M-ANNHEIM Clinical Staging of Chronic Pancreatit...
The M-ANNHEIM clinical staging system referred to a previous one（Chari and Singer 1994）.It is subcategorized into an asymptomatic phase（stage 0）and a symptomatic phase（stages Ⅰ，Ⅱ，Ⅲ，Ⅳ）of CP（Table 2.3）.“Stage I is characterized by abdominal pain without pancreatic insufficiency”（Ammann et al.1984，1996；Lankisch et al.1993；Layer et al.1994；Ammann and Muellhaupt 1999）.“Stage Ⅱ is determined by the presence of partial pancreatic insufficiency with or without abdominal pain”（Lankisch et al.1993；Layer et al.1994；Ammann et al.1996；Ammann and Muellhaupt 1999）.In this stage，patients present with only one of exocrine and endocrine insufficiency，but not with both of them.“Stage Ⅲ is characterized by the presence of both exocrine and endocrine insufficiency”（Lankisch et al.1993；Layer et al.1994；Ammann et al.1996；Ammann and Muellhaupt 1999）.At last，in stage IV，abdominal pain may alleviate and almost more than 10 years later，permanent pain relief may typically occur.It is a natural course followed by fibrotic destruction，progressive functional insufficiency and burnout of the gland finally（Ammann and Muellhaupt 1999；Girdwood et al.1981）.
Table 2.3 M-ANNHEIM clinical staging of chronic pancreatitis（modified from Chari and Singer 21）（Schneider et al.2007）(https://www.daowen.com)