and excluded as differentials, which can be challenging. Diagnosing chronic pancreatitis in the early stages is also challenging if pain is the only feature and imaging tests are non-diagnostic. This situation requires prospective follow-up. For example, following a first attack of acute pancreatitis, 8% to 10% of patients may progress to chronic pancreatitis;[26]Sankaran SJ, Xiao AY, Wu LM, et al. Frequency of progression from acute to chronic pancreatitis and risk factors: a meta-analysis. Gastroenterology. 2015 Nov;149(6):1490-500.
http://www.gastrojournal.org/article/S0016-5085(15)01175-0/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/26299411?tool=bestpractice.com
[82]Ahmed Ali U, Issa Y, Hagenaars JC, et al. Risk of recurrent pancreatitis and progression to chronic pancreatitis after a first episode of acute pancreatitis. Clin Gastroenterol Hepatol. 2016 May;14(5):738-46.
http://www.ncbi.nlm.nih.gov/pubmed/26772149?tool=bestpractice.com
progression is independently predicted by four variables: current smoking, idiopathic aetiology, alcohol aetiology, and necrotising pancreatitis.[82]Ahmed Ali U, Issa Y, Hagenaars JC, et al. Risk of recurrent pancreatitis and progression to chronic pancreatitis after a first episode of acute pancreatitis. Clin Gastroenterol Hepatol. 2016 May;14(5):738-46.
http://www.ncbi.nlm.nih.gov/pubmed/26772149?tool=bestpractice.com
Moreover, three longitudinal studies reported that 26% to 50% of patients with idiopathic attacks (recurrent attacks with no aetiology identified) developed evidence of chronic pancreatitis over 18 to 36 months.[83]Garg PK, Tandon RK, Madan K. Is biliary microlithiasis a significant cause of idiopathic recurrent acute pancreatitis? A long-term follow-up study. Clin Gastroenterol Hepatol. 2007 Jan;5(1):75-9.
http://www.ncbi.nlm.nih.gov/pubmed/16931169?tool=bestpractice.com
[84]Jacob L, Geenen JE, Catalano MF, et al. Prevention of pancreatitis in patients with idiopathic recurrent pancreatitis: a prospective nonblinded randomized study using endoscopic stents. Endoscopy. 2001 Jul;33(7):559-62.
http://www.ncbi.nlm.nih.gov/pubmed/11473324?tool=bestpractice.com
[85]Yusoff IF, Raymond G, Sahai AV. A prospective comparison of the yield of EUS in primary vs recurrent idiopathic acute pancreatitis. Gastrointest Endosc. 2004 Nov;60(5):673-8.
http://www.ncbi.nlm.nih.gov/pubmed/15557941?tool=bestpractice.com
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