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] 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][82] progression is independently predicted by four variables: current smoking, idiopathic aetiology, alcohol aetiology, and necrotising pancreatitis.[82] 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][84][85]

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