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Validation of Demographics, Etiology, and Risk Factors for Chronic Pancreatitis in the USA: A Report of the North American Pancreas Study (NAPS) Group

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Abstract

Background/Objectives

Our aim was to validate recent epidemiologic trends and describe the distribution of TIGAR-O risk factors in chronic pancreatitis (CP) patients.

Methods

The NAPS-2 Continuation and Validation (NAPS2-CV) study prospectively enrolled 521 CP patients from 13 US centers from 2008 to 2012. CP was defined by definitive changes in imaging, endoscopy, or histology. Data were analyzed after stratification by demographic factors, physician-defined etiology, participating center, and TIGAR-O risk factors.

Results

Demographics and physician-defined etiology in the NAPS2-CV study were similar to the original NAPS2 study. Mean age was 53 years (IQR 43, 62) with 55% males and 87% white. Overall, alcohol was the single most common etiology (46%) followed by idiopathic etiology (24%). Alcohol etiology was significantly more common in males, middle-aged (35–65 years), and non-whites. Females and elderly (≥65 years) were more likely to have idiopathic etiology, while younger patients (<35 years) to have genetic etiology. Variability in etiology was noted by participating centers (e.g., alcohol etiology ranged from 27 to 67% among centers enrolling ≥25 patients). Smoking was the most commonly identified (59%) risk factor followed by alcohol (53%), idiopathic (30%), obstructive (19%), and hyperlipidemia (13%). The presence of multiple TIGAR-O risk factors was common, with 1, 2, ≥3 risk factors observed in 27.6, 47.6, and 23.6% of the cohort, respectively.

Conclusion

Our data validate the current epidemiologic trends in CP. Alcohol remains the most common physician-defined etiology, while smoking was the most commonly identified TIGAR-O risk factor. Identification of multiple risk factors suggests CP to be a complex disease.

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Funding

NIH (DCW—DK061451, U01DK108306), NIH (DY—DK077906, U01DK108306), and UL1 RR024153 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. NIH (DC—U01DK108327) and NIH (CEF—U01DK108320).

Author information

Authors and Affiliations

  1. Brigham and Women’s Hospital, Boston, MA, USA

    Darwin L. Conwell & Peter A. Banks

  2. Virginia Commonwealth University School of Medicine, Richmond, VA, USA

    Bimaljit S. Sandhu

  3. Indiana University School of Medicine, Indianapolis, IN, USA

    Stuart Sherman & Gregory A. Cote

  4. Saint Louis University School of Medicine, St. Louis, MO, USA

    Samer Al-Kaade

  5. Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

    Timothy B. Gardner

  6. University of Michigan School of Medicine, Ann Arbor, MI, USA

    Michelle A. Anderson

  7. University of Alabama at Birmingham Hospital, Birmingham, AL, USA

    C. Mel Wilcox

  8. Mayo Clinic, Jacksonville, FL, USA

    Michele D. Lewis

  9. Griffin Hospital, Derby, CT, USA

    Thiruvengadam Muniraj

  10. University of Florida College of Medicine, Gainesville, FL, USA

    Christopher E. Forsmark

  11. University of Wisconsin School of Medicine, Milwaukee, WI, USA

    Nalini M. Guda

  12. Department of Epidemiology, University of Pittsburg Graduate School of Public Health, Pittsburgh, PA, USA

    Ye Tian & Stephen R. Wisniewski

  13. Medical University of South Carolina, Charleston, SC, USA

    Joseph Romagnuolo

  14. University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Randall Brand, Adam Slivka, David C. Whitcomb & Dhiraj Yadav

  15. University of Chicago School of Medicine, Chicago, IL, USA

    Andres Gelrud

  16. Division of Gastroenterology, Hepatology and Nutrition, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA

    Darwin L. Conwell

Authors
  1. Darwin L. Conwell
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  2. Peter A. Banks
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  3. Bimaljit S. Sandhu
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  4. Stuart Sherman
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  5. Samer Al-Kaade
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  6. Timothy B. Gardner
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  7. Michelle A. Anderson
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  8. C. Mel Wilcox
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  9. Michele D. Lewis
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  10. Thiruvengadam Muniraj
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  11. Christopher E. Forsmark
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  12. Gregory A. Cote
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  13. Nalini M. Guda
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  14. Ye Tian
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  15. Joseph Romagnuolo
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  16. Stephen R. Wisniewski
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  17. Randall Brand
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  18. Andres Gelrud
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  19. Adam Slivka
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  20. David C. Whitcomb
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  21. Dhiraj Yadav
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Contributions

DLC, DY, and DCW were involved in study design. DLC, DY, PAB, BSS, SS, SA, TBG, MAA, CMW, MDL, TM, CEF, GAC, NMG, REB, AG, and AS were involved in acquisition of data. DLC and DY were involved in analysis and interpretation. DLC and DY were involved in drafting of manuscript. All authors were involved in critical review. YT, SRW, DLC, and DY were involved in statistical analysis.

Corresponding author

Correspondence to Darwin L. Conwell.

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The authors declare that they have no conflict of interest.

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Conwell, D.L., Banks, P.A., Sandhu, B.S. et al. Validation of Demographics, Etiology, and Risk Factors for Chronic Pancreatitis in the USA: A Report of the North American Pancreas Study (NAPS) Group. Dig Dis Sci 62, 2133–2140 (2017). https://doi.org/10.1007/s10620-017-4621-z

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  • DOI: https://doi.org/10.1007/s10620-017-4621-z

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