Gastroenterology

Gastroenterology

Volume 144, Issue 6, May 2013, Pages 1252-1261
Gastroenterology

Disease and Therapy of Pancreatic Disorder
Review
The Epidemiology of Pancreatitis and Pancreatic Cancer

https://doi.org/10.1053/j.gastro.2013.01.068Get rights and content

Acute pancreatitis is one of the most frequent gastrointestinal causes of hospital admission in the United States. Chronic pancreatitis, although lower in incidence, significantly reduces patients' quality of life. Pancreatic cancer is associated with a high mortality rate and is one of the top 5 causes of death from cancer. The burden of pancreatic disorders is expected to increase over time. The risk and etiology of pancreatitis differ with age and sex, and all pancreatic disorders affect the black population more than any other race. Gallstones are the most common cause of acute pancreatitis, and early cholecystectomy eliminates the risk of future attacks. Alcohol continues to be the single most important risk factor for chronic pancreatitis. Smoking is an independent risk factor for acute and chronic pancreatitis, and its effects could synergize with those of alcohol. Significant risk factors for pancreatic cancer include smoking and non-O blood groups. Alcohol abstinence and smoking cessation can alter the progression of pancreatitis and reduce recurrence; smoking cessation is the most effective strategy to reduce the risk of pancreatic cancer.

Section snippets

Incidence, Prevalence, and Trends

The annual incidence of AP3, 4, 5 ranges from 13 to 45/100,000 persons and of CP5, 6 ranges from 5 to 12/100,000; the prevalence of CP is about 50/100,000 persons.6, 7 The incidence of pancreatitis and pancreatic cancer in the United States is shown in Figure 1.8, 9 Population distributions are mostly reported from the United States, Europe, and Japan, but data are emerging from other regions.4 Variations in disease estimates result from differences in study methodology, difficulties in

Age and Sex

Although equal proportions of men and women develop AP, CP is more common among men. The risk of AP progressively increases with age, whereas CP mainly affects middle-aged individuals. Age and sex distribution differ based on etiology (see Figure 2, Figure 3). Alcohol-related pancreatitis is more common in men, although sex differences disappear with similar levels of alcohol consumption.18 Studies are needed to determine whether genetic factors increase risk in men. Pancreatitis in women is

Race

The risk of pancreatitis is 2- to 3-fold higher among the black population than the white population,2, 24 and rates of pancreatic cancer are considerably higher in the black population than in any other racial group,9 which is a disparity similar to that of lung cancer. Little is known about the reasons for the racial disparity, and further research is urgently needed. Distributions of lifestyle factors, such as heavy drinking or smoking, are similar among the US black and white populations.25

Alcohol

Although patients who have never consumed alcohol can develop pancreatitis, alcohol appears to increase the sensitivity of the pancreas to injury from other factors (genetic or environmental),26 and the risk of pancreatitis is undoubtedly increased by alcohol consumption. The prevalence of pancreatitis is increased approximately 4-fold among subjects with a history of alcoholism compared with those without.27 The absolute risk of pancreatitis from alcohol consumption is much lower than that for

Obesity

In a population-based study, abdominal adiposity, but not total adiposity or body mass index, increased the risk of AP after controlling for demographic and lifestyle factors.57 The effect was similar for gallstone- and non–gallstone-related AP and for mild and severe AP. Individuals with a waist circumference of >105 cm had a 2-fold increase in risk of AP (relative risk, 2.37) compared with those with a waist circumference of 75 to 85 cm. Obesity also increases the severity of AP. In a recent

Diabetes

In 3 large retrospective cohorts, type 2 diabetes mellitus increased the risk of AP by 1.5- to 3-fold after controlling for demographic and other risk factors.63, 64, 65 Compared with nondiabetic subjects, the risk was particularly high in younger diabetic patients (incidence rate ratio of 5.26 for individuals younger than 45 years and 2.44 for individuals older than 45 years).65 The use of antidiabetic medications was found to reduce the excess risk.64 Interestingly, following case reports of

Gallstones

Gallstones are the most common cause of AP.10 The prevalence of gallstones in the US adult population is 7%.89 The risk of gallstone-related pancreatitis increases with age and is higher in women, consistent with the demographic distribution of gallstones. It is important to perform cholecystectomy as soon as feasible after an attack of gallstone-related AP to eliminate the risk of future attacks. A delay in cholecystectomy increases the risk of recurrence, and subsequent attacks could be more

CP

A meta-analysis of 6 cohort studies and one case-control study found that the pooled relative risk estimate for pancreatic cancer among patients with CP is 13.3.100 Among individuals with the rare form of pancreatitis found mostly in tropical countries, the association appears to be even stronger.101 Pancreatic stellate cells link pancreatitis and cancer.102 One pooled analysis of 5048 patients with pancreatic cancer (in 10 case-control studies) found only a small association between pancreatic

Disease Progression and Mortality

There are data to indicate that AP progresses to recurrent AP and then to CP in a disease continuum.33, 111, 112, 113 Overall, approximately 20% to 30% of patients with AP have a recurrence and approximately 10% develop CP. Progression from AP to CP occurs more frequently with continued exposure to alcohol or smoking and in patients with genetic causes of pancreatitis (hereditary pancreatitis). Patients with pancreatitis should receive appropriate counseling and be referred to rehabilitation

Future Directions

Much of the research on pancreatic disease has focused on identifying risk factors, clarifying the relationship between risk factors and disease, and discovering better methods for diagnosis, management, and prevention of pancreatitis. Faster, less costly methods of genetic analysis, which are rapidly becoming available, will provide much needed answers to the numerous unsolved questions concerning all types of pancreatic disorders.

Acknowledgments

The authors thank Michelle L. Kienholz (Department of Medicine, University of Pittsburgh, Pittsburgh, PA) for critical review and editorial assistance.

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    Conflicts of interest The authors disclose no conflicts.

    Funding Dr Yadav is supported in part by the National Institutes of Health (National Institute of Diabetes and Digestive and Kidney Disease grant 077906). The contents of the manuscript are solely the responsibility of the authors and do not necessarily represent the official view of the NIH.

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