The Etiology of Chronic Pancreatitis in Western ...
Alcohol is considered the most frequent factor associated with chronic pancreatitis in Western countries，and alcoholic chronic pancreatitis develops mainly in young male adults of 30-40 years of age；the pathological lesions are chronic and，clinically，the disease is characterized by recurrent flares of abdominal pain.The frequency of alcohol as an associated factor of chronic pancreatitis increased from 19（O'Sullivan et al.1972）to 50%（James et al.1974）and even up to 80%（Durbec and Sarles 1978；Sarles et al.1979）in the period from 1940 to 2003 in Western countries.These results on the etiology of chronic pancreatitis have been subsequently confirmed in studies coming from Europe（Gullo et al.1977；Thorsgaard Pedersen et al.1982；Ammann et al.1984；Dzieniszewski et al.1990；Johnson and Hosking 1991；Jaakkola and Nordback 1993；Cavallini et al.1998；Dite et al.2001）as well as from Brazil（Dani et al.1990），Australia（Garg and Tandon 2004）and South Africa（Marks et al.1980）.Four consecutive surveys carried out in Japan（from1977 to 1979，from 1978 to 1984，in 1994，and in 1999，respectively）（Otsuki 2003）reported that alcohol in chronic pancreatitis accounted is an associated factor for fewer than 60%of chronic pancreatitis cases.Regarding Japan，the last survey on chronic pancreatitis reported an incidence of alcoholic chronic pancreatitis of 67.5%（Hirota et al.2014）.This latter study introduced a new insight into the etiology of chronic pancreatitis because it has been found that，among patients without a drinking habit，the incidences of diabetes mellitus and pancreatic calcifications were significantly higher in smokers than in non-smokers；however，smoking was not identified as an independent risk factor for the appearance of abdominal pain（Hirota et al.2014）.
The results of a study on chronic pancreatitis carried out recently in United States reported that alcohol accounted for 44.5%of the cases as an etiological factor of chronic pancreatitis（Coté et al.2011）.(https://www.daowen.com)
The most important finding of the recent studies is the increase in the idiopathic form of chronic pancreatitis reaching 20%.How can this finding be explained？It is probable that the introduction of sophisticated and highly sensitive imaging techniques，such as magnetic resonance imaging（Pezzilli 2014）and endoscopic ultrasonography（Catalano et al.2009）into clinical practice have allowed the diagnosis of chronic pancreatitis in patients without any symptoms and apparent risk factors，and these results in an increase of chronic pancreatitis of unknown origin.